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Posting Date: 09/13/2022
Medicare Coverage for Living Organ Transplant Donors
Medicare Coverage for Living Organ Transplant Donors Table of Contents Coverage Hospital Guidelines Physician Guidelines Billing Guidelines Transplant Centers Physicians and Surgeons Related Content [Return to Top] Coverage [...]
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Posting Date: 11/26/2018
Kidney Transplant Services
Kidney Transplant Services Table of Contents Kidney Transplant Services Physician Services Pretransplant Services Immunosuppressive Drugs Cadaver Donor Updated CMS-1500 Claim Form Guidelines [Return to Top] Kidney Transplant [...]
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Posting Date: 09/03/2024
September 2024
In This Issue National Government Services Articles for Part A and Part B Providers Introducing the All-New Medicare University! Removal of Facet HCPCS Codes National Government Services Articles for Part A Providers [...]
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Posting Date: 08/29/2024
MLN Connects® Newsletter: August 29, 2024
MLN Connects® Newsletter: August 29, 2024 News CMS Roundup (August 23, 2024) Physicians, Teaching Hospitals, & Non-Physician Practitioners: Review Your Open Payment Data by December 31 Claims, Pricers, & Codes Home Health [...]
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Posting Date: 08/21/2018
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]
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Posting Date: 07/06/2018
Eligible Method II Providers
Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com. Suppliers who can enroll in as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]
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Posting Date: 02/04/2021
CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers
CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers Review the standards on page 2 and follow the instructions printed on the CMS-20134 application Section General Guidelines Section 1: Basic [...]
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Posting Date: 04/29/2021
Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits
Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits Revalidation instructions for sole proprietor using SSN or EIN: Download CMS-855I. Complete Sections 1, [...]
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Posting Date: 08/21/2018
Approved Pending Regional Office Review
Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS. National Government [...]
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Posting Date: 10/12/2022
Medicare Coverage for Zika Virus Testing
Medicare Coverage for Zika Virus Testing In February, 2016 the Zika virus was declared a PHE by the WHO. In the United States, the CDC considers the Zika virus disease to be a nationally notifiable condition. The Zika virus is primarily [...]
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Posting Date: 10/12/2022
Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim
Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Table of Contents Molecular Pathology: Claims Review and Supporting Information to Submit on the Claim Prepayment and/or Post Payment Review Tier 2 Codes [...]
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Posting Date: 10/12/2022
Surgical Pathology Billing Tips
Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]
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Posting Date: 10/13/2022
Pathology Interpretation Services
Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]
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Posting Date: 10/12/2022
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427 National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this [...]
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Posting Date: 08/16/2022
Background/Overview
Background/Overview Effective for dates of service on and after 1/1/2020, CMS pays OTPs, through weekly bundled payments, to deliver OUD treatment services to Medicare beneficiaries. OTP is a Medicare Part B benefit that provides coverage for [...]
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Posting Date: 08/16/2022
How to Become a Medicare-Enrolled OTP Supplier
How to Become a Medicare-Enrolled OTP Supplier Table of Contents How to Become a Medicare-Enrolled OTP Supplier National Government Services Provider Enrollment Call Center NGS Provider Enrollment Mailing Address [Return to Top] How [...]
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Posting Date: 08/16/2022
Coding and Billing for OTP Services
Coding and Billing for OTP Services Table of Contents Coding and Billing for OTP Services Coding for OTP Weekly Bundles New for 2024 HCPCS Code G0137 Separate Add-on Codes Frequency of Use and Billing Billing Cycles [Return [...]
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Posting Date: 08/16/2022
Payment Rates
Payment Rates Medicare-enrolled OTPs are paid flat dollar payment rates for the codes describing the OTP bundled services (HCPCS codes G2067 through G2080, and G2215 to G2216). Payment rates are based on the OTP provider’s geographic location. [...]
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Posting Date: 08/16/2022
Claim Submission Instructions
Claim Submission Instructions Use the instructions on the Billing/Payment section of the CMS Opioid Treatment Program (OTP) web pages. Reviewed 9/3/2024
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Posting Date: 08/16/2022
Billing and Payment for Dual Eligible Beneficiaries
Billing and Payment for Dual Eligible Beneficiaries A person who is eligible for both Medicare and Medicaid at the same time is “dually eligible”. Medicare is the primary payer for OTP services delivered to dually eligible beneficiaries. [...]
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