Provider Specialty

Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]

Scribes

Scribes When a physician or NPP performs a service that is documented by a scribe, what are the documentation requirements? Answer: As per CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4: “CMS [...]

Separately Identifiable Service

Separately Identifiable Service Please define the appropriate use of modifier 57 to identify a separately payable E/M with an initial decision for surgery. Answer: Modifier 57 is added to an E/M service that resulted in an initial [...]

Skilled Nursing Facility Services

Skilled Nursing Facility Services Please define rules for initial and subsequent SNF services, when the same provider has treated the patient at another site on the same date of service. Answer: This depends on the site of the prior [...]

Smoking Cessation

Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]

Teaching Environment E/M Services

Teaching Environment E/M Services Please define levels of care for E/M services that can be performed by residents in a hospital outpatient setting under the PCE rules. Answer: CMS PCE guidelines for the hospital outpatient setting permit [...]

Telehealth Services

Telehealth Services Note: View National Government Services' Place of Service Codes for CY 2024 Updates Please explain Medicare’s definition of a telehealth service. Answer: Medicare defines a telehealth service as a service provided by [...]

Time-Based Services

Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]

Transitional Care Management

Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]

Urgent Care

Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]

Why is radiofrequency ablation (RFA) noncovered?

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

Emergency Department

Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

ASCA: Must an Administrative Simplification Compliance Act waiver be mailed or can it be faxed?

ASCA: When applying for an ASCA waiver, do I need to complete the Waiver Request form for each provider number?

ASCA: I was under Administrative Simplification Compliance Act review once and received an approved waiver request to send paper claims, why am I under review again?

EDI: Is the 277CA returned for each test submission?

EDI: After I receive a 277CA will I receive anything else?

EDI: How can I tell if I am set up for electronic billing?

EDI: How do I restore a remit file?

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: I am receiving the following Claim Status Code and EIC code on my 277CA. What do these codes mean?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: I received a payer acknowledgement/acceptance report from my clearinghouse. Does this mean you accepted my claims?

EDI: I received my application back with errors on my Provider Authorization Form. Can I correct it or will I have to complete an entirely new application and authorization form?

EDI: What Entity Name should I enter on the EDI Enrollment Agreement form?

EDI: What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

EDI: What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

EDI: What is a Network Service Vendor (NSV)?

EDI: What is an Approved Entity?

EDI: What provider address should I include on the EDI enrollment forms?

EDI: When is a provider authorization form required?

EDI: Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?

EDI: Will you reject claims where the group number and policy number are the same values?

EDI: Will you reject claims with a P.O. Box in the billing provider address?

Are CPT codes 98966-98968 (telephone assessment and management services) billable to Medicare after 5/11/2023?

Are both place of service 02 and place of service 10 billable to Medicare?