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. [...]

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Agreement (11/23) Version Effective 4/30/2024 the MACs may only accept the CMS-588 EFT (11/23) version, the outdated form will be returned.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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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, [...]

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 [...]

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 [...]

Discarded Drugs/Wastage and JW, JZ Modifier

Discarded Drugs/Wastage and JW, JZ Modifier Medicare may pay for discarded drugs or wasted drugs and biologicals when: The provider/supplier must discard the remainder of a single-dose container after administering a dose or quantity to a [...]

Radiopharmaceutical Reimbursement

FQHC PPS Calculator

FQHC PPS Calculator   1/1/2024-12/31/2024 2023 2022 2021 2020 2019 Updated 3/26/2024

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 [...]

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 [...]

Copy Claim Entry

Copy Claim Entry Table of Contents Copy Claim Entry Claim Lines Information – Add, Edit or Delete Ready to Submit Claim [Return to Top] Copy Claim Entry Part B providers who have a completed EDI enrollment form on file can submit [...]

Check Status of Prior Authorization Requests

Check Status of Prior Authorization Requests Table of Contents Check Status of Prior Authorization Requests View the Prior Authorization Submission Attachments [Return to Top] Check Status of Prior Authorization Requests You will [...]

View Financial Claim Number Information

View Financial Claim Number Information Table of Contents View Financial Claim Number Information Financial Claim Number Patient Search [Return to Top] View Financial Claim Number Information The FCN can be found on the Medicare [...]

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 [...]

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 [...]