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Posting Date: 08/04/2022
Correct Usage of Modifier 79 for Multiple Procedures
Correct Usage of Modifier 79 for Multiple Procedures National Government Services Medical Review department has identified widespread problems with the use of modifier 79 for multiple procedures. The global surgical package was established by [...]
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Posting Date: 08/04/2022
Co-Surgery/Team Surgery/Assistant Surgery Modifiers
Co-Surgery/Team Surgery/Assistant Surgery Modifiers Table of Contents Co-Surgery/Team Surgery/Assistant Surgery Modifiers Co-Surgery (Modifier 62) Team Surgery (Modifier 66) Assistant-at-Surgery Services Assistant Surgery Modifiers [...]
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Posting Date: 08/04/2022
Modifier 51
Modifier 51 Table of Contents Modifier 51 Definitions Appropriate System Usage Inappropriate System Usage Additional Information Related Content [Return to Top] Modifier 51 Modifier 51 denotes more than one medical/surgical [...]
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Posting Date: 08/05/2022
Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
Modifier 59 and the Subset Modifiers XE, XP, XS, XU – Specific Modifiers for Distinct Procedural Services Table of Contents Continued Use of Modifier 59 after 1/1/2015 Modifier 59 Appropriate Usage Modifier XE Modifier XP [...]
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Posting Date: 08/30/2022
Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Table of Contents Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Exceptions Date(s) of Service Care Provided in Different Payment Localities 55 Modifier [...]
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Posting Date: 03/29/2022
Critical Care Policy Clarification
Critical Care Policy Clarification The CMS implemented the new policy for critical care services as published in the Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, [...]
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Posting Date: 02/01/2022
Critical Care Tip Sheet
Critical Care Tip Sheet Table of Contents Service and Medical Necessity The Following CMS Billing Consideration Guidelines Apply Provider Time Assessment and Documentation The Following CMS Billing Consideration Guidelines [...]
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Posting Date: 04/26/2022
Critical Care Services: CPT Codes 99291-99292
Critical Care Services: CPT Codes 99291-99292 Table of Contents Definition Context Providers Who May Perform Critical Care Services and Medical Necessity Palliative and Hospice Patients Full Attention of the Provider and Provider [...]
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Posting Date: 10/20/2017
Certification or Recertification of Medicare Covered Home Health Services
Certification or Recertification of Medicare Covered Home Health Services Billing HCPCS Codes G0180 and G0179 of Patient Eligibility for Medicare-covered Home Health Services under a Home Health Plan of Care Physician [...]
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Posting Date: 11/13/2020
Initial Episode Clarified for Home Health Face-to-Face Encounter
Initial Episode Clarified for Home Health Face-to-Face Encounter CMS requires a patient receiving HH services under the Medicare HH benefit have a FTF encounter with the certifying physician for the initial episode. CMS has clarified that this [...]
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Posting Date: 03/13/2023
Sacroiliac Joint Injections and Procedures
Sacroiliac Joint Injections and Procedures Table of Contents Sacroiliac Joint Injections and Procedures Diagnostic SIJI Diagnostic SIJI Limitations Therapeutic SIJI Therapeutic SIJI Limitations SIJ Denervation [...]
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Posting Date: 02/14/2024
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: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 02/01/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]
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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: 11/15/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]
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Posting Date: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 10/03/2024
Local Coverage Determination Open Meeting
Local Coverage Determination Open Meeting National Government Services is hosting a Proposed Local Coverage Determination Open Meeting on 10/24/2024. Details are available by accessing the Local Coverage Determination Open Meeting [...]
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Posting Date: 10/03/2024
Claim Denials During Hospice Elections Liability Reminder
Claim Denials During Hospice Elections Liability Reminder When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatment and palliative care associated with it in [...]
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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, [...]
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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 [...]
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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 [...]
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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[...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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 [...]
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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. [...]
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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 [...]
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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 [...]
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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 [...]
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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. [...]
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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 [...]
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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
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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 [...]
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