Annual Wellness Visit Screening

Preventive Services Guide Annual Wellness Visit Screening Table of Contents Annual Wellness Visit Screening Coverage Criteria Two Types of AWV Elements Elements of Initial AWV Personalized Prevention Plan Services – [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 Illinois, Minnesota, Wisconsin Jurisdiction K Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont Jurisdiction 6 and Jurisdiction K Combined Meeting 12/5/2024 8/8/2024 4/4/2024

Medicare Change of Status Notice

Medicare Change of Status Notice Attention: Hospitals, including CAHs and other providers billing Medicare for inpatient services. The Medicare Change of Status Notice (MCSN) became effective 10/11/2024 and implemented 2/15/2025. Hospitals, [...]

Alcohol Misuse and Counseling

Preventive Services Guide Alcohol Misuse and Counseling Table of Contents Alcohol Misuse and Counseling Two-Part Benefit Cost Sharing Reimbursement Nonparticipating Providers Common Claim Denial Reasons Related Content [Return [...]

Initial Preventive Physical Examination

Preventive Services Guide Initial Preventive Physical Examination The IPPE is also known as the “Welcome to Medicare Preventive Visit.” The goals of the IPPE are health promotion and disease detection and prevention. Table of Contents [...]

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative Beginning 3/3/2025, NGS will only issue electronic versions of the MRN when a Medicare Part B Redetermination request is electronically submitted through our portal, NGSConnex. [...]

MLN Connects® Newsletter: February 24, 2025

MLN Connects® Newsletter: February 24, 2025 Compliance Mechanical Ventilation: Bill Correctly for Inpatient Claims Claims, Pricers, & Codes Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for [...]

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application

Institutional Providers: Revised CMS-855A Version (09/24) Medicare Enrollment Application  Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting [...]

Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection

Preventive Services Guide Pre-Exposure Prophylaxis Using Antiretroviral Therapy to Prevent HIV Infection PrEP involves the use of antiretroviral drugs to decrease the risk of acquiring HIV. Under Section 1861(ddd)(1) of the Social Security [...]

Common Working File Host Dark Days for April 2025 Release

Common Working File Host Dark Days for April 2025 Release For Production, CWF will be observing the Gray Day on Thursday, April 3rd, and Dark Days starting Friday, April 4th through Sunday, April 6th to accommodate the anticipated duration of [...]

Important Update for Part B Providers – New NCCI Lookup Tool

Important Update for Part B Providers – New NCCI Lookup Tool The Medicare NCCI promotes accurate coding and prevents improper payments. We have added the NCCI Lookup Tool to our Part B Tools and Calculators page. This tool helps providers [...]

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting [...]

MLN Connects® Newsletter: February 28, 2025

MLN Connects® Newsletter: February 28, 2025 CMS Provider Education Message: Hospitals: Actions to Make Healthcare Prices Transparent Update: On February 25, the White House issued an Executive Order to empower patients with clear, accurate, [...]

Clinicians: Are You Ordering Urological Supplies for Your Patients?

Clinicians: Are You Ordering Urological Supplies for Your Patients? Urological supplies are covered as part of the prosthetic device benefit as outlined in the Social Security Act, Section 1861(s)(8). Prosthetic devices (other than dental) [...]

Procedure to Procedure Edits

Procedure to Procedure Edits The purpose of the NCCI PTP edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for [...]

National Correct Coding Initiative

National Correct Coding Initiative The Medicare NCCI promotes correct coding of Medicare Part B claims. Coding policies are based on coding conventions defined in the AMA’s CPT professional, national and local Medicare policies and edits, [...]

Related Resources

Related Resources MLN® Educational Tool: How to Use the Medicare National Correct Coding Initiative (NCCI) Tools Medicare National Correct Coding Initiative (NCCI) Edits National Correct Coding Initiative Policy Manual Medicare NCCI [...]

Add-on Codes

Add-on Codes Add-on codes are procedure codes that indicate additional work associated with another primary procedure. Add-on codes can be reimbursed when reported with the primary procedure code by the same practitioner. Add-on codes may be [...]

National Correct Coding Initiative

National Correct Coding Initiative We recently introduced the NCCI Lookup Tool on our Part B Tools and Calculators page. This tool is designed to assist providers in identifying codes subject to automated prepayment edits, thereby facilitating [...]

Immunization Roster Billing

Immunization Roster Billing Table of Contents Immunization Roster Billing Claim Submission Options for Roster Billing Electronic Claim Submissions Paper Claim Submissions Vaccine Billing and Coding Resources [Return to Top] [...]

Hepatitis B Virus Vaccine and Administration

Preventive Services Guide Hepatitis B Virus Vaccine and Administration Hepatitis B is a virus that can damage the liver; it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected [...]

Part A Incorrect Dialysis Payments

We have recently become aware of an issue which began on 7/15/2024 where ESRD claims with demo code 94P were finalizing with incorrect payment amounts (overpayments as well as underpayments). The incorrect payment amount is a result of FISS [...]

ASC Claim Hold Until 1/28/2025

Due to a January 2025 fee schedule pricing correction, CMS has instructed Part B MACs to hold Part B ASC claims impacted by CBSA updates until 1/28/2025. ASC claims not impacted by CBSA updates may be impacted by a 10-day hold. 

Understanding the Strength of Medical Evidence

FQHC PPS Calculator

FQHC PPS Calculator 4/1/2025-12/31/2025 1/1/2025-3/31/2025 1/1/2024-12/31/2024 2023 2022 2021 2020 2019 Revised 3/5/2025

New Medicare Part B Redetermination Notice Initiative – Implementation Delayed

New Medicare Part B Redetermination Notice Initiative - Implementation Delayed As we’ve communicated recently, National Government Services will be starting a new initiative for providers who submit Medicare Part B Redetermination requests [...]

Modifier/Code List

Modifier/Code List CMS established a new modifier, AB, for audiologists to use that describes: audiology service furnished personally by an audiologist without a physician/NPP order for non-acute hearing assessment unrelated to disequilibrium, [...]

MLN Connects® Newsletter: March 6, 2025

MLN Connects® Newsletter: March 6, 2025 News Therapy Services: Get Updates for CY 2025 Hospitals: Apply for Additional Residency Positions by March 31 Compliance Oral Anticancer & Antiemetic Drugs: Prevent Claim Denials Claims, [...]

Understanding the Strength of Medical Evidence In the pursuit of evidence-based medical practice, it is essential to evaluate the quality and strength of scientific research thoroughly. The table below provides a comprehensive ranking of [...]

Privacy Notice Policy

Privacy Notice Policy National Government Services, Inc. (NGS) is a contractor with the Centers for Medicare & Medicaid Services (CMS) under the authority granted in Sections 1842, 1862(b) and 1874 of Title XVIII of the Social Security Act [...]

Contractor Advisory Committee Meeting Records

Contractor Advisory Committee (CAC) Meeting Records Jurisdiction 6 and Jurisdiction K CAC Meeting Records Meeting Date Audio Transcript Key Questions Bibliography 2/3/2025 - Topic: Peripheral Nerve Blocks [...]

New York

New York Member Name Professional Title Association Business Name/Address Email Auster, Morris Vice President Division of Socio-Medical Economics Medical Society of the State of New York P. O. Box 5404 [...]

Save the Date! National A/B MAC Ambulance Provider/Supplier Coalition

Save the Date! National A/B MAC Ambulance Provider/Supplier Coalition Attention Ambulance Providers As the MACs celebrate and honor the dedication and contributions to healthcare made by those who provide frontline lifesaving services to our [...]

Transitional Care Management

Transitional Care Management Table of Contents Billing Codes Billing Information Documentation Related Content [Return to Top] Billing Codes 99495: Moderate complexity F2F 7 to 14 days 99496: High complexity F2F 7 days [...]

Medicare Part B Redetermination Notice Initiative Coming Soon

Medicare Part B Redetermination Notice Initiative Coming Soon National Government Services will discontinue issuing paper MRNs for Medicare Part B redetermination requests that are submitted electronically through our portal, NGSConnex. [...]

Home Health Billing When a New MBI is Assigned

Home Health Billing When a New MBI is Assigned A patient’s MBI number is required on all home health billing submitted to Medicare. CMS will issue a new MBI when an original MBI may have been, or has been compromised. There are times a home [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction 6 Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or [...]

MLN Connects® Newsletter: March 13, 2025

MLN Connects® Newsletter: March 13, 2025 News Medicare Shared Savings Program: Application Deadlines for January 1, 2026, Start Date Claims, Pricers & Codes ICD-10 Coordination & Maintenance Committee: Submit Procedure Code [...]