Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]

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 [...]

What Should Be Provided if Medical Records Are Requested for Review?

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]

Prepare and Submit an MSP Claim

Table of Contents Step 1: Determine if an MSP Claim Must be Submitted to Medicare Step 2: Check Medicare’s Eligibility Files via NGSConnex to Determine if There's Other Insurance Primary to Medicare Step 3: Prepare the MSP (Partial-Payment [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

837D Edit Spreadsheet

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation  Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could [...]

Resources

Resources You Can Help Your Patients Quit Tobacco Use Smoking Cessation Tools and Resources Smokefree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and Prevention: Office on [...]

Navigating Medicare Home Health & Hospice Insights for Providers Podcast

Navigating Medicare Home Health & Hospice Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts!   We invite you to join our thoughtful conversations and helpful insights into the Home Health & [...]

Navigating Medicare Part A Insights for Providers Podcast

Navigating Medicare Part A Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts! Listen to our podcast, Navigating Medicare Part A Insights for Providers, now available on Spotify and Apple Podcasts! We will be [...]

Common Tobacco Withdrawal Symptoms

Common Tobacco Withdrawal Symptoms Trying to quit tobacco use feels different for each person, but almost everyone will have some symptoms of nicotine withdrawal. When stopped, the body and brain must get used to not having nicotine. This can [...]

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases Effective 1/1/2025 Definition of G0545 Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or [...]

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211 Effective 1/1/2024 Definition of G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025 The April 2025 quarterly system release will update FISS DDE as described below: Inquiries Submenu (01) Option 1C (CMHC Payment Totals)/MAP1D62 - Monetary [...]

Tobacco Cessation and Cognitive Behavioral Therapy

Tobacco Cessation and Cognitive Behavioral Therapy CBT is a type of psychotherapy that’s problem oriented. It may help your patients learn how to change unhelpful or unhealthy ways of thinking, feeling and behaving especially when related to [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

MCReF Hospice Cap Functionality

MCReF Hospice Cap Functionality Attention Hospice providers: The new MCReF Hospice Cap functionality will be covered in the upcoming MCReF Webinar scheduled for 3/19/2025, from 1:00 – 3:00PM ET.  The Hospice Cap provider community is [...]

NGS Review of Prior Authorization Request

NGS Review of Prior Authorization Request Table of Contents NGS Review of Prior Authorization Request Number of Trips Extended Affirmation Periods for Beneficiaries with Chronic Conditions Decision Letters Resubmitting a Prior [...]

Expedited Requests

Expedited Requests The requester may submit for an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does [...]

About Hospital OPD PA Model

About Hospital OPD PA Model Table of Contents About Hospital OPD PA Model General Information Related Content [Return to Top] About the Hospital OPD PA Model CMS implemented a PA program for certain hospital OPD services for DOS on [...]

Documentation Information

Documentation Information It is recommended that PARs are submitted at least seven calendar days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. For [...]

Log In

Log In Table of Contents Log In Log into NGSConnex Log In Issues [Return to Top] Log In In order to login to NGSConnex, go to our website landing page. Read the standard disclaimer and click Accept to continue. [Return to [...]

Account Suspensions

Account Suspensions Table of Contents Account Suspensions Unsuspend Your Account Invalid Login Attempts [Return to Top] Account Suspensions If an NGSConnex account has not been used within the last 30 days, the account will be [...]

Caregiver Training Services

Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could result in [...]

Medicare Diabetes Prevention Program 2025 Changes

Medicare Diabetes Prevention Program 2025 Changes The MDPP Expanded Model is intended to prevent Medicare beneficiaries with an indication of prediabetes from developing diabetes. Prevention of diabetes among this high-risk group of Medicare [...]

Home Health Claims Returning to Provider RC 19963

HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]

NGS Office of Congressional Affairs Welcome Letter

Dear Members of Congress and Staff: As your work continues in the 119th Congress, National Government Services, Inc. maintains its dedicated role in serving your district/state as a Medicare contractor for Original Medicare. We are your [...]

Ambulance Services and the Advance Beneficiary Notice of Noncoverage

Ambulance Services and the Advance Beneficiary Notice of Noncoverage To follow are Medicare’s guidelines regarding the use of an ABN for ambulance services. Per the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Level 1: Redetermination Request Form

Ensure Accurate Provider Enrollment Information on File

Ensure Accurate Provider Enrollment Information on File ATTENTION: Claims and Provider Enrollment Verify that accurate provider enrollment information is on file with Medicare. Are you familiar with the details identified in the PECOS system [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

Ambulance Duplicate Claim Denials

Ambulance Duplicate Claim Denials Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same [...]

Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

Top JK Part B Claim Errors are Available

Top JK Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides:  Claim Error Reason Code [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions:  Referring physician: Requests an item or service for a Medicare beneficiary. [...]

CO-16

Avoiding/Correcting This Error This denial message is specific to chiropractic claims with CPT/HCPCS codes that are not billable by Medicare enrolled chiropractors. Medicare Part B coverage for chiropractic care is limited to spinal [...]

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use [...]

CO-109

Avoiding/Correcting This Error Palmetto GBA is the Medicare Administrative Contractor for processing claims of railroad retirees, regardless of their location. Providers and suppliers must verify patients' Medicare entitlement before [...]

OA-18

Avoiding/Correcting This Error A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the: same beneficiary; for the [...]

CO-109

Avoiding/Correcting This Error This denial is received when your Medicare patient is enrolled in a MA plan, instead of “traditional fee-for-service” Medicare. MA plans are health plans offered by private companies approved by Medicare that [...]

PR-31

Avoiding/Correcting This Error Services were denied for one or more of the following reasons: The name or Medicare number was incorrect or missing. The date of death precedes the date of service. Expenses were incurred prior to coverage. [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code, and phone [...]

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

Ambulance Billing Guidance

Ambulance Billing Guidance Table of Contents Ambulance Billing Ambulance Billing HCPCS Codes How to Bill Units with Transpiration HCPCS Codes Using Ambulance Modifiers When Billing Transportation Indicators Related Content [Return [...]

MLN Connects® Newsletter: March 27, 2025

MLN Connects® Newsletter: March 27, 2025 News Extension of Medicare Provisions Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement Nutrition-Related Health Conditions: Recommend Medicare Preventive Services [...]

Fundamentals of Medicare

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

Screening Mammography

Preventive Services Guide Screening Mammography A mammogram is an X-ray of the breast. Screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms. Coverage Guidelines and Frequency Limits [...]

APPEALS: How would one submit a paper appeal?

APPEALS: Where can I find the regulations on Medicare appeals?

APPEALS: What are the top appeals submitted to NGS?

MLN Connects® Newsletter: March 25, 2025

MLN Connects® Newsletter: March 25, 2025 News ESRD: Payment for Phosphate Binders Effective January 1, 2025 Hospitals: Apply for Additional Residency Positions by March 31 Skilled Nursing Facilities: Revalidation Deadline is May 1 [...]

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

APPEALS: Can one appeal a claim that rejected with MA130?