Smoking Cessation

Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]

Time-Based Services

Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]

Transitional Care Management

Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]

Urgent Care

Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]

Jurisdiction K Part B Top Claim Errors Are Updated

Jurisdiction K Part B Top Claim Errors Are Updated Did you know we publish the top claim errors on our website? This resources provides detailed information including: the error reason code; a description of the error; the error type; [...]

What are the administration codes for the pneumococcal vaccine?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Is an order required to administer the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

What are the allowance limits for the cost of the pneumococcal vaccine?

What is the frequency requirement for the pneumococcal vaccine?

With the end of the PHE, will HIPAA compliant telehealth platforms only be allowed, or can we continue to use any platform?

Can a resident in a teaching physician program that’s located in a Metropolitan Statistical Area continue to provide telehealth services when the teaching physician is physically present with the resident during the key portions of the service?

Are telephone E/M codes (99441-99443) allowed for new patients after the end of the PHE?

Are CPT codes 98966-98968 (telephone assessment and management services) billable to Medicare after 5/11/2023?

Are both place of service 02 and place of service 10 billable to Medicare?

Can principal care management and chronic care management services be permanently allowed for telehealth?

During the PHE, our pharmacy provided COVID-19 vaccines in the nursing home to patients. Is this still allowed?

For mental health services provided via telehealth do we need to bill with both modifier 95 and FQ?

I thought CMS was permanently allowing the beneficiary to have telehealth sessions in their homes. Is there an end date to this?

Is the GT modifier not accepted for professional telehealth services after the PHE or at the end of December?

Will the originating site fee (Q3014) be billable for telehealth services when the patient is located in their home?

With the end of the PHE on 5/11/2023, will Medicare beneficiaries be required to have a physician order to receive a laboratory conducted COVID-19 test?

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Please take time to review these FAQs for answers to [...]

Medicare Secondary Payer Provisions Group and Nongroup Health Plans

Who pays first? This Medicare Secondary Payer learning session will be on the provisions of group health plans that include working aged, disability and end stage renal disease and nongroup health plans that include auto, liability, no-fault, [...]

Provider Enrollment: Initially Enrolling a Dentist in the Medicare Program

During this webinar, we’ll address the Medicare dental specialty codes and provide an overview of how to enroll using Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]

Medicare Telehealth Changes for 2024/2025

Medicare Telehealth Changes for 2024/2025 Table of Contents Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE Reporting Home Address Direct Supervision Requirements Teaching Physicians Remote Evaluations, [...]

Medicare Secondary Payer: Preparing and Submitting Claims (Examples) – Part 2

Join us for Part 2 of a two-part webinar. In Part 2, we will briefly recap the Medicare Secondary Payer (MSP). Claim coding and billing instructions we reviewed in Part 1. We will then focus on reviewing examples of MSP claims. Be sure you are [...]

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis. View Top Claim Errors to quickly identify the information you need to avoid processing delays and get [...]

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you [...]

Admission and Discharge Services

Admission and Discharge Services Is it permissible for an NPP to perform an initial hospital admission or discharge service on behalf of the attending physician, or on a split/shared basis, when both are members of the same provider [...]

General E/M Information

General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services.   Answer: These terms are often used in defining which staff members can perform Medicare services [...]

Hospitals Must Correctly Code Claims Involving Chimeric Antigen Receptor T-cell and Other Immunotherapy to Receive Proper Payment

Hospitals Must Correctly Code Claims Involving Chimeric Antigen Receptor T-cell and Other Immunotherapy to Receive Proper Payment We have noticed that inpatient hospital claims for CAR T-cell and other immunotherapy are not always coded [...]

Podiatry Services - Routine Foot Care and Debridement of Nails

While the Medicare Program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits. Medicare payment may be made for routine foot care when the patient has [...]

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]

W7010

Avoiding/Correcting This Error This edit is applied to claims submitted with condition code 21 for an insurance denial.  If the services were not meant to be sent for insurance denial, you will need to go through the appropriate [...]

17729

Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Attending field do not match the physician’s NPI and first four letters of the physician’s last [...]