View a General Inquiry

View a General Inquiry Table of Contents View a General Inquiry Attachments [Return to Top] View a General Inquiry National Government Services, Inc. will respond to your inquiry via NGSConnex within 45-business days of the date your [...]

Drugs and Biologicals

Drugs and Biologicals We’ve updated the drugs and biologicals section of our website to offer easier navigation to the information you need. Updates include: Created a left-side navigation list with hyperlinks to specific information Added [...]

Providers Performing Facet Joint Injections (CPT Code 64476) 

Providers Performing Facet Joint Injections (CPT Code 64476) The OIG released the results of an investigation into facet joint injections. Per the OIG report: "Facet joint injections are typically performed using radiological guidance [...]

Related Content

Related Content LCD L33394 - Drugs and Biologicals, Coverage of, for Label and Off-Label Uses Drug Coverage under Different Parts of Medicare Medicare Program Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently [...]

Create an Account - Local Security Officer (LSO)

Create an Account — Local Security Officer (LSO) Table of Contents Create an Account — Local Security Officer (LSO) Step 1 – Account Step 2 – Individual Step 3 – Business [Return to Top] Create an Account — Local Security [...]

LSO Responsibilities

LSO Responsibilities Table of Contents LSO Responsibilities Approve/Decline/Modify/Remove Access [Return to Top] LSO Responsibilities The LSO is responsible for managing access for other NGSConnex users within the organization. [...]

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 [...]

Intravitreal Beovu (Brolucizumab-dbl) Billing

Intravitreal Beovu (Brolucizumab-dbl) Billing National Government Services has seen multiple variations of billing from providers for Intravitreal Beovu. This job aid provides clarification and proper billing for this drug. For Medicare [...]

Navigation Structure

Navigation Structure Table of Contents NGSConnex Home Page Breadcrumbs Progress Bar Select a Provider Select a Beneficiary Cancel Reset Search [Return to Top] NGSConnex Home Page After you successfully log in to NGSConnex the [...]

Preventive Services

Medicare Preventive Services Resource Guide

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

Medicare Secondary Payer Calculator

Temporary Relief Available for Providers on Medical Review That Have Been Impacted by CHOPD

Temporary Relief Available for Providers on Medical Review That Have Been Impacted by CHOPD Per the direction of CMS, as of 3/27/2024, National Government Services may grant extensions for responses to ADRs to providers under active medical [...]

Medicare Preventive Services Resource Guide Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep Medicare beneficiaries [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment

Provider Enrollment: Verify Bank Account Information to Prevent Interruption in Medicare Payment National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. [...]

Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1: Identify the MSP Record for the Beneficiary on the CWF that Needs Correction Step 2: Prepare a Medicare Primary Claim for the Beneficiary’s Services Step 3: [...]

Hospital-Issued Notices of Noncoverage

Prolonged Services Timetable 2024

Prolonged Services Timetable 2024 CPT Code HCPCS Code for Prolonged Service CPT and CMS Base Time CMS-Extra Minutes Needed CMS Time Requirement for Prolonged Services Date Span 99205 G2212 60 15 [...]

Part A Ambulance Claims Not Retaining Fractional Units

Fractional Units are not being retained on ambulance mileage HCPCS entered via DDE. This results in reason code 32226 (Units required but not present).  

ESRD Claims Are Paying Incorrectly

National Government Services has been made aware of ESRD claims with HCPCS code 90999 processing at rates that are cents instead of hundreds of dollars. This is causing the claims to pay incorrectly. This issue appears to have started mid-July, 2023.

Home Health 32G Adjustment Issue for Separation Periods of < 60 Days

A segment of home health claims with 32G type of bills are incorrectly being re-coded to earlier periods during processing, instead of the correct later periods. This error is occurring when the separation between the two periods is 60 days or [...]

Hospice Informational Unsolicited Response Adjustments - Type of Bill 8XG

Due to original informational unsolicited responses (IURs) processing not occurring between the timeframe of 8/1/2017 and 4/1/2021, a significant volume of hospice IUR adjustments have been initiated by the common working file (CWF) to [...]

Optical Character Recognition Misreading Referring Provider Names

OCR software is misreading the referring/ ordering provider name (item 17) on some Part B claims.

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721)

Laboratory Tests Billing Alert: Lipid Panel Test (80061) Completed on the Same Date of Service as an LDL Test (83721) National Government Services, Inc. Medical Review initiated a review of claims containing both a lipid panel test and [...]

G0179FrequencyCalculatorBottom

  The home health agency (HHA) certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The HHA recertification code is used after a patient has received services for [...]

G0179FrequencyCalculatorTop

G0179 Frequency Calculator Use this calculator to determine the date the next recertification code G0179 may be billed. Enter the date of the last recertification or certification service that met the billing requirements for code G0179 or [...]

Publications for People with Medicare

Publications for People with Medicare Medicare & You Handbook Medicare News Medicare Publications

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

Get PECOS Access to Maintain Medicare Provider Enrollment Records

Get PECOS Access to Maintain Medicare Provider Enrollment Records Do you need to work on behalf of an individual provider and/or entity to update or submit Medicare enrollment information electronically through PECOS? There are certain [...]

What is Medicare Secondary Payer?

Medicare Secondary Payer is the term used for when a Medicare beneficiary has other insurance or coverage that is the primary payer, based on a federal MSP provision, for the beneficiary’s healthcare services. As a result, Medicare is the [...]

Inhalation Treatment CPT 94640 – Billing Errors

Inhalation Treatment CPT 94640 – Billing Errors The National Government Services Appeals Department has identified billing errors relevant to CPT code 94640 for inhalation treatment. When you bill more than one unit per episode of care, the [...]

DME CERT Physician's Corner

DME CERT Physician’s Corner In an effort to reduce the CERT claims error rate, CGS Jurisdiction B DME MAC, has created a Physician’s Corner page which is specifically designed for physicians and practitioners to provide detailed information [...]

Download Medicare Remit Easy Print

Download Medicare Remit Easy Print To download MREP, please select the external link below to navigate to the MREP portion of the CMS Website. Download Medicare Remit Easy Print

Prevent an MSP Rejection on a Medicare Primary Claim

Table of Contents Prevent an MSP Rejection on a Medicare Primary Claim Step 1 Step 2 Step 3 Related Content [Return to Top] Prevent an MSP Rejection on a Medicare Primary Claim If you submit a Medicare primary claim when there is [...]

Populating MSP Insurance Type Code on Electronic Claims

Table of Contents Populating MSP Insurance Type Code on Electronic Claims GHP NGHP Related Content [Return to Top] Populating MSP Insurance Type Code on Electronic Claims When you identify beneficiaries that have Medicare as the [...]

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, [...]

GlobalPeriodCalculator Bottom

Please refer to the Physician Fee Schedule Look up on the CMS Web site to determine whether the procedure in question has a 90 day global period.

General Information

General Information Since 2001, CMS has formally recognized qualified audiologists (specialty 64) to personally furnish diagnostic tests (Section 410.32(b)(2)(ii)) without supervision by a physician or NPP. The statute, at section 1861(ll)(3) [...]

Letter of Authorization for EDI

Letter of Authorization for EDI We’ve extended our Letter of Authorization PIN expiration period based on user feedback. Letter of Authorization PINs are now valid for 30 days and there is no limit on the number of times a PIN can be used. [...]

Hospice Claims Edit Issue RC W7048

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 [...]

Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Interim Rate Review Documentation Request Form for Hospitals

Hospice PIP Rate Review Form

Submitting Credit Balance Reports

Submitting Credit Balance Reports Table of Contents Submitting Credit Balance Reports Initiate a Credit Balance Report Credit Balance Certification Page [Return to Top] Submitting Credit Balance Reports This function allows [...]

Initiate Audit and Reimbursement Document Submissions

Initiate Audit and Reimbursement Document Submissions Table of Contents Initiate Audit and Reimbursement Document Submissions Step 1: Provider Details Step 2: Audit & Reimbursement Step 3: Document Submission Step 4: Submit [...]

A&R Inquiries

A&R Inquiries Table of Contents A&R Inquiries Email Notification View/Initiate an A&R Inquiry Response Inquiry Details Step 1: Response Description Step 2: Attachments Step 3: Submit Response What to do if you [...]

Initiate a Prior Authorization Request

Initiate a Prior Authorization Request Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [Return to Top] Initiate a Prior Authorization [...]

DSMT: Documentation & Physician Order Requirements

DSMT: Documentation & Physician Order Requirements Table of Contents DSMT: Documentation & Physician Order Requirements Documentation & Physician Order Requirements Provider Actions Related Content [Return to Top] DSMT: [...]

Claim Timely Filing Job Aid

Claim Timely Filing Job Aid Table of Contents Claim Timely Filing Job Aid Timely Filing Limits Date of Service Considerations Timely Filing Limits Chart Timely Filing Exceptions Related Content [Return to Top] [...]

A/B and DME Collaborative General Documentation Requirements

A/B and DME Collaborative General Documentation Requirements The A/B and DME Collaborative General Documentation Requirements YouTube Video is available. Posted 3/27/2024

NGSConnex Part B Claim Submission Issue – Mammography Claims

NGSConnex Part B Claim Submission Issue - Mammography Claims At this time, we are unable to accept mammography claims through Part B Claim Submission in NGSConnex. We are working to resolve the issue; please watch for Email Updates on the [...]

MLN Connects® Newsletter: March 28, 2024

MLN Connects® Newsletter: March 28, 2024 Proposed Payment Rule FY 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule News CMS Roundup (Mar 22, 2024) Hospital Price Transparency: Tools to Help Hospitals [...]

April 2024

In This Issue National Government Services Articles for Part A and Part B Providers Attention Electronic Billers Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Important Reminder: Change [...]

Submitting a Medicare GME Affiliation Agreement

Submitting a Medicare GME Affiliation Agreement Table of Contents Submitting a Medicare GME Affiliation Agreement Jurisdiction K MAC (NGS) Jurisdiction 6 MAC (NGS) Submitting a Medicare GME Affiliation Agreement In [...]

Rural Health Claims Impacted by FS2540

This utility will adjust Rural Health claims - 71X TOB Reimbursed incorrectly with the implementation of FS2540 in the A20232CP release Installed to production on 5/15/23 Note: changes for FS2540 were backed out with FS2540R1 on 6/13/23. [...]

Part A Claims Returning to Provider (RTP) RC 38361

Claims are continuing to incorrectly RTP even when the prior claims are not No Pay Claims.