-
Posting Date: 10/03/2024
MLN Connects® Newsletter: October 3, 2024
MLN Connects® Newsletter: October 3, 2024 News HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program Resources & Flexibilities to Assist with the Public Health Emergency in Florida, [...]
Read More -
Posting Date: 10/04/2024
HCPCS 75580 Returning to Provider With Reason Code 32402
Part A claims being billed with HCPCS 75580 are receiving reason code 32402 when billed with the cardiology revenue code (048X) and cannot process for payment. CMS has determined that claims should be allowed to process when HCPCS 75580 is [...]
Read More -
Posting Date: 10/04/2024
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error CMS informed NGS of an issue that occurred on 7/26/2024 impacting some claims from 2021 – 2024 related to the ACO REACH Model. CMS [...]
Read More -
Posting Date: 10/04/2024
Botulinum Toxins
Botulinum Toxins Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation L33646 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33646 A52848 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5284[...]
Read More -
Posting Date: 10/04/2024
Cervical Fusion
Cervical Fusion L39770 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39770 A59632 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59632 A59772 [...]
Read More -
Posting Date: 10/04/2024
[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business
[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business Our Provider Contact Center Customer Services Representative phone lines were down for all lines of business. Technical support was engaged and the [...]
Read More -
Posting Date: 09/06/2023
Influenza Virus Vaccine and Administration
Preventive Services Guide Influenza Virus Vaccine and Administration Influenza (flu) is a contagious respiratory illness caused by the influenza virus that causes mild to severe illness. According to the CDC, millions of people get the flu [...]
Read More -
Posting Date: 02/17/2022
Introduction to Outpatient OT and PT Services
Outpatient OT and PT Services Billing Guide Introduction to Outpatient OT and PT Services Therapy services are a covered benefit in Sections 1861(g), 1861(p), and 1861(ll) of the Act. Therapy services may also be provided incident to the [...]
Read More -
Posting Date: 02/17/2022
Annual Update to the Therapy Code List
Annual Update to the Therapy Code List Annual CRs update the list of codes that are described as “sometimes” or “always” therapy services. This will include additions, changes and deletions to the therapy code list. The current and previous [...]
Read More -
Posting Date: 02/17/2022
Targeted Medical Review
Targeted Medical Review CMS knows in certain circumstances you may need to treat a patient whose condition exceeds the KX modifier threshold amounts. This is always based on the medical necessity of the patient. If this is the case, you must [...]
Read More -
Posting Date: 02/17/2022
Functional Reporting - Using the G Codes
Functional Reporting ‒ Using the G Codes Effective for dates of service on and after 1/1/2019, the functional reporting requirements of reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on claims for therapy [...]
Read More -
Posting Date: 02/17/2022
What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy
What is the Advance Beneficiary Notice of Noncoverage and When to Use It in Outpatient Therapy The ABN is a notice given to the Medicare patient before services are rendered when you believe Medicare may deny services. These may be for medical [...]
Read More -
Posting Date: 02/17/2022
Maintenance Programs
Outpatient OT and PT Services Billing Guide Maintenance Programs Skilled therapy services that do not meet the criteria for rehabilitative therapy may be covered in certain circumstances as maintenance therapy under a maintenance program. [...]
Read More -
Posting Date: 02/17/2022
Multiple Procedure Payment Reduction
Multiple Procedure Payment Reduction Medicare applied MPPR to the PE payment of select therapy services paid under the physician fee schedule or paid at the physician fee schedule rate. Currently, the reduction is 50 percent for therapy [...]
Read More -
Posting Date: 02/17/2022
The National Correct Coding Initiative
Outpatient OT and PT Services Billing Guide The National Correct Coding Initiative The purpose of the NCCI Procedure-to-Procedure (PTP) edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one [...]
Read More -
Posting Date: 02/17/2022
Recovery Auditor
Recovery Auditor The mission of the Recovery Audit Program is to detect and correct past improper payments made on health care claims for services provided to Medicare beneficiaries. The goal is to help CMS and the MACs implement actions that [...]
Read More -
Posting Date: 02/17/2022
Common Billing Errors and Remittance Message
Common Billing Errors and Remittance Message Remittance Remark Code Listing: X12 Message Narrative 119 Benefit maximum for this time period or occurrence has been met. 18 Duplicate claim/service. [...]
Read More -
Posting Date: 02/17/2022
Medical Review Therapy Documentation Checklist for Additional Development Request Letters
Medical Review Therapy Documentation Checklist for Additional Development Request Letters Refer to the checklist below when preparing your documentation in response to an ADR: Doctor’s orders Certifications/recertifications Initial [...]
Read More -
Posting Date: 02/17/2022
Related Content
Outpatient OT and PT Services Billing Guide Related Content Therapy Services American Physical Therapy Association (APTA) American Occupational Therapy Association (AOTA) Reviewed 10/07/2024
Read More -
Posting Date: 10/22/2021
Counting Units for Therapy Codes
Counting Units for Therapy Codes Counting units for therapy services can be complicated; therefore, we are providing guidance. First, you must understand the difference between timed codes and untimed codes in order to determine how to [...]
Read More