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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: 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: 04/18/2025
The National Correct Coding Initiative and Medically Unlikely Edits for Part B Providers
This webinar will assist Part B providers with navigating tables for the National Correct Coding Initiative and the medically unlikely edits. We'll also review the proper modifiers to use to avoid denials. There will be time for your questions [...]
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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: 01/27/2022
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 [...]
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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: 01/28/2022
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: 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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