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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
Medicare Secondary Payer Provisions Group and Nongroup Health Plans
Who pays first? This Medicare Secondary Payer learning session will be on the provisions of group health plans that include working aged, disability and end stage renal disease and nongroup health plans that include auto, liability, no-fault, [...]
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Posting Date: 04/25/2024
Local Coverage Determination Open Meeting Announcement
Local Coverage Determination Open Meeting Announcement Table of Contents Jurisdiction 6/Jurisdiction K Part A/Part B MAC Requests to Present Registered Presenters (Slide Presentations Only) Observers Comments on Proposed LCDs [...]
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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: 07/07/2021
MSP Right Hand
Helpful Resources BCRC Contact Information Note: Providers should not contact the BCRC to set up new MSP records. Instead, report MSP coding on your MSP and conditional claims. Providers should not contact the BCRC to correct MSP records to [...]
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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: 10/07/2024
Part B Medicare Administrative Contractor Overview for Dental Providers
The purpose of this webinar is to introduce dental providers to National Government Services and explain our role as the Medicare Administrative Contractor for Jurisdictions 6 and K. We’ll also share helpful resources related to coverage, [...]
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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: 02/08/2022
KX Modifier Threshold
KX Modifier Threshold The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that [...]
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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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Posting Date: 01/25/2024
Caregiver Training Services
Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]
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Posting Date: 02/17/2022
Outpatient Occupational and Physical Therapy Coverage
Outpatient OT and PT Services Billing Guide Outpatient Occupational and Physical Therapy Coverage Table of Contents CMS References LCDs and Billing and Coding Articles CMS MLN Matters® Certifying Physician/NPP Therapy Plan of [...]
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Posting Date: 01/25/2024
2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring
2024 Annual Update to the Therapy Code List: Remote Therapeutic Monitoring As of 1/1/2024, physical and occupational therapists in private practice may provide general supervision of their therapy assistants when they don’t personally furnish [...]
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Posting Date: 02/17/2022
Common Questions and Answers
Outpatient OT and PT Services Billing Guide Common Questions and Answers Can a PTA treat a Medicare B patient in an outpatient setting with direct supervision by the physical therapist? Answer: Yes, however PTAs are limited in the [...]
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