When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

What is the correct way to bill an unlisted drug or biological?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

Is the shingles vaccine covered by Medicare?

ASCA: Where do we mail our Administrative Simplification Compliance Act (ASCA) waiver request?

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

ASCA: If my Administrative Simplification Compliance Act Waiver Request is denied, what will happen to my paper claims?

ASCA: How will the Administrative Simplification Compliance Act enforcement review affect me as a “small provider/supplier?” Will I be required to submit claims electronically?

ASCA: What kind of supporting documentation should I attach to my Administrative Simplification Compliance Act Waiver Request?

ASCA: How will I know the outcome of my Administrative Simplification Compliance Act waiver request form?

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?

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

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

Are unclassified drug codes included in average sales price (ASP) files?

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

MEDICAL REVIEW: Why did I receive a Comparative Billing Report?

MEDICAL REVIEW: Where can I find more details about the reasons my claims were denied?

MEDICAL REVIEW: Where can I get answers to billing questions?

MEDICAL REVIEW: What mailing address does NGS use to send Medical Review additional documentation requests (ADRs) to providers?

MEDICAL REVIEW: What constitutes a valid signature?

MEDICAL REVIEW: We are a large group and could potentially have many providers on TPE review. We have difficulty managing the process for each provider. Does NGS have any guidance for large groups?

MEDICAL REVIEW: The Medical Review Department did a post payment review of my Medicare claim and it was denied. How do I pay the money back to NGS Medicare?

MEDICAL REVIEW: My claim was reopened or adjusted by Medical Review. Does this impact the appeal window?

MEDICAL REVIEW: My claim was denied “56900 Documentation not received”; however, I did send in documentation. What now?

MEDICAL REVIEW: How do I respond to an ADR Not In List?

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?

MEDICAL REVIEW: I am under TPE review and my claims were denied, who can I speak to about this?

MEDICAL REVIEW: How do I request an appeal on a claim reviewed by the Medical Review Department?

MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?

MEDICAL REVIEW: How do I appeal a claim that MR reviewed but went to a T status or R status because of a CWF issue after MR processed?

MEDICAL REVIEW: How can I use NGSConnex to respond to Medical Review additional documentation requests?

MODIFIERS: When should the QW modifier be appended?

MODIFIERS: When should modifier 51 be added to a claim?

MODIFIERS: When is it appropriate to append the AQ modifier?

MODIFIERS: When is modifier 50 used?

MODIFIERS: When do I need to append the 99 modifier?

Where is the written Part B Reopening Form located?

What is timely filing to adjust a claim?

Where are the appeal forms?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

What is the receipt date of the claim?

What is the timely filing for an appeal?

What is the refund address?

What is timely filing for a claim?

What is the mailing address for submitting a claim?

What is the denial date?

What is the address to send the QIC appeal?

What is the QIC timely filing limit?

What is my pay-to address?

What is the ICN?