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Posting Date: 09/07/2021
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 N/A A58649 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58649 58999
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Posting Date: 09/07/2021
Billing and Coding: Hyaluronans Intra-articular Injections of
Billing and Coding: Hyaluronans Intra-articular Injections of drug, knee, ankle A52420 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52420 J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, [...]
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Posting Date: 09/07/2021
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee – Medical Policy Article injection A52369 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52369 29877, 29999, G0289
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Posting Date: 04/19/2021
Clinical Trials - Medical Policy Article
Clinical Trials – Medical Policy Article IDE, Q0, modifier A52840 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52840
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Posting Date: 04/19/2021
Chiropractic Services - Medical Policy Article
Chiropractic Services – Medical Policy Article subluxation, manipulation A57889 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57889 98940, 98941, 98942
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Posting Date: 04/19/2021
Blepharoplasty - Medical Policy Article
Blepharoplasty - Medical Policy Article eye, cosmetic A52837 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52837 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, [...]
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Posting Date: 04/19/2021
Billing and Coding: Removal of Benign Skin Lesions
Billing and Coding: Removal of Benign Skin Lesions cosmetic A54602 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=54602 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, [...]
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Posting Date: 04/19/2021
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based - Medical Policy Article
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based – Medical Policy Article N/A A53018 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53018 [...]
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Posting Date: 04/19/2021
Process for Determining Self-Administered Drug Exclusions - Medical Policy Article
Process for Determining Self-Administered Drug Exclusions – Medical Policy Article SAD A53020 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53020
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Posting Date: 04/19/2021
Polysomnography and Sleep Studies - Medical Policy Article
Polysomnography and Sleep Studies – Medical Policy Article N/A A53019 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53019 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400
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Posting Date: 04/19/2021
New Local Coverage Determination (LCD) Request Process
New Local Coverage Determination (LCD) Request Process N/A A56198 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=56198
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Posting Date: 04/19/2021
Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article
Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article N/A A52842 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52842
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Posting Date: 04/19/2021
Investigational Device Exemption Requests - Medical Policy Article
Investigational Device Exemption Requests - Medical Policy Article IDE, clinical, Q0 modifier A52841 https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52841
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Posting Date: 04/19/2021
CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article
CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article staph, MRSA A52379 [...]
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Posting Date: 12/26/2023
Tobacco Counseling via Telehealth
Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Medicare Part B covers intermediate and intensive tobacco [...]
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Posting Date: 12/28/2023
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: 12/28/2023
January 2024 Billing and Coding Articles Updates
January 2024 Billing and Coding Articles Updates Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399) Coding Information #2 has been removed based on Transmittal 12397 (CR 13468), Payment of Codes for Chemotherapy Administration and [...]
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Posting Date: 01/02/2024
January Code Set Update for PC Print: January 2024
January Code Set Update for PC-Print: January 2024 The PC-Print January code set update will be available on our website 1/3/2024. The update contains the following enhancements: CR13303 Implement Operating Rules - Phase III Electronic [...]
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Posting Date: 12/28/2023
Improving Customer Experience
Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]
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Posting Date: 01/02/2024
New Version of PC-ACE: January 2024
New Version of PC-ACE: January 2024 PC-ACE Version 6.1 contains several CMS mandates and product enhancements including but not limited to the items listed below. MLN Matters® MM13248 Revised: Processing Services During Disenrollment from [...]
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Posting Date: 01/02/2024
New Medicare Topic – Medicare Part B Final Rule 2024
New Medicare Topic – Medicare Part B Final Rule 2024 CMS issued the final rule on 11/2/2023, which announces finalized policy changes for Medicare payments under the PFS and other Medicare Part B issues, effective on or after 1/1/2024. There [...]
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Posting Date: 04/21/2022
CMS Region 2 Office Hours
CMS Region 2 Office Hours The CMS Region 2 Office recently began conducting a series of “Office Hours” calls. The purpose of these sessions is to provide brief updates on Medicare topics of current interest to Part A facilities, physicians and [...]
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Posting Date: 01/03/2024
Hospice Cap Self-Reporting Reminder for the 2023 Cap Year
Hospice Cap Self-Reporting Reminder for the 2023 Cap Year The Hospice Cap Self-Reporting for the 2023 Cap Year (10/1/2022-9/30/2023) is due no later than 2/29/2024. Hospice providers should submit the pro-forma calculation along with [...]
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Posting Date: 12/22/2022
Therapy Requirements for Inpatient Rehabilitation Facilities
Therapy Requirements for Inpatient Rehabilitation Facilities The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 1 is the primary source for inpatient [...]
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Posting Date: 01/04/2024
Correct Coding Reminder for Breast Imaging
Correct Coding Reminder for Breast Imaging When there are no abnormal and inconclusive findings on mammography and the only finding is dense breast tissue (ICD-10-CM codes R92.30-R92.34), the provision of an ultrasound is considered screening. [...]
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Posting Date: 01/04/2024
MLN Connects® Newsletter: January 4, 2024
MLN Connects® Newsletter: January 4, 2024 News CMS Roundup (Dec 29, 2023) In-Home Vaccine Administration: Additional Payment Organizational Providers: Do You Need to Revalidate Your Enrollment Record Soon? Value-Based Insurance Design [...]
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Posting Date: 01/05/2024
340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022
340B Drug Payment Policy Remedy Payment for CY 2018 to CY 2022 On 6/15/2022, the Supreme Court held in American Hospital Association v. Becerra that because CMS had not conducted a survey of hospitals’ acquisition costs, it could not vary the [...]
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Posting Date: 01/11/2024
MLN Connects® Newsletter: January 11, 2024
MLN Connects® Newsletter: January 11, 2024 News Marriage and Family Therapist & Mental Health Counselor Services: Overpayments to Critical Access Hospitals Billing under Method II Medicare Part A Cost Report Exhibits: New Electronic [...]
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Posting Date: 01/11/2024
MLN Matters® MM13331: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule
MLN Matters® MM13331 - Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule Revised 1/12/2024
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Posting Date: 07/29/2019
Provider Compliance Tips for Home Health Services (Part A Non DRG)
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Posting Date: 06/07/2021
Eligibility Criteria for Face-to-Face Encounters
Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]
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Posting Date: 05/11/2020
Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify
Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]
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Posting Date: 04/12/2022
Home Health: The Definition of an Allowed Practitioner
Home Health: The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]
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