Prolonged Drug and Biological Infusions Using an External Pump

Prolonged Drug and Biological Infusions Using an External Pump In some situations, a hospital outpatient department or physician office may purchase a drug for a medically reasonable and necessary prolonged drug infusion, begin the drug [...]

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident As a follow up to our 2/28/2024 article, Change Healthcare Security Incident, providers have asked if they can submit their [...]

Coding for Sinuva™ Claims

Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Coding updated effective 4/1/2021: Claims submitted to National Government Services [...]

Radiopharmaceutical Reimbursement

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Table of Contents Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Billing Guidelines Claim Completion Instructions Wastage Claim Completion Instructions [...]

Factor VIII Billing

Factor VIII Billing National Government Services has received questions on the proper billing for Factor VIII drugs. This article outlines appropriate billing for these services. If the submitted amount does not exceed $99,999.99, bill the [...]

Proper Billing for LEQVIO® HCPCS Code J1306

Proper Billing for LEQVIO® HCPCS Code J1306 Table of Contents Proper Billing for LEQVIO® HCPCS Code J1306 Claim Completion Requirements Drug Wastage Related Content [Return to Top] Proper Billing for LEQVIO® HCPCS Code J1306 [...]

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Table of Contents Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Drugs and Dosage Conditions Requiring Prior [...]

Proper Billing Units for HCPCS Code J7320

Proper Billing Units for HCPCS Code J7320 National Government Services has noticed improper billing units used for HCPCS code J7320, Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg. GenVisc 850 is indicated for the [...]

MLN Connects® Newsletter: March 21, 2024

MLN Connects® Newsletter: March 21, 2024 News New Initiative to Increase Investments in Person-Centered Primary Care Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare Electronic Funds [...]

Inquiry Reference Numbers Are Now Available on the IVR

Inquiry Reference Numbers Are Now Available on the IVR You can now get an inquiry reference number through the IVR. Once the caller makes a selection from the main menu, the IVR will ask, "Would you like an inquiry reference ID?" This will [...]

View Claim Details

View Claim Details Select the Claim Number hyperlink to view additional claim details. If the claim was denied, you can view the reason for denial. You can view the following claim details from the Left-Side navigation. Claim Header [...]

Important Reminder: Change Healthcare Security Incident

Important Reminder: Change Healthcare Security Incident This is an important reminder related to the Change Healthcare Security Incident and the efforts of the CMS and National Government Services. Change Healthcare is a clearinghouse vendor [...]

Understanding the Medicare Summary Notice and Options

Understanding the Medicare Summary Notice and Options If you get a Medicare-covered service, you’ll get an MSN in the mail every three months. The notice shows all your services that your Medicare provider of service billed to Medicare during [...]

Attention Electronic Billers

Attention Electronic Billers National Government Services has experienced issues with electronic files downloaded by some of our trading partners (those who receive electronic files directly from NGS). This was not a widespread issue and only [...]

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Effective 4/30/2024 the MACs may only accept the CMS-588 EFT (11/23) version, the outdated form will be returned. NOTE: An electronic application [...]

LCD and Article Updates for March/April 2024

LCD and Article Updates for March/April 2024 Local Coverage Determinations Fluid Jet System Treatment for LUTS/BPH (L38367) The age limitation of >80 years of age has been removed, effective for services rendered on or after 4/1/2024. [...]

Medicare Part B General Billing

Medicare Part B General Billing Claims for drugs and biologicals are mandatory assignment. Claims submitted as nonassigned will be converted to adjudicate as assigned. When billing drugs or biologicals, the drug name, dosage and invoice price [...]

Patient-Supplied or Free-of-Charge Drugs

Patient-Supplied or Free-of-Charge Drugs When a patient purchases a drug and the physician administers it, the cost of the drug is not covered because it does not represent a cost to the physician. However, the administration of the drug is a [...]

Providers Performing Facet Joint Injections (CPT Code 64476) 

Providers Performing Facet Joint Injections (CPT Code 64476) The OIG released the results of an investigation into facet joint injections. Per the OIG report: "Facet joint injections are typically performed using radiological guidance [...]