PR-204

Avoiding/Correcting This Error Medicare Fee-for-Service does not cover the service that has been billed for the condition. The CPT/HCPCS on the claim is not a covered Medicare service/equipment or drug. There are multiple reasons for denial [...]

CO-119

Avoiding/Correcting This Error The beneficiary has reached their therapy cap limit for the year. The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold [...]

Federally Qualified Health Center

Federally Qualified Health Center Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Billing FQHC for Smoking and Tobacco Cessation Services Related Content [Return to Top] Counseling to Prevent Tobacco [...]

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

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 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?

What should be done if patient does not want to continue conservative treatment?

When does a pain scale or functional assessment need to be done?

When will this go into effect?

Will RFA be an acceptable treatment?

Will prior authorization be required?

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

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Is an order required to administer the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

What are the allowance limits for the cost of the pneumococcal vaccine?

What is the administration code for the pneumococcal vaccine?

What is the frequency requirement for the pneumococcal vaccine?

CMS-855I: How do I complete a reassignment?

CMS-855I: Who needs to sign the CMS-855I for a reassignment?

APPLICATION STATUS: Where can I find the status of a submitted application?

APPLICATION FEE: Who needs to pay an application fee?

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

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

PECOS: In PECOS, how do I submit an application?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for submitted application.

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS-855I application?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

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

Local Coverage Determination Retirement

Local Coverage Determination Retirement An LCD is a policy decision made by a MAC concerning whether to allow coverage of a particular item or service. The Centers for Medicare & Medicaid Services, Internet-Only Manual Publication 100-08, [...]

10/14/2024

table, td, th table { border-collapse: collapse; width: 50%; } Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most [...]