-
Posting Date: 01/03/2024
PCACE Full Install Text - ALOB
Version 6.4 (Institutional and Professional) PC-ACE users
Read More -
Posting Date: 01/03/2024
About PC-ACE
About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a stand-alone [...]
Read More -
Posting Date: 02/21/2020
IPPE and AWV Services
IPPE and AWV Providers are reminded that the IPPE and AWV are Medicare-covered services within their own benefit category. As such, they are not subject to standard “incident to” billing guidelines and must be billed by the performing [...]
Read More -
Posting Date: 04/29/2021
Medical Decision Making
Medical Decision Making In a split/shared service, when a medical record includes a plan of care developed by the physician, based on a history and/or examination performed by the NPP and a personal review of diagnostic findings, [...]
Read More -
Posting Date: 01/27/2022
New vs. Established Patients
New vs. Established Patients How does CMS define a patient as “new” versus “established”? Answer: In 2023, the definition of a “new” patient differs based on whether the patient is being treated in an office or an observation/ inpatient [...]
Read More -
Posting Date: 10/26/2022
Nonphysician Practitioner Services
Nonphysician Practitioner Services In addition to the frequently asked questions below, please view NGS’ Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue article for related information. Is it permissible for [...]
Read More -
Posting Date: 01/27/2022
Observation Services
Observation Services Please define guidelines for providers billing observation services. Answer: Observation services are ordered, performed and billed by the practitioner (or group), who is responsible for the patient’s care during the [...]
Read More -
Posting Date: 01/28/2022
Preoperative Clearance
Preoperative Clearance What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable? Answer: CMS does not set requirements for medical clearance; these are established by individual [...]
Read More -
Posting Date: 04/01/2022
Prolonged Services
Prolonged Services Note: View NGS’ Prolonged Services Timetable for CPT codes and time requirements. Please explain why time thresholds for some E/M services vary between AMA/CPT and CMS guidance. Answer: The CMS RVU RUC assessed [...]
Read More -
Posting Date: 01/28/2022
Provider Specialty
Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]
Read More -
Posting Date: 08/29/2017
Separately Identifiable Service
Separately Identifiable Service Please define the appropriate use of modifier 57 to identify a separately payable E/M with an initial decision for surgery. Answer: Modifier 57 is added to an E/M service that resulted in an initial [...]
Read More -
Posting Date: 01/04/2023
Skilled Nursing Facility Services
Skilled Nursing Facility Services Please define rules for initial and subsequent SNF services, when the same provider has treated the patient at another site on the same date of service. Answer: This depends on the site of the prior [...]
Read More -
Posting Date: 06/09/2017
Smoking Cessation
Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]
Read More -
Posting Date: 05/13/2022
Teaching Environment E/M Services
Teaching Environment E/M Services Please define levels of care for E/M services that can be performed by residents in a hospital outpatient setting under the PCE rules. Answer: CMS PCE guidelines for the hospital outpatient setting permit [...]
Read More -
Posting Date: 01/28/2022
Telehealth Services
Telehealth Services Note: View National Government Services' Place of Service Codes for CY 2024 Updates Please explain Medicare’s definition of a telehealth service. Answer: Medicare defines a telehealth service as a service provided by [...]
Read More -
Posting Date: 05/11/2022
Time-Based Services
Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]
Read More -
Posting Date: 01/28/2021
Transitional Care Management
Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]
Read More -
Posting Date: 01/08/2018
Urgent Care
Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]
Read More