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Posting Date: 06/25/2021
Outpatient Department Prior Authorization UTN Alert
Each UTN is Valid for One-Time Use The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty [...]
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Posting Date: 06/25/2021
Outpatient Department Prior Authorization Type of Bill Alert
Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient [...]
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Posting Date: 09/10/2021
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN
UTN Alert: Implanted Spinal Neurostimulator Trial and Permanent UTN The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, [...]
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Posting Date: 03/30/2023
Type of Bill Code is a Requirement for All Prior Authorization Requests
Type of Bill Code is a Requirement for All Prior Authorization Requests The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; [...]
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Posting Date: 02/21/2022
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert
Outpatient Department Prior Authorization Implanted Spinal Neurostimulators Alert Implanted Spinal Neurostimulator Prior Authorization National Government Services Medical Review initiated a prior authorization review outpatient department [...]
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Posting Date: 09/14/2023
MLN Connects® Newsletter: September 14, 2023
MLN Connects® Newsletter: September 14, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Roundup (Sept 8, 2023) New Provider [...]
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Posting Date: 10/31/2019
Billing for Originating Site
Billing for Originating Site Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible [...]
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Posting Date: 10/31/2019
Distant Site
Distant Site The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system. Medicare distant site practitioners who [...]
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Posting Date: 10/31/2019
General Information
General InformationTelehealth services require use of an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the Medicare beneficiary at the originating [...]
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Posting Date: 10/31/2019
Originating Site
Originating Site An originating site is the location of an eligible Medicare beneficiary at the time the telehealth services is being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only [...]
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Posting Date: 10/31/2019
Facility Fee for Originating Site
Facility Fee for Originating Site The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site [...]
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Posting Date: 10/31/2019
Billing and Payment for Distant Site Professional Fee
Billing and Payment for Distant Site Professional Fee Claims for distant site telehealth services are submitted to the Part B MAC that processes claims for the performing physician/practitioner’s service area. Physicians/practitioners submit [...]
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Posting Date: 10/31/2019
List of Covered Medicare Telehealth Services
List of Covered Medicare Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the Physician Fee Schedule. The service must be on the list of Medicare telehealth services and meet [...]
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Posting Date: 10/31/2019
G0 Modifier Required for Telehealth for Individuals with Acute Stroke
G0 Modifier Required for Telehealth for Individuals with Acute Stroke Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to identify telehealth services furnished for purposes of diagnosis, [...]
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Posting Date: 10/31/2019
GT Modifier
GT Modifier Effective 10/01/2018, the GT modifier (via interactive audio and video telecommunications systems) is only required on institutional claims for distant site services billed under CAH Method II (claim type 085X). The GT modifier is [...]
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Posting Date: 10/31/2019
Clarification of Telehealth for DSMT
Clarification of Telehealth for DSMT Individual and group DSMT services may be paid as a Medicare telehealth service. Effective for claims with dates of service on and after 1/1/2019, Medicare allows all ten hours of the initial DSMT training [...]
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Posting Date: 10/31/2019
ESRD-Related Services as a Telehealth Service
ESRD-Related Services as a Telehealth Service Effective for DOS on/after 1/1/2019, renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis may be originating sites and will not apply originating site geographic [...]
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Posting Date: 04/19/2022
Ambulatory Surgical Center Pass-Through Devices
Ambulatory Surgical Center Pass-Through Devices What is a Pass-Through Device? Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Drugs and devices qualifying for pass-through status [...]
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