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  • Posting Date: 10/31/2022
    Related Content

    Related Content CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 5, Section 70.5 CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 Includes the [...]

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  • Posting Date: 10/31/2022
    Micro-invasive Glaucoma Surgery Update

    Micro-invasive Glaucoma Surgery Update The MIGS LCD, L37244, and Billing and Coding Article, A56588, will not become final and therefore have been removed from the Medicare Coverage Database. Accordingly, at this time there will be no change [...]

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  • Posting Date: 09/11/2024
    Comprehensive Error Rate Testing Program

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  • Posting Date: 03/07/2023
    PECOS Starter Guide

    PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application Add a New [...]

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  • Posting Date: 09/12/2024
    Understanding Authorized Official and Delegated Official Roles

    Table of Contents Understanding Authorized Official and Delegated Official Roles Medicare Enrollment Records CMS Identity and Access Management System [Return to Top] Understanding Authorized Official and Delegated Official Roles [...]

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  • Posting Date: 09/12/2024
    National Government Services Medicare Part B Care Management Services September Series

    National Government Services Medicare Part B Care Management Services September Series According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for [...]

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  • Posting Date: 09/12/2024
    MLN Connects® Newsletter: September 12, 2024

    MLN Connects® Newsletter: September 12, 2024 News COVID-19: Updated Vaccines for 2024–2025 Season Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidance CMS Roundup (September 6, 2024) [...]

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  • Posting Date: 09/12/2024
    Portable X-Ray Pricing Update

    Portable X-ray pricing fees for CY 2024 will have new fees in production by 9/6/2024.

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  • Posting Date: 09/02/2022
    Check Appeal Status

    Check Appeal Status Table of Contents Check Appeal Status Check Status of Requests Submitted in NGSConnex Check Status of Requests Not Submitted in NGSConnex [Return to Top] Check Appeal Status Click the Appeals button from the [...]

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  • Posting Date: 10/26/2022
    Provider Qualifications

    Podiatry Billing Guide  Provider Qualifications A doctor of podiatric medicine is a physician, but only with respect to those functions which he/she is legally authorized to perform in the State in which he/she performs them. The [...]

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  • Posting Date: 12/12/2014
    Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)

    Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) Medicare will provide supplemental payments to FQHCs that contract with MAOs to cover the difference, between the payment received from the MAO and the payment to which the FQHC [...]

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  • Posting Date: 09/13/2024
    Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon!

    Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon! CBR submissions can be submitted starting on 10/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare [...]

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  • Posting Date: 10/26/2021
    Introduction to Podiatry Services

    Podiatry Billing Guide Introduction to Podiatry Services Foot Care Table of Contents Treatment of Subluxation of Foot Exclusions from Coverage Exceptions to Routine Foot Care Exclusion Systemic Conditions That Might Justify Coverage [...]

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  • Posting Date: 10/26/2022
    Podiatry Local Coverage Determinations

    Podiatry Billing Guide Podiatry Local Coverage Determinations Table of Contents LCD for Routine Foot Care and Debridement of Nails (L33636) LCD for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory [...]

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  • Posting Date: 10/26/2022
    Podiatry National Coverage Determinations

    Podiatry Billing Guide  Podiatry National Coverage Determinations The following are in reference to CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1. Part 1 Section 20.29 [...]

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  • Posting Date: 10/26/2022
    Modifier Usage

    Podiatry Billing Guide  Modifier Usage 25 – Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service  Medicare allows payment for an E/M service performed on the same [...]

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  • Posting Date: 10/26/2022
    Podiatry Coding Tips

    Podiatry Billing Guide  Podiatry Coding Tips Coding Information Procedure codes may be subject to NCCI edits or OPPS packaging edits. Refer to CCI and OPPS requirements prior to billing Medicare. For services requiring a [...]

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  • Posting Date: 10/26/2022
    Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative

    Podiatry Billing Guide  Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative ABN Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to [...]

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  • Posting Date: 10/26/2021
    Related Content

    Related Content CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter 5, Section 70.3 CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 290: Foot Care CMS [...]

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  • Posting Date: 10/26/2021
    Biopsy to Prove Onychomycosis in Routine Foot Care

    Biopsy to Prove Onychomycosis in Routine Foot Care National Government Services has been made aware of a situation where podiatrists have been approached by laboratories stating that they need to biopsy their patients to make sure they have [...]

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  • Posting Date: 09/16/2024
    Third Quarter Top Ten EDI Part B Edits

    Third Quarter Top Ten EDI Part B Edits Using data analysis we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits and their description, and learn how you can quickly identify the [...]

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  • Posting Date: 09/16/2024
    Third Quarter Top Ten EDI Institutional Edits

    Third Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits and their description, and learn how you can [...]

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  • Posting Date: 01/02/2024
    Medicare Part B Final Rule 2024

    Medicare Part B Final Rule 2024 CMS announced finalized policy changes for Medicare payments under the PFS, and other Medicare Part B topics, effective on or after 1/1/2024. The CY 2024 PFS final rule is one of several final rules that [...]

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  • Posting Date: 11/07/2022
    Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?

    Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Table of Contents Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Who Can Bill for DSMT Billable Codes for Diabetes Self-Management Training [...]

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  • Posting Date: 11/07/2022
    Common Questions for Diabetes Self-Management Program Accreditation

    Common Questions for Diabetes Self-Management Program Accreditation Does my organization need to be accredited to bill for DSMT services? Answer: Yes. In order to bill Medicare for DSMT services, your organization’s DSMT program must be [...]

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  • Posting Date: 11/07/2022
    Medical Nutrition Therapy Tool for Billing

    Medical Nutrition Therapy Tool for Billing CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are [...]

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  • Posting Date: 06/13/2022
    Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information

    Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information Table of Contents Remote Physiological Monitoring Services CPT Codes: 99091, 99453, 99454, 99457, 99458 Remote Physiological Monitoring [...]

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  • Posting Date: 09/17/2024
    National Government Services Contractor Advisory Committee Meeting

    National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details can be found on the National Government [...]

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  • Posting Date: 09/19/2024
    Laboratory and Diagnostic Services: Documentation Responsibilities

    Laboratory and Diagnostic Services: Documentation Responsibilities When National Government Services is conducting a pre-pay or post-pay review of claims and services, we may request additional documentation. The billing provider must obtain [...]

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  • Posting Date: 11/01/2021
    Global Surgery

    Global Surgery Table of Contents Definition of a Global Surgical Package Where can I find the postoperative periods for covered surgical procedures? What services are included in the global surgery payment? What services are not [...]

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  • Posting Date: 08/10/2023
    Duplicate Claim Editing Information

    Duplicate Claim Editing Information Part B Duplicate Claim Edit National Government Services implemented a Part B duplicate claim edit in our EDI front-end processing system for Part B providers. Providers are notified that a claim is a [...]

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  • Posting Date: 10/15/2021
    Physician Dialysis Services

    Physician Dialysis Services Table of Contents Physician Dialysis Services Monthly Capitation Payment Coding Claim Submission Tips Billing for a Partial Month Documentation Requirements Related Content [...]

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  • Posting Date: 11/23/2021
    Oncology Care Model

    Oncology Care Model Note: If you did not register for the CMS OCM during the open application and selection period, then you are not a part of this program. The names of those practices and payers participating in OCM can be found on the OCM [...]

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  • Posting Date: 11/29/2021
    Spinraza (nusinersen) Billing

    Spinraza (nusinersen) billing Spinraza (nusinersen) is a medication that was approved in December 2016 by the U.S. FDA for the treatment of all forms of SMA. HCPCS code J2326 - Inj, nusinersen, 0.1mg should be used to report Spinraza. [...]

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  • Posting Date: 02/22/2023
    Chimeric Antigen Receptor (CAR) T-cell Therapy

    Chimeric Antigen Receptor (CAR) T-cell Therapy Table of Contents NCD 110.24: Chimeric Antigen Receptor (CAR) T-cell therapy: Billing Instructions Overview Billing and coding CAR T-cell therapy for inpatient services Clinical [...]

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  • Posting Date: 09/19/2024
    MLN Connects® Newsletter: September 19, 2024

    MLN Connects® Newsletter: September 19, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data [...]

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  • Posting Date: 09/19/2024
    Billing Errors on 2024/2025 Influenza Season Claims

    Billing Errors on 2024/2025 Influenza Season Claims The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season. This season, some codes no longer have a [...]

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  • Posting Date: 01/19/2022
    Learn About MDPP

    Learn About MDPP The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services is available to eligible [...]

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  • Posting Date: 01/19/2022
    Framework for Prevention and Goals

    Framework for Prevention and Goals CMS along with the CDC provides a framework for diabetes prevention efforts. It brings together partners from the public and private sectors to prevent or delay type 2 diabetes. The MDPP is structured [...]

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  • Posting Date: 01/19/2022
    Delivering a Lifestyle Change for Medicare Beneficiaries

    Delivering a Lifestyle Change for Medicare Beneficiaries Providers play a vital role in beneficiary referrals. Although a referral is not required, a provider’s assessment during the AWV or the IPPE is strongly recommended by NGS. Providers [...]

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