Counseling to Prevent Tobacco Use

Preventive Services Guide Counseling to Prevent Tobacco Use Smoking is the leading preventable cause of disease, disability and death in the United States. It harms nearly every organ in the body and causes about one in every five deaths. [...]

Depression Screening

Preventive Services Guide Depression Screening Also Known as Screening for Depression in Adults Coverage Criteria Covered annually At least 11 months must have passed since last depression screening G0444: Annual depression [...]

Glaucoma Screening

Preventive Services Guide Glaucoma Screening Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight. Medicare beneficiaries over the age of 60 have an increased risk of developing glaucoma. CMS has [...]

Hepatitis C Virus Screening

Preventive Services Guide Hepatitis C Virus Screening Hepatitis C is a virus that can damage the liver; it is transmitted through infected blood or body fluids. The most common way people get infected is by sharing needles used to inject [...]

Human Immunodeficiency Virus Screening

Preventive Services Guide Human Immunodeficiency Virus Screening HIV attacks cells that help the body fight infection making a person vulnerable to other infections. Nearly 1.2 million Americans are now living with HIV infection and about [...]

Intensive Behavioral Therapy for Cardiovascular Disease

Preventive Services Guide Intensive Behavioral Therapy for Cardiovascular Disease CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. CMS has determined [...]

Intensive Behavioral Therapy for Obesity

Preventive Services Guide Intensive Behavioral Therapy for Obesity In 2003, the United States Preventive Services Task Force found good evidence that BMI “is reliable and valid for identifying adults at increased risk for mortality and [...]

Medical Nutrition Therapy

Preventive Services Guide Medical Nutrition Therapy MNT is a dietary intervention that is used to prevent or treat health conditions that are caused by or made worse by unhealthy eating habits. Table of Contents Eligibility Criteria [...]

Prostate Cancer Screening

Preventive Services Guide Prostate Cancer Screening Prostate cancer is the second most common cancer in men in the United States, after skin cancer. Older men, African-American men and men who have a family history of prostate cancer have a [...]

Screening for Cervical Cancer with Human Papillomavirus Tests

Preventive Services Guide Screening for Cervical Cancer with Human Papillomavirus Tests Cervical cancer is commonly caused by the HPV. The USPSTF found that regular screening greatly reduces the rate of cervical cancer and the number of [...]

Screening Pelvic Examinations

Preventive Services Guide Screening Pelvic Examination A pelvic examination is a type of gynecologic examination for women. Some of the conditions that health care providers look for during a pelvic examination include infections, fibroids, [...]

Ultrasound Screening for Abdominal Aortic Aneurysm

Preventive Services Guide Ultrasound Screening for Abdominal Aortic Aneurysm An ultrasound screening for AAA is a procedure using sound waves (or such other procedures using alternative technologies, of commensurate accuracy and cost, as [...]

Screening Pap Tests

Preventive Services Guide Screening Pap Tests Cervical cytology, also called a Pap test, looks for abnormal changes in cells in the cervix, which is part of a woman’s reproductive organs. Screening for cervical cancer via a Pap test is very [...]

PC-ACE

Provider Enrollment: Reduce Development Requests for Additional Action

Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]

Tobacco Counseling via Telehealth

Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth helps improve access to healthcare for various [...]

Evaluation and Management Services

Evaluation and Management Services E/M services are professional face to face services rendered by a physician or NPP in various sites or POS. The nature and amount of physician work and documentation will vary by type of service, place of [...]

Related Resources

Related Resources MLN®Booklet: Evaluation and Management Services Guide AMA CPT Guidelines CMS IOM Publication 100-04, Medicare Claims Processing Manual,Chapter 12, Section 30.6 MLN®Fact Sheet: Complying with Medicare [...]

General Principles of Medical Record Documentation

General Principles of Medical Record Documentation   The medical record should be complete and legible. The documentation of each patient encounter should include: The reason for the encounter and relevant history, physical [...]

October 2024

In This Issue National Government Services Articles for Part A and Part B Providers Common Working File Host Dark Days for October 2024 Release LCD and Article Updates for August/September 2024 October 2024 EDI Front End Quarterly Release [...]

Medicare Preventive Services Resource Guide

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

Anesthesia Modifiers

Anesthesia Modifiers Use Anesthesia Modifiers Appropriately National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly. Claims submitted incorrectly will [...]

Appropriate Usage of Modifier 99

Appropriate Usage of Modifier 99 Table of Contents Appropriate Usage of Modifier 99 Appropriate Usage Inappropriate Usage Related Content [Return to Top] Appropriate Usage of Modifier 99 Modifier 99 indicates multiple modifiers; [...]

Correct Usage of Modifier 79 for Multiple Procedures

Correct Usage of Modifier 79 for Multiple Procedures National Government Services Medical Review department has identified widespread problems with the use of modifier 79 for multiple procedures. The global surgical package was established by [...]

Co-Surgery/Team Surgery/Assistant Surgery Modifiers

Co-Surgery/Team Surgery/Assistant Surgery Modifiers Table of Contents Co-Surgery/Team Surgery/Assistant Surgery Modifiers Co-Surgery (Modifier 62) Team Surgery (Modifier 66) Assistant-at-Surgery Services Assistant Surgery Modifiers [...]

Modifier 51

Modifier 51 Table of Contents Modifier 51 Definitions Appropriate System Usage Inappropriate System Usage Additional Information Related Content [Return to Top] Modifier 51 Modifier 51 denotes more than one medical/surgical [...]

Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services

Modifier 59 and the Subset Modifiers XE, XP, XS, XU – Specific Modifiers for Distinct Procedural Services Table of Contents Continued Use of Modifier 59 after 1/1/2015 Modifier 59 Appropriate Usage Modifier XE Modifier XP [...]

Proper Billing of Surgical Comanagement (Modifiers 54 and 55)

Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Table of Contents Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Exceptions Date(s) of Service Care Provided in Different Payment Localities 55 Modifier [...]

Critical Care Policy Clarification

Critical Care Policy Clarification The CMS implemented the new policy for critical care services as published in the Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, [...]

Critical Care Tip Sheet

Critical Care Tip Sheet Table of Contents Service and Medical Necessity The Following CMS Billing Consideration Guidelines Apply Provider Time Assessment and Documentation The Following CMS Billing Consideration Guidelines [...]

Critical Care Services: CPT Codes 99291-99292

Critical Care Services: CPT Codes 99291-99292 Table of Contents Definition Context Providers Who May Perform Critical Care Services and Medical Necessity Palliative and Hospice Patients Full Attention of the Provider and Provider [...]

Certification or Recertification of Medicare Covered Home Health Services

Certification or Recertification of Medicare Covered Home Health Services Billing HCPCS Codes G0180 and G0179 of Patient Eligibility for Medicare-covered Home Health Services under a Home Health Plan of Care Physician [...]

Initial Episode Clarified for Home Health Face-to-Face Encounter

Initial Episode Clarified for Home Health Face-to-Face Encounter CMS requires a patient receiving HH services under the Medicare HH benefit have a FTF encounter with the certifying physician for the initial episode. CMS has clarified that this [...]

Sacroiliac Joint Injections and Procedures

Sacroiliac Joint Injections and Procedures Table of Contents Sacroiliac Joint Injections and Procedures Diagnostic SIJI Diagnostic SIJI Limitations Therapeutic SIJI Therapeutic SIJI Limitations SIJ Denervation [...]

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Approved Pending Regional Office Review

Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS. National Government [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Local Coverage Determination Open Meeting

Local Coverage Determination Open Meeting National Government Services is hosting a Proposed Local Coverage Determination Open Meeting on 10/24/2024.  Details are available by accessing the Local Coverage Determination Open Meeting [...]

MSP Right Hand

Helpful Resources BCRC Contact Information Note: Providers should not contact the BCRC to set up new MSP records. Instead, report MSP coding on your MSP and conditional claims. Providers should not contact the BCRC to correct MSP records to [...]

CMS Links

Accreditation Medicare Provider/Supplier Enrollment  National Provider Identifier Registry  National Provider Identifier Standard (NPI)  Advance Beneficiary Notice Beneficiary Notices Initiative (BNI)  Appeals [...]

Claim Denials During Hospice Elections Liability Reminder

Claim Denials During Hospice Elections Liability Reminder When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatment and palliative care associated with it in [...]

MLN Connects® Newsletter: October 3, 2024

MLN Connects® Newsletter: October 3, 2024   News HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program Resources & Flexibilities to Assist with the Public Health Emergency in Florida, [...]

HCPCS 75580 Returning to Provider With Reason Code 32402

Part A claims being billed with HCPCS 75580 are receiving reason code 32402 when billed with the cardiology revenue code (048X) and cannot process for payment. CMS has determined that claims should be allowed to process when HCPCS 75580 is [...]

Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error

Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error CMS informed NGS of an issue that occurred on 7/26/2024 impacting some claims from 2021 – 2024 related to the ACO REACH Model. CMS [...]

[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business

[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business Our Provider Contact Center Customer Services Representative phone lines were down for all lines of business. Technical support was engaged and the [...]

Influenza Virus Vaccine and Administration

Preventive Services Guide Influenza Virus Vaccine and Administration Influenza (flu) is a contagious respiratory illness caused by the influenza virus that causes mild to severe illness. According to the CDC, millions of people get the flu [...]

Introduction to Outpatient OT and PT Services

Outpatient OT and PT Services Billing Guide Introduction to Outpatient OT and PT Services Therapy services are a covered benefit in Sections 1861(g), 1861(p), and 1861(ll) of the Act. Therapy services may also be provided incident to the [...]

Annual Update to the Therapy Code List

Annual Update to the Therapy Code List Annual CRs update the list of codes that are described as “sometimes” or “always” therapy services. This will include additions, changes and deletions to the therapy code list. The current and previous [...]

Targeted Medical Review

Targeted Medical Review CMS knows in certain circumstances you may need to treat a patient whose condition exceeds the KX modifier threshold amounts. This is always based on the medical necessity of the patient. If this is the case, you must [...]

Functional Reporting - Using the G Codes

Functional Reporting ‒ Using the G Codes Effective for dates of service on and after 1/1/2019, the functional reporting requirements of reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on claims for therapy [...]

What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy

What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy The ABN is a notice given to the Medicare patient before services are rendered when you believe Medicare may deny services. These may be for medical [...]

Maintenance Programs

Outpatient OT and PT Services Billing Guide Maintenance Programs Skilled therapy services that do not meet the criteria for rehabilitative therapy may be covered in certain circumstances as maintenance therapy under a maintenance program. [...]