Opioid Use Disorder Screening and Treatment: G0402, G0438, G0439, G2011, G0396, G0397

Opioid Use Disorder Screening and Treatment: G0402, G0438, G0439, G2011, G0396, G0397 Medicare coverage includes OUD screening when performed by physicians and NPPs. OUD screening must be performed as part of a Medicare beneficiary’s IPPE and [...]

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Related Content CMS-1500 Claim Form Instructions CMS IOM Publication 100-02, Medicare Benefit Policy Manual CMS IOM Publication 100-04, Medicare Claims Processing Manual Chapter 1 - General Billing Requirements Chapter 12 - [...]

Provider Revalidation Fact Sheet for Congressional Field Offices

Provider Revalidation Fact Sheet for Congressional Field Offices The Affordable Care Act, Section 6401 (a), requires enrolled providers to revalidate their Medicare enrollment every five years, and enrolled durable medical equipment suppliers [...]

CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement

CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement CMS issued CR 13294,“Change Request (CR) to Implement the Medicare Program Final Action: Treatment of Medicare Part C Days in the [...]

Discarded Drugs/Wastage and JW, JZ Modifier

Discarded Drugs/Wastage and JW, JZ Modifier Medicare may pay for discarded drugs or wasted drugs and biologicals when: The provider/supplier must discard the remainder of a single-dose container after administering a dose or quantity to a [...]

Chemotherapy General Infusion Information

Chemotherapy General Infusion Information There are CPT codes for several different types of infusions and injections for drugs and biologicals. These include codes for chemotherapy infusions and injections, therapeutic, prophylactic and [...]

Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon! CBR submissions can be submitted starting on 4/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)

Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999) An unlisted code should only be used when no other code adequately describes the service. They are commonly used when the drug/biological does not have a specific HCPCS code, [...]

Compound Drugs

Compound Drugs If there is not a HCPCS code for the compound drug you are billing, then it is appropriate to bill J7999 ‒ Compounded Drug, Not Otherwise Classified. This applies to both pump and nonpump compound drugs. The name, dose and [...]

Prolonged Drug and Biological Infusions Using an External Pump

Prolonged Drug and Biological Infusions Using an External Pump In some situations, a hospital outpatient department or physician office may purchase a drug for a medically reasonable and necessary prolonged drug infusion, begin the drug [...]

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident As a follow up to our 2/28/2024 article, Change Healthcare Security Incident, providers have asked if they can submit their [...]

Coding for Sinuva™ Claims

Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Coding updated effective 4/1/2021: Claims submitted to National Government Services [...]

Radiopharmaceutical Reimbursement

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Table of Contents Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Billing Guidelines Claim Completion Instructions Wastage Claim Completion Instructions [...]

Factor VIII Billing

Factor VIII Billing National Government Services has received questions on the proper billing for Factor VIII drugs. This article outlines appropriate billing for these services. If the submitted amount does not exceed $99,999.99, bill the [...]

Proper Billing for LEQVIO® HCPCS Code J1306

Proper Billing for LEQVIO® HCPCS Code J1306 Table of Contents Proper Billing for LEQVIO® HCPCS Code J1306 Claim Completion Requirements Drug Wastage Related Content [Return to Top] Proper Billing for LEQVIO® HCPCS Code J1306 [...]

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Table of Contents Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Drugs and Dosage Conditions Requiring Prior [...]

Proper Billing Units for HCPCS Code J7320

Proper Billing Units for HCPCS Code J7320 National Government Services has noticed improper billing units used for HCPCS code J7320, Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg. GenVisc 850 is indicated for the [...]

MLN Connects® Newsletter: March 21, 2024

MLN Connects® Newsletter: March 21, 2024 News New Initiative to Increase Investments in Person-Centered Primary Care Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare Electronic Funds [...]

Inquiry Reference Numbers Are Now Available on the IVR

Inquiry Reference Numbers Are Now Available on the IVR You can now get an inquiry reference number through the IVR. Once the caller makes a selection from the main menu, the IVR will ask, "Would you like an inquiry reference ID?" This will [...]