DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

Lab National Coverage Determinations (NCDs) Alphabetical Index

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Medicare Part B Top Claim Denials

During this webinar, we’ll review the current top ten claim denials which are identified by internal claim data and provide guidance for correcting them, and solutions to prevent them from occurring on future claims. There will be time for your [...]

Pneumococcal Vaccine and Administration

Preventive Services Guide Pneumococcal Vaccine and Administration Pneumonia affects approximately 450 million people globally (seven percent of the population) and results in about four million deaths per year. Pneumonia was regarded by [...]

Vaccinations

Vaccinations Part B Medicare provides coverage for specific vaccination types: Seasonal Influenza Virus Pneumococcal Hepatitis B COVID-19 Vaccines and Administration [Return to Top] Seasonal Influenza Virus Annual Influenza Vaccine [...]

Assistants at Surgery at Teaching Hospitals

Assistants at Surgery at Teaching Hospitals CMS instructs providers to use specific modifiers on claims representing assistance during a surgical procedure: Modifier 80 denotes service by an assistant surgeon Modifier 82 denotes service by [...]

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission Accurate coding and reporting of services are critical aspects of proper billing. Services denied based on the NCCI code pair edits or MUEs may not be billed to [...]

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50 National Government Services has identified some providers who have been billing for services on the fingers and/or the toes with [...]

Modifier 25

Modifier 25 National Government Services has identified problems common with claims submitted for evaluation and management (E/M) services where modifier 25 was appended. This article is designed to provide education regarding the correct [...]

Modifier 33

Modifier 33 Table of Contents Preventive Services Anesthesia Services Moderate Sedation Related Content [Return to Top] Preventive Services When the primary purpose of the service is the delivery of an evidence-based service in [...]

COVID-19

COVID-19 The 2019 Novel Coronavirus (COVID-19) was declared a PHE on 3/13/2020 and it was officially expired on 5/11/2023. Please visit CMS' Current emergencies web page for complete details on the PHE. Email Updates To keep you informed [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Table of Contents Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Roster Billing How to Submit a Centralized Bill Medicare [...]

Medicare Coverage of Over-the-Counter COVID-19 Tests

Medicare Coverage of Over-the-Counter COVID-19 Tests The OTC COVID-19 test demonstration ended on 5/11/2023. Starting on 5/12/2023, Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits. Beginning [...]

Electronic Data Interchange

Medicare Part B 101 Manual Electronic Data Interchange Table of Contents Electronic Data Interchange Transactions Benefits of Submitting Electronically Becoming an Electronic Submitter PC-ACE EDI: Beyond Claims and Extra Features [...]

National Provider Identifier

Medicare Part B 101 Manual National Provider Identifier Table of Contents National Provider Identifier Background Application Process Sharing Your NPI NPI Contractor Mailing Address NPI Registry [Return to Top] National [...]