General Information

General Information Medicare Part B provides benefits for psychiatric services, which are medically necessary for the diagnosis or treatment of diagnostic and/or behavioral health treatment. Medicare recognizes the following Part B providers [...]

Provider Qualifications

Provider Qualifications Table of Contents Physicians - Psychiatrists Clinical Psychologist Independently Practicing Psychologist (IPP) Clinical Social Worker Marriage and Family Therapist (MFT) Mental Health Counselor (MHC) Physician [...]

Incident-to Services

Incident-to Services A physician, CP, CNS, NP, PA, or CNM may have outpatient psychiatric services and supplies furnished incident to his or her professional service. To be covered under the Incident to provision, the following requirements [...]

Mental Health Services

Mental Health Services Table of Contents Psychiatric Diagnostic Procedures: 90791‒90792 Interactive Complexity: 90785 Psychotherapy: 90832‒90838 Psychotherapy for Crisis: 90839‒90840 Mobile Psychotherapy for Crisis Services: G0017-G0018 [...]

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 [...]

Related Content

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 [...]

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 [...]

View Claim Details

View Claim Details Select the Claim Number hyperlink to view additional claim details. If the claim was denied, you can view the reason for denial. You can view the following claim details from the Left-Side navigation. Claim Header [...]

Important Reminder: Change Healthcare Security Incident

Important Reminder: Change Healthcare Security Incident This is an important reminder related to the Change Healthcare Security Incident and the efforts of the CMS and National Government Services. Change Healthcare is a clearinghouse vendor [...]

Understanding the Medicare Summary Notice and Options

Understanding the Medicare Summary Notice and Options If you get a Medicare-covered service, you’ll get an MSN in the mail every three months. The notice shows all your services that your Medicare provider of service billed to Medicare during [...]

Attention Electronic Billers

Attention Electronic Billers National Government Services has experienced issues with electronic files downloaded by some of our trading partners (those who receive electronic files directly from NGS). This was not a widespread issue and only [...]

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Effective 4/30/2024 the MACs may only accept the CMS-588 EFT (11/23) version, the outdated form will be returned. NOTE: An electronic application [...]

LCD and Article Updates for March/April 2024

LCD and Article Updates for March/April 2024 Local Coverage Determinations Fluid Jet System Treatment for LUTS/BPH (L38367) The age limitation of >80 years of age has been removed, effective for services rendered on or after 4/1/2024. [...]

Medicare Part B General Billing

Medicare Part B General Billing Claims for drugs and biologicals are mandatory assignment. Claims submitted as nonassigned will be converted to adjudicate as assigned. When billing drugs or biologicals, the drug name, dosage and invoice price [...]

Patient-Supplied or Free-of-Charge Drugs

Patient-Supplied or Free-of-Charge Drugs When a patient purchases a drug and the physician administers it, the cost of the drug is not covered because it does not represent a cost to the physician. However, the administration of the drug is a [...]

Providers Performing Facet Joint Injections (CPT Code 64476) 

Providers Performing Facet Joint Injections (CPT Code 64476) The OIG released the results of an investigation into facet joint injections. Per the OIG report: "Facet joint injections are typically performed using radiological guidance [...]

Related Content

Related Content LCD L33394 - Drugs and Biologicals, Coverage of, for Label and Off-Label Uses Drug Coverage under Different Parts of Medicare Medicare Program Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently [...]

Intravitreal Beovu (Brolucizumab-dbl) Billing

Intravitreal Beovu (Brolucizumab-dbl) Billing National Government Services has seen multiple variations of billing from providers for Intravitreal Beovu. This job aid provides clarification and proper billing for this drug. For Medicare [...]

Drugs and Biologicals

Drugs and Biologicals We’ve updated the drugs and biologicals section of our website to offer easier navigation to the information you need. Updates include: Created a left-side navigation list with hyperlinks to specific information Added [...]

NGSConnex Part B Claim Submission Issue – Mammography Claims

NGSConnex Part B Claim Submission Issue - Mammography Claims At this time, we are unable to accept mammography claims through Part B Claim Submission in NGSConnex. We are working to resolve the issue; please watch for Email Updates on the [...]

Copy Claim Entry

Copy Claim Entry Table of Contents Copy Claim Entry Claim Lines Information – Add, Edit or Delete Ready to Submit Claim [Return to Top] Copy Claim Entry Part B providers who have a completed EDI enrollment form on file can submit [...]

Check Appeal History

Check Appeal History Table of Contents Check Appeal History Attaching Additional Supporting Documentation Attachments Submit [Return to Top] Check Appeal History Click the Appeals button from the NGSConnex homepage. [...]

Initiate a General Inquiry

Initiate a General Inquiry Table of Contents Initiate a General Inquiry Step 1: Provider Details Step 2: Inquiry Information Step 3: Attachments [Return to Top] Initiate a General Inquiry Click the Inquiries button from [...]

Initiate a Prior Authorization Request

Initiate a Prior Authorization Request Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Certifying Physician Information Attachments [Return to Top] Initiate a Prior [...]