APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

APPLICATION FEE: What is the amount of the application fee?

National Government Services Medicare Part B Redetermination Notice Initiative Is Here

National Government Services Medicare Part B Redetermination Notice Initiative Is Here As previously announced, National Government Services is pleased to announce we are discontinuing issuing paper MRNs for requests submitted electronically [...]

Provider Enrollment

Medicare Part B 101 Manual Provider Enrollment Table of Contents National Provider Identifier Required Tips for Successfully Enrolling with the Medicare Part B Contractor When Mailing Paper Applications Tip 1: Submit the correct [...]

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications CMS announced they utilize an MFA process for users of their Provider Enrollment Systems.  MFA is a second layer of security used to [...]

[RESOLVED] NGS Phone Lines Currently Unavailable

[RESOLVED] NGS Phone Lines Experiencing Outages The outages we were experiencing with our Provider Contact Center telephone lines have now been resolved. This includes EDI, Provider Enrollment Customer Inquiry, Telephone Reopening Unit and [...]

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications CMS recently announced they will begin utilizing a MFA process for users of their Provider Enrollment Systems. MFA is a second layer of security used to [...]

Credit Balance Report - CMS 838 (R3)

Chapter VII: Online Reports View Submenu (04) Credit Balance Report - CMS 838 (R3) Purpose Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit [...]

Do hospitals bill a different CPT to receive compensation? Usually, the doctor’s office will bill 27096 on 1500 and we bill G0260 for facility claim (UB-04). Will PA need to have both CPTs? 27096 on Medicare fee schedule receives no compensation?

There is a contrast shortage. Use may not be an option.

Do we use the same billing guideline for 64550 and 20551?

If using steroid during diagnostic is that when the 12-month clock start?

If a patient fails an initial diagnostic or therapeutic injection is there a certain criteria that must be fulfilled prior to considering it again, such as duration since the last injection (like over a year ago) or change in symptom character or location?

Can the patient can have two diagnostic SIJI and then four therapeutic SIJI within a 12-month rolling period for a total of six per year?

What is the time period between a therapeutic injection and repeat diagnostic, if the therapeutic injection has not been performed for an extended period? At this point, does diagnostic need to be repeated?

What is the purpose of a diagnostic injection, to select patients for fusion surgery only? Also, with diagnostic injections using anesthetic and steroid, what is the duration of effect expected for the steroid?

Do we use the KX modifier on facility charges for the ASC?

It does not make sense to use steroids during a diagnostic injection. Please explain.

Does anti-inflammatory steroid as named in the diagnostic injection mean an injected NSAID or corticosteroid?

What is the time period between a therapeutic injection and repeat diagnostic? If the therapeutic injection has not been performed for an extended period of time does diagnostic need to be repeated?

When will this go into effect?

Are there more studies going on to get sacroiliac joint radiofrequencies to be a covered benefit?

Can SIJ ligaments be included in a therapeutic injection?

CPT code 27096 includes “Image guidance,” what’s the necessary required documentation? Does the physician still need permanently recorded images? Because the fluoroscopy/CT is bundled into the procedure and therefore the fluoroscopy/CT will not be separately reported, would the image guidance in the Radiology section regarding guidance procedures still apply?

What is the requirements for diagnostic injections? Are two required?

Will RFA be an acceptable treatment?

What is the expected duration of steroid effect for diagnostic injection?

Will there be a minimal amount of time between SI joint steroid injections?

Why is radiofrequency ablation (RFA) noncovered?

Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

For patients who are already receiving treatment do they need to repeat diagnostic procedures under the new policy?

How can provider access post injection pain after the injection?

We are in a group of eight physicians. What if the patient saw a different physician in clinic and a different physician is doing injection. Is that okay?

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

We receive referrals for an injection with detailed chart notes, does our provider need to see and examine the patient again?

Don't use G0260 only applies to POS 49? So, regardless of facility type, G0260 no longer needs to be used? And Is G0260 still fine to bill for an ASC or will they now just have 27096 for facility & should be billed with POS 24 and bill G0260 for our SIJI on the facility side?

Many patients have degeneration throughout the spine does that justify need for multiple procedures in same session?

Will prior authorization be required?

How many injections per calendar year?

Can sacroiliac joint injections be performed bilaterally?