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Posting Date: 01/27/2025
Jurisdiction 6 Part B Top Claim Errors Are Updated
Jurisdiction 6 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; [...]
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Posting Date: 01/15/2025
Prepare and Submit a Medicare Secondary Payer Claim
Table of Contents Background Step 1: Determine If You Must Submit an MSP Claim Step 2: Prepare an MSP Claim MSP Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common Working File Step [...]
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Posting Date: 07/20/2023
Contractor Advisory Committee Meeting
Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]
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Posting Date: 01/15/2025
Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025
Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025 The Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting is scheduled for 2/3/2025 from 2:00–4:00 p.m. ET, via [...]
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Posting Date: 01/16/2025
MLN Connects® Newsletter: January 16, 2025
MLN Connects® Newsletter: January 16, 2025 News Resources & Flexibilities to Assist with the Public Health Emergency in California CMS Moves Closer to Accountable Care Goals with 2025 Accountable Care Organization Initiatives [...]
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Posting Date: 01/16/2025
FQHC and RHC Claims RTP for W7072
Between 10/1/2024 and 12/31/2024, RHC (TOB 071X) and FQHC (TOB 077X) claims that contained HCPCS code 93010 were RTP in error with reason code W7072.
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Posting Date: 01/17/2025
Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number
Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number If you received a letter from National Government Services dated 1/10/2025 regarding a deactivation of your enrollment due to infrequent billing, [...]
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Posting Date: 01/21/2025
2024 Calendar Year 1099 Form Information
2024 Calendar Year 1099 Form Information National Government Services will mail all 1099 Forms for calendar year 2024 no later than 1/31/2025. Medicare providers and beneficiaries, who are serviced by NGS regardless of their location, will [...]
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Posting Date: 01/02/2025
Improving Customer Experience
Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]
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Posting Date: 01/22/2025
Connecticut ASC Fee Schedule Listing
Connecticut ASC Fee Schedule Listing CMS is using CBSA planning areas/numbers instead of counties for fee schedule listings for ASCs in the state of Connecticut. CBSAs refer collectively to metropolitan statistical areas and [...]
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Posting Date: 04/24/2018
Fee Schedule Assistance
Fee Schedule Assistance Connecticut Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and [...]
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Posting Date: 01/27/2022
Observation Services
Observation Services Please define guidelines for providers billing observation services. Answer: Observation services are ordered, performed and billed by the practitioner (or group), who is responsible for the patient’s care during the [...]
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Posting Date: 01/27/2022
Global Period Services
Global Period Services How do global period rules apply to critical care services Answer: Global surgery rules apply to the primary surgeon who performed and billed the surgical service that established the global period. When the primary [...]
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Posting Date: 11/03/2022
Split/Shared and Incident To Services
Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit in 2024? Answer: The following factors apply in determining the substantive portion of a split (or shared) visit: Total [...]
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Posting Date: 01/28/2022
Behavioral/Mental Health Services
Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Answer: As of 1/1/2025, CMS has permanently extended permission for behavioral and mental [...]
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Posting Date: 10/10/2024
Complex and Chronic Care - HCPCS Code G2211
Complex and Chronic Care - HCPCS Code G2211 Please define appropriate usage and billing for HCPCS code G2211. Answer: CPT G2211 is an approved add-on code representing complex and/or continuous management in the office and outpatient [...]
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Posting Date: 01/27/2022
Advanced Care Planning
Advanced Care Planning Please define documentation requirements when billing advanced care planning (CPT 99497 and 99498). Answer: ACP codes may be used with or without a base E/M code on the same date of service, based on whether a [...]
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Posting Date: 01/27/2022
Chronic Care Management
Chronic Care Management The guidelines state moderate or high complex MDM. Do the E/M guidelines apply here? Answer: Yes, the E/M guidelines for MDM are applicable, since chronic care management (CPT 99490) is included within the E/M [...]
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Posting Date: 03/18/2022
Consultations
Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]
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Posting Date: 01/28/2022
Critical Care Services
Critical Care Services Please define the time requirement for billing CPT code 99292. Answer: Whether critical care is performed by a single provider or on a split (or shared) basis, the time requirement for CPT code 99292 remains the [...]
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Posting Date: 01/27/2022
Documentation
Documentation What are the basic documentation requirements for a service submitted to Medicare for payment? Answer: For all services submitted to Medicare, the medical record (whether electronic or paper) must clearly define the provider [...]
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Posting Date: 05/11/2022
Emergency Department
Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]
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Posting Date: 01/27/2022
Examination
As of 1/1/2023, CMS has eliminated prior specifications for the scope of examination and associated documentation in the outpatient office and hospital settings. The provider is expected to perform and document a medically necessary and [...]
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Posting Date: 01/28/2022
Fee-For-Time Compensation Arrangements
Fee-For-Time Compensation Arrangements Can a physician return to work in his or her practice for a short period of time to reset the 60-day clock requirement for the fee-for-time compensation arrangement provider? Answer: In order for the [...]
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Posting Date: 02/21/2020
IPPE and AWV Services
IPPE and AWV Providers are reminded that the IPPE and AWV are Medicare-covered services within their own benefit category. As such, they are not subject to standard “incident to” billing guidelines and must be billed by the performing [...]
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Posting Date: 04/29/2021
Medical Decision Making
Medical Decision Making In a split/shared service, when a medical record includes a plan of care developed by the physician, based on a history and/or examination performed by the NPP and a personal review of diagnostic findings, [...]
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Posting Date: 01/27/2022
New vs. Established Patients
New vs. Established Patients How does CMS define a patient as “new” versus “established”? Answer: In 2023, the definition of a “new” patient differs based on whether the patient is being treated in an office or an observation/ inpatient [...]
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Posting Date: 10/26/2022
Nonphysician Practitioner Services
Nonphysician Practitioner Services In addition to the frequently asked questions below, please view NGS’ Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue article for related information. Is it permissible for [...]
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Posting Date: 01/28/2022
Preoperative Clearance
Preoperative Clearance What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable? Answer: CMS does not set requirements for medical clearance; these are established by individual [...]
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Posting Date: 01/28/2022
Provider Specialty
Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]
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