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Posting Date: 07/21/2023
Original Medicare First Level of Appeal Tips Sheet for Medicare Providers
Original Medicare First Level of Appeal Tips Sheet for Medicare Providers If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal [...]
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Posting Date: 10/27/2022
Coverage of Rural Air Ambulance Services
Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]
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Posting Date: 06/01/2020
New York State Ambulance Services in Rural Areas (for JK providers only)
New York State Ambulance Services in Rural Areas NYS has unique requirements for the payment of paramedic intercept services when an ambulance company can provide only BLS services. Paramedic intercept services can be approved in counties and [...]
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Posting Date: 03/08/2023
PECOS Starter Guide
PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. Table of Contents New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application [...]
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Posting Date: 10/31/2022
General Information
General Information Original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs if associated with other covered expenses (that is, Medicare may cover some vision [...]
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Posting Date: 10/31/2022
Provider Qualifications
Provider Qualifications Definition Ophthalmologist An ophthalmologist is a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) who has completed medical school and an ophthalmology residency that specialized in eye and [...]
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Posting Date: 10/31/2022
Local Coverage Determinations
Local Coverage Determinations Table of Contents Cataract Extraction LCD L33558 Corneal Pachymetry LCD L33630 Coding Guidelines Ophthalmic Biometry for Intraocular Lens Power Calculation LCD L33621 A-Scan Ultrasound Ophthalmic [...]
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Posting Date: 10/31/2022
National Coverage Determinations
National Coverage Determinations Table of Contents Hydrophilic Contact Lens for Corneal Bandage Photodynamic Therapy Ocular Photodynamic Therapy Photosensitive Drugs Verteporfin Hydrophilic Contact Lenses Scleral Shell Intraocular [...]
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Posting Date: 10/31/2022
Limitation of Liability (Advance Beneficiary Notice)
Limitation of Liability (Advance Beneficiary Notice) Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. The ABN is a [...]
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Posting Date: 10/31/2022
Glaucoma Screening ‒ Preventive Services Coverage
Glaucoma Screening ‒ Preventive Services Coverage Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups: Individuals with diabetes mellitus; Individuals with a family [...]
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