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  • Posting Date: 04/21/2021
    Related Content

    Related Content CMS-1500 Claim Form Instructions CMS IOM Publication 100-02, Medicare Benefit Policy Manual CMS IOM Publication 100-04, Medicare Claims Processing Manual Chapter 1 - General Billing Requirements Chapter 12 - [...]

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  • Posting Date: 02/14/2019
    Provider Revalidation Fact Sheet for Congressional Field Offices

    Provider Revalidation Fact Sheet for Congressional Field Offices The Affordable Care Act, Section 6401 (a), requires enrolled providers to revalidate their Medicare enrollment every five years, and enrolled durable medical equipment suppliers [...]

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  • Posting Date: 03/19/2024
    CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement

    CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement CMS issued CR 13294,“Change Request (CR) to Implement the Medicare Program Final Action: Treatment of Medicare Part C Days in the [...]

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  • Posting Date: 03/26/2024
    Chemotherapy General Infusion Information

    Chemotherapy General Infusion Information There are CPT codes for several different types of infusions and injections for drugs and biologicals. These include codes for chemotherapy infusions and injections, therapeutic, prophylactic and [...]

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  • Posting Date: 03/19/2024
    Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon!

    Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon! CBR submissions can be submitted starting on 4/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

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  • Posting Date: 03/26/2024
    Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)

    Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999) An unlisted code should only be used when no other code adequately describes the service. They are commonly used when the drug/biological does not have a specific HCPCS code, [...]

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  • Posting Date: 03/26/2024
    Compound Drugs

    Compound Drugs If there is not a HCPCS code for the compound drug you are billing, then it is appropriate to bill J7999 ‒ Compounded Drug, Not Otherwise Classified. This applies to both pump and nonpump compound drugs. The name, dose and [...]

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  • Posting Date: 03/26/2024
    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 [...]

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  • Posting Date: 03/21/2024
    [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 [...]

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  • Posting Date: 01/26/2022
    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 [...]

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  • Posting Date: 03/26/2024
    Radiopharmaceutical Reimbursement

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  • Posting Date: 09/08/2021
    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 [...]

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  • Posting Date: 09/09/2021
    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 [...]

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  • Posting Date: 11/15/2022
    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 [...]

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  • Posting Date: 12/19/2016
    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 [...]

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  • Posting Date: 09/08/2021
    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 [...]

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  • Posting Date: 03/21/2024
    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 [...]

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  • Posting Date: 03/21/2024
    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 [...]

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  • Posting Date: 02/26/2022
    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 [...]

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  • Posting Date: 03/22/2024
    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 [...]

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