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Posting Date: 02/26/2022
Home Health Plan
Home Health Plan Select Home Health Plan from the left-side navigation. The Home Health Plan information section will display information if the beneficiary is currently in a home health episode of care. The Home Health Plan information will [...]
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Posting Date: 02/26/2022
Inpatient and SNF Spell History
Inpatient and SNF Spell History Select Inpatient and SNF Spell History from the left-side navigation. The Inpatient and SNF Spell History section will display information if the beneficiary is currently receiving inpatient or SNF care or has [...]
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Posting Date: 02/26/2022
End Stage Renal Disease
End Stage Renal Disease Select End Stage Renal Disease (ESRD) from the left-side navigation. The ESRD information panel provides information when a beneficiary is eligible for Medicare due to ESRD. This information is important because some [...]
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Posting Date: 02/26/2022
Preventive Services
Preventive Services Select Preventive Services from the left-side navigation. The Preventive Services section provides a list of Medicare-covered preventive services that are eligible for coverage for the beneficiary and when they are next [...]
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Posting Date: 09/27/2023
Audiology Screening
Audiology Screening Select Audiology Screening from the left-side navigation. The Audiology Screening section provides a list of Medicare-covered audiology screening services that are eligible for coverage for the beneficiary and when they [...]
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Posting Date: 02/26/2022
COVID-19 Vaccine
COVID-19 Vaccine Select Covid-19 Vaccine from the left-side navigation. The COVID-19 Vaccine Information panel provides information for the following HCPCS codes. 91300 – Pfizer-Biontech Covid-19 Vaccine 91301 – Moderna Covid-19 Vaccine [...]
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Posting Date: 02/26/2022
Pneumococcal Vaccine
Pneumococcal Vaccine Select Pneumococcal Vaccine from the left-side navigation. The Pneumococcal Vaccine panel provides information for the following HCPCS codes. 90670 ‒ Pneumococcal conjugate vaccine, 13-valent, for intramuscular use [...]
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Posting Date: 02/26/2022
Cardiac Rehabilitation
Cardiac Rehabilitation Select Cardiac Rehabilitation from the left-side navigation. Medicare Part B (Medical Insurance) provides coverage for a cardiac rehabilitation or physical therapy program if a Medicare beneficiary has had at least [...]
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Posting Date: 02/26/2022
Pulmonary Rehabilitation
Pulmonary Rehabilitation Select Pulmonary Rehabilitation from the left-side navigation. Medicare Part B (Medical Insurance) covers a comprehensive pulmonary rehabilitation program if a Medicare beneficiary has moderate to very severe COPD. [...]
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Posting Date: 02/26/2022
Acupuncture Benefits
Acupuncture Benefits Select Acupuncture Benefits from the left-side navigation. Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare covers an additional eight sessions if [...]
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Posting Date: 02/26/2022
Diabetes Self Management Training (DSMT)
Diabetes Self Management Training (DSMT) Select Diabetes Self Management Training (DSMT) from the left-side navigation. Medicare Part B (Medical Insurance) covers outpatient DSMT if a patient has been diagnosed with diabetes. Medicare may [...]
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Posting Date: 02/26/2022
Medical Nutrition Therapy (MNT)
Medical Nutrition Therapy (MNT) Select Medical Nutrition Therapy (MNT) from the left-side navigation. Medicare Part B (Medical Insurance) may cover MNT services and certain related services if a patient has diabetes or kidney disease, or has [...]
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Posting Date: 02/26/2022
Accessing Eligibility for MDPP in NGSConnex
Accessing Eligibility for MDPP in NGSConnex Select Medicare Diabetes Prevention Program from the left-side navigation. The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 [...]
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Posting Date: 02/26/2022
Hospice Notice of Elections
Hospice Notice of Elections Select Notice of Elections Information from the left-side navigation. The Hospice Notice of Elections information section will display information if the beneficiary has currently elected to receive hospice care or [...]
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Posting Date: 02/26/2022
Hospice Benefit Periods
Hospice Benefit Periods Select Hospice Benefit Periods from the left-side navigation. The Hospice Benefit Periods information section will display information if the beneficiary has elected to receive hospice care or has elected to receive [...]
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Posting Date: 02/26/2022
Smoking Cessation Counseling
Smoking Cessation Counseling Select Smoking Cessation Counseling from the left-side navigation. Medicare Part B (Medical Insurance) covers up to eight visits of smoking and tobacco-use cessation counseling visits in a 12-month [...]
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Posting Date: 11/12/2021
NGSConnex Online Web Application Can Save Time and Money
NGSConnex Online Web Application Can Save Time and Money NGSConnex is a free, secure web-based system that allows providers and suppliers to conduct business via online instead of calling into an IVR or contact center. NGSConnex provides [...]
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Posting Date: 11/19/2021
NGS Check Provider Enrollment Application Status Tool
NGS Check Provider Enrollment Application Status Tool The Check Provider Enrollment Application Status Tool can be used to check on the status of your CMS-855 enrollment application. Reviewed 10/21/2024
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Posting Date: 11/15/2021
National Correct Coding Initiative
National Correct Coding Initiative In 1996, CMS developed the NCCI to promote national correct coding methodologies and to eliminate improper coding. NCCI edits are developed based on coding conventions defined in the American Medical [...]
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Posting Date: 11/15/2021
National Coverage Determination
National Coverage Determination NCDs are policies developed by CMS that indicates whether and under what circumstances certain services are covered under the Medicare Program. NCDs are the same for all contractors across the country. [...]
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Posting Date: 11/15/2021
National ICD-10-CM-PCS: The Next Generation of Coding
National ICD-10-CM-PCS: The Next Generation of Coding The ICD-10-CM-PCS classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical [...]
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Posting Date: 11/15/2021
National Provider Calls and Events
National Provider Calls and Events MLN Connects® National Provider Calls (MLN Connects® Calls) are educational conference calls held by CMS for the Medicare provider and supplier community to educate and inform participants about new policies [...]
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Posting Date: 11/19/2021
National Provider Identifier
National Provider Identifier A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the CMS. The NPI has replaced the UPIN as the required identifier for Medicare [...]
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Posting Date: 11/15/2021
National Provider Identifier Registry
National Provider Identifier Registry The NPI Registry is free and enables providers to search provider National Plan & Provider Enumeration System information. All information produced by the NPI Registry is provided in accordance with [...]
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Posting Date: 11/15/2021
National Uniform Claim Committee
National Uniform Claim Committee The NUCC is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the noninstitutional health care [...]
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Posting Date: 11/15/2021
Open Door Forums
Open Door Forums CMS conducts ODFs. The ODF addresses the concerns and issues of providers. Providers may participate via conference call and have the opportunity to express concerns and ask questions. For more information, including signing [...]
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Posting Date: 11/15/2021
P.O. Box Mailing Addresses
P.O. Box Mailing Addresses For the P.O. Box mailing addresses, please visit the Contact Us page on our website. Reviewed 10/21/2024
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Posting Date: 11/15/2021
Patient Protection and Affordable Care Act of 2010
Patient Protection and Affordable Care Act of 2010 For information related to the HIPAA Privacy and Security Rules, visit the Office for Civil Rights website. The Privacy and Security Rules are available for download, and you will find [...]
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Posting Date: 11/16/2021
Physician Quality Payment Program
Physician Quality Payment Program The MACRA ended the SGR formula for clinician payment under the MPFS and established a quality payment incentive program, the QPP. This program provides clinicians with two ways to participate: through [...]
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Posting Date: 11/16/2021
Provider Contact Center
Provider Contact Center For information about the Provider Contact Center, please visit the Contact Us page on our website. Reviewed 10/21/2024
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Posting Date: 11/16/2021
Provider Enrollment
Provider Enrollment The Provider Enrollment Customer Service Department has direct telephone lines available for provider enrollment inquiries. Toll-Free Provider Enrollment Numbers Please use the following toll-free provider enrollment [...]
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Posting Date: 11/16/2021
Reconsideration (Second Level of Appeal)
Reconsideration (Second Level of Appeal) A written reconsideration request must be filed with a QIC within 180 days of receipt of the redetermination. When providers receive an unfavorable redetermination, providers shall follow the [...]
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Posting Date: 11/16/2021
Recovery Audit Program
Recovery Audit Program The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare [...]
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Posting Date: 11/16/2021
Redetermination (First Level of Appeal)
Redetermination (First Level of Appeal) A redetermination is an examination of a claim by National Government Services personnel who are different from the personnel who made the initial claim determination. The appellant (the provider filing [...]
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Posting Date: 11/16/2021
U.S. Government Printing Office
U.S. Government Printing Office The GPO is responsible for the production and distribution of information products and services including the official publications of Congress, the White House and other federal agencies in digital and print [...]
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Posting Date: 11/16/2021
Washington Publishing Company
Washington Publishing Company Washington Publishing Company, Inc. is a private company categorized under the commercial Printing and Newspaper Publishing Combined company that is an established health care IT and consulting company. WPC [...]
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Posting Date: 09/07/2021
CMS-1500 Claim Form Completion Instructions
CMS-1500 Claim Form Completion Instructions Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion Optical Character Recognition System [...]
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Posting Date: 10/24/2024
Submit an Initial Enrollment Application
Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]
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Posting Date: 10/24/2024
Submit an Initial Enrollment Application
Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]
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Posting Date: 10/24/2024
Submit an Initial Enrollment Application
Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]
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Posting Date: 04/14/2022
View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment
View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment Important: If you recently submitted an application to request a PTAN, please verify the approval letter was received prior to submission of claims. Log [...]
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Posting Date: 03/22/2022
Connecticut
Connecticut Member Name Professional Title Association Business Name/Address Email Fitzgerald, Elizabeth Audit and Education Specialist Hartford Healthcare 181 Patricia Genova Drive Newington, CT [...]
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Posting Date: 12/17/2021
General Information
General Information Certain diagnostic services provided by an IDTF are considered for Medicare payment when medically necessary. A referring/treating provider must order all covered services. The treating physician or nonphysician [...]
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Posting Date: 05/23/2019
Performance Standards
Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]
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Posting Date: 11/23/2021
Interpreting Physicians and Personnel (Technicians) Who Perform Tests
IDTF Billing Guide Interpreting Physicians and Personnel (Technicians) Who Perform Tests An IDTF may be either a mobile or stationary/fixed facility. Portable/Mobile Facility There are two types of mobile IDTFs. Each are large [...]
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Posting Date: 11/19/2021
Supervising Physicians
Supervising Physicians Supervision means the imaging is done under the physician’s overall control and direction and the licensed supervising physician is directly overseeing and ensuring the quality of medical care. An IDTF must have one or [...]
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Posting Date: 11/19/2021
Code Level Supervision
Code Level Supervision The supervision level required for diagnostic services is assigned by CMS. A list of diagnostic procedures and the supervision level required for each service is available in the CMS Medicare Physician Fee Schedule [...]
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Posting Date: 06/15/2021
Lung Cancer Screening
Lung Cancer Screening Early detection by screening is an important strategy for patients with a high risk for lung cancer. The LDCT is an additional preventive service benefit under the Medicare program. CMS established NCD for lung cancer [...]
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Posting Date: 05/14/2019
Claim Guidelines
Claim Guidelines The name and NPI of the referring/ordering provider must be in Items 17 and 17b of the CMS-1500 claim form or the EMC equivalent. An IDTF shall not be allowed to bill for any CPT or HCPCS codes that are solely therapeutic. [...]
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Posting Date: 11/14/2024
Electronic Funds Transfer
EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) [...]
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Posting Date: 10/24/2024
Electronic Funds Transfer Form and Instructions
Table of Contents Electronic Funds Transfer Form and Instructions Submitting the EFT Form CMS-588 EFT Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations, Providers and Suppliers [Return to Top] Electronic [...]
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Posting Date: 10/24/2024
Frequently Asked Questions Have Been Reviewed and Updated
Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]
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Posting Date: 10/24/2024
9/18/2024 Part B POE Advisory Group Meeting
9/18/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Elizabeth Aldrich, Dawson Ballard, Doris Barnes, Aurelia Barraco, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Louise [...]
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Posting Date: 10/24/2024
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]
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Posting Date: 10/24/2024
MLN Connects® Newsletter: October 24, 2024
MLN Connects® Newsletter: October 24, 2024 News CMS Roundup (October 18, 2024) Rural Health Clinic & Federally Qualified Health Center: Final CY 2024 Payment Policies Claims, Pricers, & Codes Home Health Consolidated [...]
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Posting Date: 06/03/2021
PECOS Correct and Resubmit Application Instructions
PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following: My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for applicable [...]
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Posting Date: 11/01/2024
Supporting Documentation Information
Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]
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