Search Results - NGSMEDICARE

Posting Date: 06/26/2023

Helpful Reminders on Advance Care Planning

Helpful Reminders on Advance Care Planning ACP billing codes: 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms. 99498: [...]

Posting Date: 04/19/2024

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024

Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024 Effective for hospice claim "From" dates on or after 5/1/2024, CMS implemented edits to enforce a new rule that would deny hospice claims if the certifying [...]

Posting Date: 04/22/2024

Top Claim Errors Have Been Reviewed and Updated

Top Claim Errors Have Been Reviewed and Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors under Resources > Claims and Appeals to learn what you can do to avoid claim [...]

Posting Date: 04/23/2024

Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex

Table of Contents Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex What are the benefits? [Return to Top] Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex National Government [...]

Posting Date: 04/24/2024

Home Office Cost Statements

A home office of a chain organization is a related organization to its participating providers. Home offices usually furnish central management and administrative services, e.g., centralized accounting, purchasing, personnel services, [...]

Posting Date: 04/25/2024

MLN Connects® Newsletter: April 25, 2024 (UPDATE)

MLN Connects® Newsletter: April 25, 2024 (UPDATE) Editor's Note: CMS updated a message because we delayed the effective date that physicians who certify hospice services must enroll in or opt-out of Medicare until 6/3/2024. You may have to [...]

Posting Date: 04/29/2024

LCD and Article Updates for April/May 2024

LCD and Article Updates for April/May 2024 Billing and Coding Articles Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311) [...]

Posting Date: 04/29/2024

Billing for Drug Wastage: JW and JZ Modifier

Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]

Posting Date: 04/29/2024

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]

Posting Date: 04/29/2024

What Are the Recovery Auditors' Responsibilities_Part A-B-FQHC-HHH

What Are the Recovery Auditors' Responsibilities? What Are the Recovery Auditors' Responsibilities? Recovery Auditors review claims on a postpayment basis using the same Medicare policies as MACs: NCDs LCDs and CMS manuals/regulations To ensure [...]

Posting Date: 04/29/2024

How Will I Know When a Payment Determination Has Been Issued_Part A-B-FQHC-HHH

How Will I Know When a Payment Determination Has Been Issued? How Will I Know When a Payment Determination Has Been Issued? When a Recovery Auditor finds that improper payments have been made, they will submit claim adjustments to your MAC. The [...]

Posting Date: 04/29/2024

ALOB_What Are My Options When I Receive the Recovery Auditor Demand Letter

What Are My Options When I Receive the Recovery Auditor Demand Letter? What Are My Options When I Receive the Recovery Auditor Demand Letter? If you agree with the Recovery Auditor’s determination you can: repay the overpayment amount by check; [...]

Posting Date: 03/26/2024

Covered Medicare Part B Drugs/Biologicals

Covered Medicare Part B Drugs/Biologicals Each drug and biologic that can be considered for coverage under Medicare Part B has its own set of coverage guidelines. Below are examples of covered Medicare Part B drugs and biologicals, which may [...]

Posting Date: 04/30/2024

Biomarker Testing for Prostate Cancer Diagnosis

Biomarker Testing for Prostate Cancer Diagnosis N/A L37733 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37733 A56609 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56609 A59220 [...]

Posting Date: 04/07/2022

Panniculectomy Best Practices

Panniculectomy Best Practices Table of Contents Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy) and Related Services Coverage Documentation Requirements Best practice/documentation [...]

Posting Date: 05/03/2022

Botulinum Toxin Best Practices

Botulinum Toxin Best Practices Table of Contents Botulinum Toxin Injections Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips and Help Related Content [Return to Top] Botulinum Toxin [...]

Posting Date: 10/29/2021

Implantation of Spinal Neurostimulator

Implantation of Spinal Neurostimulator Table of Contents Implantation of Spinal Neurostimulator Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips Related Content [Return to Top] Implantation of [...]

Posting Date: 06/14/2023

Facet Joint Interventions for Pain Management Best Practices

Facet Joint Interventions for Pain Management Best Practices Table of Contents Indications and/or Medical Necessity Coverage Documentation Requirements Diagnostic Facet Joint Injections (IA or MBB) Therapeutic Facet Joint Injection [...]

Posting Date: 01/03/2022

Respiratory Pathogen Panel Testing

Respiratory Pathogen Panel Testing N/A L39027 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39027 A58741 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58741 A58890 [...]

Posting Date: 10/05/2023

Cardiovascular Nuclear Medicine

Cardiovascular Nuclear Medicine cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool L33560 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33560 A56743 [...]

Posting Date: 10/05/2023

Epidural Steroid Injections for Pain Management

Epidural Steroid Injections for Pain Management spine, pain, transforaminal, sacral, steroid, spinal L39036 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39036 A58745 [...]

Posting Date: 09/30/2021

Visual Fields Testing

Visual Fields Testing eyes, ophthalmology, vision L33574 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33574 A56551 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56551 92081, 92082, 92083

Posting Date: 04/19/2021

Visual Electrophysiology Testing

Visual Electrophysiology Testing N/A L36831 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36831 A57060 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57060 A55475 [...]

Posting Date: 06/01/2023

Urodynamics

Urodynamics cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction L33576 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33576 A57455 [...]

Posting Date: 10/12/2022

Transthoracic Echocardiography (TTE)

Transthoracic Echocardiography (TTE) cardiac, doppler, stress, cardovascular, myocardial, heart, contrast L33577 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33577 A56781 [...]

Posting Date: 10/02/2022

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) OCT, eyes, cornea, glaucoma L34380 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34380 A56537 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]

Posting Date: 07/13/2023

Peripheral Nerve Blocks

Peripheral Nerve Blocks N/A L36850 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36850 A57452 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57452 A55421 [...]

Posting Date: 04/19/2021

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention heart, angina, intracoronary L33623 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33623 A56823 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56823 92920, [...]

Posting Date: 10/02/2022

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) retinal, retinopathy, chorioretinitis, vitreous L33567 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33567 A56726 [...]

Posting Date: 07/27/2023

Nonvascular Extremity Ultrasound

Nonvascular Extremity Ultrasound clot, plantar fasciitis L33619 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33619 A56787 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56787 76881, 76882

Posting Date: 10/02/2022

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography electrodiagnostic, neurologic, EMG, NCS, neuromuscular, motor, needle L35098 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35098 A57668 [...]

Posting Date: 10/02/2022

Computed Tomographic (CT) Colonography for Diagnostic Uses

Computed Tomographic (CT) Colonography for Diagnostic Uses virtual colonoscopy L33562 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33562 A57026 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5702[...]

Posting Date: 02/14/2023

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) heart, calcium, congenital, bypass L33559 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33559 A56737 [...]

Posting Date: 04/04/2023

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation depression, major depressive disorder, magnetic field L33398 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33398 A57528 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]

Posting Date: 04/04/2023

Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures paronychia, skin, carbuncle, boil L33563 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33563 A56766 [...]

Posting Date: 01/06/2023

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases N/A L37606 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37606 A56793 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56[...]

Posting Date: 10/31/2022

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses administration, compendia, FDA L33394 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33394 A52855 [...]

Posting Date: 10/26/2022

Osteopathic Manipulative Treatment

Osteopathic Manipulative Treatment somatic, skeletal, dysfunction L33616 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33616 A56954 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56954 A55318 [...]

Posting Date: 10/02/2022

Psychiatric Inpatient Hospitalization

Psychiatric Inpatient Hospitalization active treatment L33624 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33624 A56865 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56865

Posting Date: 10/02/2022

Frequency of Hemodialysis

Frequency of Hemodialysis dialysis, kidney disease, end stage renal disease L37475 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37475 A55672 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=55672 [...]

Posting Date: 08/10/2022

Prostate Rectal Spacers

Prostate Rectal Spacers N/A L37485 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37485 A56539 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56539 A58100 [...]

Posting Date: 07/31/2022

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) L39226 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39226 A58963 https://www.cms.gov/medicare-coverage-database/view/article.aspx?article[...]

Posting Date: 04/19/2021

Multimarker Serum Tests Related to Ovarian Cancer Testing

Multimarker Serum Tests Related to Ovarian Cancer Testing N/A L38371 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38371 A57020 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57020 A58112 [...]

Posting Date: 04/19/2021

Varicose Veins of the Lower Extremity, Treatment of

Varicose Veins of the Lower Extremity, Treatment of telangiectasia, spider veins, cosmetic, ligation and stripping, Endovenous radiofrequency ablation, EFRA, laser ablation L33575 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdi[...]

Posting Date: 06/15/2022

Platelet Rich Plasma

Platelet Rich Plasma N/A L38937 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38937 A58609 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58609 A58693 [...]

Posting Date: 09/06/2021

Corneal Hysteresis

Corneal Hysteresis N/A L38014 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38014 A56528 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56248 A56529 [...]

Posting Date: 02/10/2022

Hospice - Determining Terminal Status

Hospice - Determining Terminal Status Decline, life expectancy L33393 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33393 A52830 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52830

Posting Date: 02/10/2022

Biomarker Testing for Neuroendocrine Tumors/Neoplasms

Biomarker Testing for Neuroendocrine Tumors/Neoplasms N/A L37851 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37851 A57059 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57059 A56247 [...]

Posting Date: 02/10/2022

Select Minimally Invasive GERD Procedures

Select Minimally Invasive GERD Procedures N/A L35080 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35080 A56863 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56863 A58614 [...]

Posting Date: 09/06/2021

B-type Natriuretic Peptide (BNP) Testing

B-type Natriuretic Peptide (BNP) Testing congestive heart failure, acute dyspnea L33573 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33573 A56826 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56[...]

Posting Date: 01/04/2022

Colon Capsule Endoscopy (CCE)

Colon Capsule Endoscopy (CCE) N/A L38571 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38571 A58294 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58294 A58630 [...]

Posting Date: 01/04/2022

Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea N/A L38387 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38387 A57092 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5709[...]

Posting Date: 01/04/2022

Thyroid Nodule Molecular Testing

Thyroid Nodule Molecular Testing N/A L38968 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38968 A58656 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58656 A58853 [...]

Posting Date: 09/30/2021

Speech-Language Pathology

Speech-Language Pathology dysphagia, swallowing, communication L33580 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33580 A52866 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52866 31579, 92507, [...]

Posting Date: 09/30/2021

RAST Type Tests

RAST Type Tests FAST, Radioallergosorbent, fluoroallergosorbent, antigen, allergen, IGE L33591 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33591 A56844 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]

Posting Date: 09/30/2021

Proton Beam Therapy

Proton Beam Therapy radiation, radiotherapy L35075 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35075 A56827 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56827 A55124 [...]

Posting Date: 09/30/2021

Heavy Metal Testing

Heavy Metal Testing metal toxicity, aluminum, arsenic, iron, lead, nickel, zinc, mercury L35074 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35074 A56767 https://www.cms.gov/medicare-coverage-database/view/article.aspx?arti[...]

Posting Date: 04/19/2021

Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency

Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency CCSVI, multiple sclerosis, MS L35028 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35028 A56845 [...]

Posting Date: 04/19/2021

Transrectal Ultrasound

Transrectal Ultrasound prostate, ultrasound, echography L33578 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33578 A57427 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57427 76872, 76873

Posting Date: 04/19/2021

Total Joint Arthroplasty

Total Joint Arthroplasty Knee, TKA, Hip, THA L36039 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36039 A57428 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57428 27130, 27132, 27134, 27137, [...]