Requests for Additional Information

Table of Contents Requests for Additional Information Paper Application Submissions PECOS Application Submissions [Return to Top] Requests for Additional Information While processing the application(s), National Government [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]

MLN Connects® Newsletter: December 5, 2024

MLN Connects® Newsletter: December 5, 2024 News Clinical Laboratory Fee Schedule: CY 2025 Final Payment Determinations CMS Roundup (November 29, 2024) Advanced Primary Care Management Services: Get Information about Billing Medicare Flu [...]

Common Working File (CWF) Host Dark Days for January 2025 Release

Common Working File (CWF) Host Dark Days for January 2025 Release  For Production, 1/1/2025 – Observe Holiday – No Cycle, CWF will be observing the Gray Day on Thursday, 1/2/2025 and Dark Days starting Friday, 1/3/2025 through Sunday, [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-869-6504 Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: [...]

Interactive Voice Response System

Interactive Voice Response System Toll-Free Number 877-309-4290 Hours Available* Monday–Friday: 6:00 a.m.–7:00 p.m. ET Saturday: 7:00 a.m.–3:00 p.m. ET *IVR hours represent general availability for access to all menu options. The IVR is [...]

Interactive Voice Response System

Interactive Voice Response System State IVR Number Hours Available* Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington, American Samoa, Guam, Northern Mariana Island 866-277-7287 [...]

Join Us to Learn About NGSConnex

Join Us to Learn About NGSConnex We’re hosting a series of webinars focused on our free, secure internet portal, NGSConnex. During each session, we’ll review what NGSConnex has to offer. We’ll discuss registration, access, navigation and [...]

Billing Protections for Qualified Medicare Beneficiaries

Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

Screening Mammography, Pap Test and Pelvic Exam

Ensure that your patients obtain the preventive services they are eligible for by knowing the Medicare coverage, coding and billing guidelines for screening mammograms, pap tests and pelvic examinations, as well as where to find more [...]

Correct a Beneficiary's MSP Record

Table of Contents Background Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary's Services Step 2: Prepare and Submit a Medicare Primary Claim With the Reason Medicare Is the Primary Payer [...]

Provisional Period of Enhanced Oversight for New Hospices

Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare program millions of dollars annually. The CMS has initiated a [...]

Overcoming Barriers to Tobacco Counseling

Overcoming Barriers to Tobacco Counseling Healthcare providers may face different challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency Table of Contents Certified Provider and State Survey Agency Certified Providers/Suppliers Certified Providers and Certified Suppliers That Enroll Via the Form CMS-855A Certified Suppliers [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency Table of Contents Certified Provider and State Survey Agency Certified Providers/Suppliers Certified Providers and Certified Suppliers That Enroll Via the Form CMS-855A Certified Suppliers That [...]

MLN Connects® Newsletter: December 12, 2024

MLN Connects® Newsletter: December 12, 2024 News FY 2024 Medicare Fee-for-Service Improper Payment Rate Revised Home Health Change of Care Notice Form Effective February 1 Skilled Nursing Facility Value-Based Purchasing Program: December [...]

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast

Your Lunchtime Treat! Listen to the Navigating Medicare: Part A Insights for Providers Podcast “Lunch, listen and learn” twice a month with Medicare Part A! We have more than 15 Part A podcasts geared toward our Part A providers and their [...]

Intermittent Issues with NGSMedicare.com on 12/15/2024

Intermittent Issues with NGSMedicare.com on 12/15/2024 We will experience intermittent outages with NGSMedicare.com on Sunday, 12/15/2024 due to maintenance. NGSMedicare.com will be fully operational on Monday, 12/16/2024. We apologize for [...]

HCPCS 82947 RTPs End-Stage Renal Dialysis Providers

As of 1/1/2024, Medicare has covered HbA1c tests for diabetic screening (HCPCS 82947) when billed with ICD-10 Z13.1. Some of these claims submitted by ESRD providers have been RTP'd in error.

End Stage Renal Disease Claims Returning to Providers with Reason Code 31773

Due to an issue with the October 2024 release, ESRD facility claims, type of bill 72X, are RTPing in error.

Claim Billing Guidance

Claim Billing Guidance 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 been billed. [...]

Method II CAH Claims Not Paying Professional Services with Revenue Codes 096x-098x

Certain CAH claims (TOB 85X) with professional service revenue codes 096x – 098X did not process for payment because the fee amount was not correctly retrieved during processing. The affected claims have receipt/processed dates in October 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

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 [...]

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 [...]

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 [...]

[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 [...]

Description of Application Fee

The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information about how the fee was calculated [...]

Who Needs to Pay Application Fees

Institutional providers or suppliers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. Physicians, nonphysician practitioners, physician [...]

How to Pay the Application Fee

The application fee must be paid electronically. Important: If submitting a hardship request, it must be submitted with the enrollment application. It cannot be accepted separately. To pay the application fee using the Provider Enrollment, [...]

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730)

Reminder for Correcting Hospice Edits for Certifying Physicians (17729, 17730) Reason Codes 17729 and 17730: Refer to specific hospice claim edits related to certifying physicians. Adjustments: Should be submitted for correcting input [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers or suppliers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. Physicians, [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers and certain suppliers must pay an application fee or submit a hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. [...]

Who Needs to Pay Application Fees

Who Needs to Pay Application Fees Institutional providers and certain suppliers must pay an application fee or submit a hardship exception when initially enrolling, revalidating their enrollment or adding a new Medicare practice location. [...]

Description of Application Fee

Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]

Description of Application Fee

Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]