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Posting Date: 09/29/2022
Helpful Resources
Helpful Resources The absence of a local coverage determination (LCD) or Medical Policy Article does not indicate noncoverage, it means that currently, National Government Services (NGS) has not identified the service requires an associated [...]
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Posting Date: 12/16/2024
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) L39189 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39189 A58921 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58921 A59900 [...]
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Posting Date: 12/18/2024
Provider Enrollment Application Fee Amount for CY 2025
Provider Enrollment Application Fee Amount for CY 2025 The provider enrollment application fee for CY 2025 is $730. For more information, view MLN Connects® Newsletter: December 12, 2024. Posted 12/18/2024
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Posting Date: 03/21/2024
Medicare Part B Drug Coverage
Medicare Part B Drug Coverage Medicare Part B may provide coverage for medically necessary drugs/biologicals that are furnished “incident to” a physician’s service. This coverage does not apply to drugs that are usually [...]
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Posting Date: 03/21/2024
Allergen Immunotherapy: Coding and Billing CPT 95165
Allergen Immunotherapy: Coding and Billing CPT 95165 CPT 95165 is defined as “Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of [...]
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Posting Date: 12/18/2024
[REVISED UPDATE] Hospice Claims Rejected with Reason Code 17729
Claim rejections for TOB 081X and 082X with RC 17729 have occurred due to a file error. These claims did comply with CMS-required entry of the correct certifying physician in the “Attending” field, which did match the PECOS Enrolled [...]
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Posting Date: 06/14/2022
Documentation Information
Documentation Information It is recommended that PARs are submitted at least ten business days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. Effective [...]
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Posting Date: 06/09/2021
About Hospital OPD PA Model
About Hospital OPD PA Model Table of Contents About Hospital OPD PA Model General Information Related Content [Return to Top] About the Hospital OPD PA Model CMS implemented a PA program for certain hospital OPD services for DOS on [...]
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Posting Date: 12/18/2024
Home Health Claims Returning to Provider RC 19963
HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]
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Posting Date: 02/02/2021
Who May File an Appeal
Who May File an Appeal? Table of Contents Who May File an Appeal? Appointment of Representative When Is an Appointment Not Necessary? Who May Be a Representative How to Make and Revoke an Appointment When Is an Appointment Not [...]
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Posting Date: 07/08/2021
Reopenings for Minor Errors and Omissions
Reopenings for Minor Errors and Omissions Table of Contents Reopenings for Minor Errors and Omissions What is a Clerical Error? Clerical Error and Omission Reopening Request Request a Reopening- NGSConnex Request a Reopening- In Writing [...]
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Posting Date: 10/30/2023
Review Bad Debt Listing
Table of Contents Review Bad Debt Listing Identifying Fee Schedule Services Fee Schedules Included in Bad Debt Policy Related Content [Return to Top] Review Bad Debt Listing Bad debts are unrecovered costs due to uncollectible [...]
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Posting Date: 01/23/2020
Hospice Cap
Hospice Cap Table of Contents The Inpatient Day Limitation Aggregate Cap Calculation Beneficiary Count Proportional Method (applies to most hospices) Streamlined Method [Return to Top] The Inpatient Day Limitation [...]
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Posting Date: 10/30/2023
Proper Use of Modifiers JW and JZ
Proper Use of Modifiers JW and JZ National Government Services Provider Contact Center has received several inquiries regarding claim denials related to the use of the JW and JZ modifier for drugs/biologicals. As a reminder, effective [...]
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Posting Date: 10/28/2014
Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
Claim Denials for Medically Unnecessary Ambulance Transports Table of Contents Claim Denials for Medically Unnecessary Ambulance Transports Medical Necessity and Coverage Guidelines for Ambulance Transport Avoiding Reason Code 55B10 [...]
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Posting Date: 10/31/2023
November 2023
In This Issue National Government Services Articles for Part A and Part B Providers Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar Decrease Burden and Combine Multiple PDFs in one Document Before Responding to [...]
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