- Dental Services
- Dental Services
- Enrolling in Medicare
- Medicare Coverage Exclusion: Dental Services
- Claim Submission Guidelines
- Medical Documentation Requirements
- New Medicare Provider
- Additional Development Request Letters Guide
- Medicare Coverage Exclusion: Dental Services
- Inpatient Services in Connection With Dental Procedures
- The Utilization of the KX Modifier on Dental Claims
- Modifier GY
- Standard Companion Guide Health Care Claim: Dental (837D)
- 837D Edit Spreadsheet
- Dental Claim Cross Over
- Attention Clearinghouses and Vendors!
- Resources
Medical Documentation Requirements
When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government Services may issue an ADR. When responding to an ADR, or if you’re using the PWK segment to submit your claim documentation electronically, make sure you include the documentation outlined below:
- Lab report/results, including laboratory name, test name, and details of test methodology
- Office notes that support medical necessity, specifically explaining how the test will be used in the treatment and/or management of the patient
- Patient history and physical
- Procedure or operative report
- Progress or office notes
- Invoice, when applicable
- Referral information showing the service is inextricably linked to, and substantially related and integral to the clinical success of, a certain covered medical service
We encourage you to review your documentation prior to submission to ensure that all requested documentation is included in your response, and that the medical records are appropriately authenticated. View the MLN® Fact Sheet: Complying with Medicare Signature Requirements to learn more.
Revised 6/26/2024