Anesthesia Billing Modifiers

Anesthesia Billing Modifiers Table of Contents Physician Anesthesia Modifiers Qualified Nonphysician Anesthetist Modifiers Monitored Anesthesia Care (MAC) MAC Deep Complex Complicated Teaching Physicians Anesthesia Furnished in [...]

Anesthesia

Anesthesia General Anesthesia Information Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT [...]

Concurrent, Medical Direction and Supervision

Concurrent, Medical Direction and Supervision Table of Contents Concurrent Medically Directed Procedures Medical Direction and Temporary Relief Medical Directed Rate Medically Supervised Related Content [Return to Top] [...]

Group/Member Practice Responsibilities

Group/Member Practice Responsibilities Table of Contents Members of a Group More than One Teaching Physician Related Content [Return to Top] Members of a Group If anesthesiologists are in a group practice, one physician member may [...]

Local Coverage Determinations

Local Coverage Determinations General An LCD is a decision by Medicare, whether to cover, and under what circumstances to cover, a particular item or service in our jurisdiction in accordance with Section 1862(a) (1) (A) of the Social [...]

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation Moderate sedation codes 99143‒99150 were deleted and replaced with codes 99151‒99157 in 2017. 99151‒99157: Are not used to report administration of medications for pain control, minimal sedation, deep sedation, [...]

National Coverage Determinations

National Coverage Determinations General Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs [...]

Teaching Anesthesiology Services

Teaching Anesthesiology Services Table of Contents Teaching Anesthesiology Services Anesthesia Services and Teaching CRNA Physician Personally Performed and Personally Performed with CRNA and AA Related Content [Return to Top] [...]

Resources and References

Resources and References Anesthesia Guidelines and Regulations CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 50 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10 CMS [...]

Anesthesia Billing Codes

Anesthesia Billing Codes Table of Contents Anesthesia Not Otherwise Classified Codes Add-On Codes for Anesthesia Related Content [Return to Top] Anesthesia Body Area CPT Codes Head 00100‒00222 [...]

Daily Management and Pain Management

Daily Management and Pain Management Table of Contents Daily Management of Continuous Pain Control Techniques Pain Management Consultations Postoperative Pain Control Procedures [Return to Top] Daily Management of Continuous [...]

Monitoring Anesthesia Services

Monitoring Anesthesia Services Monitored Anesthesia Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs [...]

Payment and Reimbursement

Payment and Reimbursement Table of Contents Anesthesia Claim Billing Instructions Multiple Anesthesia Procedures Multiple CRNAs Same Procedure Payment at Personally Performed Rate Payment at Medically Directed Rate Payment at [...]

Provider Qualifications

Provider Qualifications Table of Contents General State Licensing Physician – Anesthesiologist (Specialty 05) Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist Qualified Nonphysician Anesthetists [...]

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

A/B DME MAC Collaborative Lower Limb Orthoses Webinar

A/B DME MAC Collaborative Lower Limb Orthoses Webinar This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of lower limb orthoses. Representatives from all four DME [...]

Cervical Fusion with Disc Removal Best Practices

Cervical Fusion with Disc Removal Best Practices Table of Contents Introduction Coverage General Documentation Requirements Medical Necessity Criteria for Each Indication Limitations and Exceptions to Conservative Therapy [Return to [...]

Home Health Billing

Avoiding Reason Code 38200

CR 9189 Transmittal 602: Medical Review of Home Health Services

Contractor Advisory Committee

Assist National Government Services in the Development of Local Coverage Determinations Background CMS released Change Request 10901 and the companion MLN® Matters MM10901: Local Coverage Determinations (LCDs) article to expand the parameters [...]

Appeals/Reopenings

Medicare Part B 101 Manual Appeals/Reopenings Table of contents Reopenings for Minor Errors and Omissions Telephone Reopening Unit Appeals Time Limit for Filing Appointment of Representative Redeterminations Acceptable Signature [...]

CMS-1500 Claim Form

Medicare Part B 101 Manual CMS-1500 Claim Form Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion OCR System Missing, Incomplete, [...]

Comprehensive Error Rate Testing

Medicare Part B 101 Manual Comprehensive Error Rate Testing Table of Contents Comprehensive Error Rate Testing What Is CERT? How Long Do Providers Have to Respond to a Request From the CERT Contractor? What Happens if the Provider [...]

Fraud and Abuse

Medicare Part B 101 Manual Fraud and Abuse Fraud and Abuse Unified Program Integrity Contractors Defining Fraud and Abuse Fraud Abuse Bribes, Kickbacks and Rebates Penalties Waiving Deductible and Coinsurance What You Can Do As a [...]

Medical Policy Development

Medicare Part B 101 Manual Medical Policy Development Table of Contents Medical Policy Development National Policies National Coverage Determinations National Coverage Provisions in Interpretive Manuals Local Policies [...]

Help with Medicare Costs

Help with Medicare Costs Medicare Savings Programs Learn about your options for help with Part B premiums Costs for Medicare Drug Coverage Learn how to get extra help with Part D Revised 11/1/2024

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information

Don’t Wait Until 11/18/2024 To Use NGSConnex for Beneficiary Eligibility Information  As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Report a Change of Tax ID (Other than Change of Ownership)

Step 1: Determine You are in the Right Place If you are currently an enrolled health care organization that is changing your Tax ID and the change does not involve a change of ownership, it is essential that you report changes of Tax ID within [...]

Report a Change of Tax ID (Other than Change of Ownership)

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place If you are [...]

Mission and Charter

​​National Government Services Provider Outreach and Education Advisory Group Charter National Government Services serves as the MAC for J6 and JK Part A, Part B and Home Health and Hospice. We maintain four POE AGs: Part A POE [...]

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service

Medicare Part B Electronic Claims that Exceed the Threshold for Charges and Units of Service  Medicare Part B electronic claims (ANSI X12 837P) with total charges exceeding $99,999.99 cannot be processed in the MCS. If a single claim [...]

MLN Connects® Newsletter: October 31, 2024

MLN Connects® Newsletter: October 31, 2024 News Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health Care Compliance Major Hip & Knee Replacement or Reattachment of Lower Extremity: [...]

11/4/2024

This is Our Last Self-Service Pulse We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

Report a Change of Ownership, Acquisition/Merger or Consolidation

Table of Contents Step 1: Determine You Are in the Right Place Step 2: Understand Type of CHOW Change of Ownership Acquisition/Merger Consolidation CHOW Reminders Step 3: Make Changes via Enrollment Application Change of [...]

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information

Two Weeks to Prepare to use NGSConnex for Beneficiary Eligibility Information As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility [...]