RC 55A00 or 55A01 Denials for Denosumab

National Government Services is aware of an issue that is causing claims to deny in error with reason code 55A00 or 55A01. The claims involved are for Denosumab (J0897) - Billing and Coding article – A52399 and are firing on edit 5XX84.

You Asked, We Listened – Enhanced Website Search

You Asked, We Listened – Enhanced Website Search We often hear from our customers that our website search function returns too many results when searching for a specific topic. We’re happy to share, we’ve enhanced our search function to help [...]

Related Content

Related Content WPC Health Care Code Lists Health Care Payment and Remittance Advice: Provides information on ERA and companion documents for assistance with receiving the Transaction 835. CMS IOM Publication, Medicare Claims [...]

Understanding Revalidation Application Requirement of Submission

Understanding Revalidation Application Requirement of Submission The 42 Code of Federal Regulations Section 424.515(b): requires that a provider/supplier must submit a CMS-855 application with complete information for revalidation by the due [...]

Understanding Revalidation Application Requirement of Submission

Understanding Revalidation Application Requirement of Submission The 42 Code of Federal Regulations Section 424.515(b): requires that a provider/supplier must submit a CMS-855 application with complete information for revalidation by the due [...]

MLN Connects® Newsletter: April 4, 2024

MLN Connects® Newsletter: April 4, 2024 Proposed Payment Rules FY 2025 Skilled Nursing Facility Prospective Payment System Proposed Rule FY 2025 Inpatient Psychiatric Facilities Prospective Payment System & Quality Reporting Updates [...]

New Provider Center

Submission of EDI Enrollment Forms

Submission of EDI Enrollment Forms We’ve added validation within the EDI Enrollment Form submission process that will verify provider information as the form is being completed. Previously, this validation was completed after submission, and [...]

Fee Schedule Assistance

Fee Schedule Assistance Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and Download Fee [...]

Billing Overlap/Dispute Resolution Process Effective 3/1/2023

Billing Overlap/Dispute Resolution Process Effective 3/1/2023 An overlapping situation may occur between hospitals for inpatient stays, home health agencies, outpatient services and hospice agencies. Overlapping situations may also occur due [...]

Dispute Request for Assistance (RFA) Form

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Best Practices for a Successful Targeted Probe and Educate Review

End of Public Health Emergency

End of the Public Health Emergency Frequently Asked Questions

End of the Public Health Emergency Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to questions about the End of the Public Health Emergency to ensure you have [...]

Drugs and Biologicals Frequently Asked Questions

Drugs and Biologicals Frequently Asked Questions We’ve added new frequently asked questions to our website. We encourage our providers to view answers to common questions about Drugs and Biologicals to ensure you have the information you need [...]

Government Efforts to Combat Cancer Deaths Related to Tobacco

Government Efforts to Combat Cancer Deaths Related to Tobacco Tobacco use is the leading preventable cause of cancer and cancer deaths. Lung cancer is what normally is thought of when talking about tobacco and cancer, but there are other [...]

Ways to Submit Requests

Ways to Submit Requests Suppliers have multiple options to submit PA requests to NGS. NGSConnex (preferred) Electronic submission of medical documentation (esMD) Fax JK: 315-442-4178 J6: 717-565-3840 U.S. Mail National [...]

Rhinoplasty and Related Services

General Documentation Requirements for Rhinoplasty and Related Services Checklist of prior authorization request (PAR) information to include: Medical documentation, with evaluation and management, supporting medical necessity of the [...]

MLN Connects® Newsletter: June 15, 2023

MLN Connects® Newsletter: June 15, 2023 News Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation CMS Announces Multi-State Initiative to Strengthen Primary Care [...]

Reactivating Reason Code 31755

Reactivating Reason Code 31755 As of 1/3/2023, reason code 31755 was reactivated per CMS instructions. This means the revenue code 0023 line-item date of service must match the date of service for the first home health visit on the claim. [...]

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device

Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device VAD supplies and accessories are billed using HCPCS codes Q0507, Q0508 and Q0509 as applicable. When billing for VAD supplies, [...]

Claims Department Requires Additional Information for Processing Certain Services

Claims Department Requires Additional Information for Processing Certain Services Are you having difficulty with what must be provided when we ask for additional information to process your claim? If so, the following articles should assist in [...]

Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services

General Documentation Requirements for Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and Related Services Checklist of prior authorization request (PAR) information to include: Stable weight loss [...]

MLN Connects® Newsletter: June 22, 2023

MLN Connects® Newsletter: June 22, 2023 News CMS Roundup (June 16, 2023) Lower Endoscopy: Comparative Billing Report in June Medicare Physician Fee Schedule Database: July Update Behavioral Health Integration Services: Get Information [...]

Prior Authorization Request for Outpatient Services: Facet Joint Interventions

Dental Services 2023

Dental Services 2023 The CMS clarified what Medicare payments may be made for medically necessary dental services that are an integral part of a covered primary medical procedure. We’ve posted this new information in the Dental Services [...]

End of the Public Health Emergency

End of the Public Health Emergency We’ve received many questions related to end of the public health emergency and changes to waivers that CMS put in place during the COVID-19 PHE. To assist our providers, we’ve developed the CMS Waivers and [...]

COVID-19 Vaccine Administration Returning to Providers - Reason Code 32287

Claims for COVID-19 vaccine administration performed on the same DOS as another vaccine administration (e.g., PPV, flu or tetanus) are incorrectly being returned to providers with RC 32287.

Part A Anesthesia Claim Returning to Providers in Error

CMS has instructed all MACs to hold all Part A 13X and 85X TOBs for anesthesia services with DOS on or after 1/1/2022 until CMS fully implements a replacement file for these claims.

Temporary Holding for Some Part B Claims

The CMS billing instructions for G0378 indicate a single line of coding with a NOS of at least eight, with all UOS on a single line and the DOS being the date of the original observation order. Claim editing changes implemented in July, 2021 [...]

Billing and Coding Article Updates for July 2023

Billing and Coding Article Updates for July 2023 Billing and Coding: Bevacizumab and Biosimilars (A52370) Based on Compendia review, ICD-10 codes Z85.09 and Z85.42 have been added to the Group 1 code list effective for dates of service on or [...]

Telehealth Home Health Billing

Telehealth Home Health Billing  As a reminder to all home health agencies, telehealth billing becomes mandatory on home health claims for periods of care that start on or after 7/1/2023. There is an article detailing how to report [...]

New and Improved EDI Enrollment Process Coming Soon

New and Improved EDI Enrollment Process Coming Soon We are improving our online EDI Enrollment process based on provider feedback. The new process will include ‘real time’ verification of data entered into many of the fields. This ‘real time’ [...]

MLN Connects® Newsletter: June 29, 2023

MLN Connects® Newsletter: June 29, 2023 News CY 2024 ESRD Prospective Payment System Proposed Rule Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework New [...]

Conflict of Interest Disclosure

Conflict of Interest Disclosure Statement Form

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03

CR13220 - Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 Posted 7/5/2023

MLN Connects® Newsletter: July 6, 2023

MLN Connects® Newsletter: July 6, 2023 News CY 2024 Home Health Prospective Payment System Proposed Rule HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices CMS Roundup (June 30, 2023) [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Jurisdiction 6 and Jurisdiction K Bobbi Jo Luciano Office: South Portland, ME 207-253-3382 Email: [...]

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023

MLN Connects® Newsletter: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval - July 7, 2023 News Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following [...]

Overcoming Barriers to Tobacco Counseling 

Overcoming Barriers to Tobacco Counseling Healthcare providers face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ performance [...]

Submitting Necessary/Appropriate Documentation

Submitting Necessary/Appropriate Documentation National Government Services has noticed an increase in the submission of improper documentation. We’ve added two new sections to our Submit Medical Record Documentation Electronically job aid to [...]

MLN Connects® Newsletter: July 13, 2023

MLN Connects® Newsletter: July 13, 2023 News Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 National Coverage Determination: Pre-exposure Prophylaxis Using [...]

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023

MLN Connects® Newsletter: PFS & OPPS/ASC Proposed Payment Rules – July 13, 2023 Proposed Rules CMS Physician Payment Rule Advances Health Equity CMS Proposes Policies to Expand Behavioral Health Access and Further Efforts to Increase [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 Therapy [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

Frequently Asked Questions Reviewed and Updated

Frequently Asked Questions 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 CAR T-cell Therapy Claims EDI [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Beginning June 4th!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Beginning June 4th! Seats are filling up quickly for our 2024 Spring/Summer Virtual Conference: Mastering Medicare- Tuesday [...]

More Medicare Resources

More Medicare Resources Medicare.gov Your online Medicare resource Replace Your Medicare Card Learn how to replace your Medicare card

Attention All Providers, Billing Services and Clearinghouses Who Submit and Receive NGS EDI Transactions

Attention All Providers, Billing Services and Clearinghouses Who Submit and Receive NGS EDI Transactions As a reminder, when submitting the EDI Enrollment Application to National Government Services, only one form should be completed for any [...]

CPT 99459 Pelvic Examination Billing for Medicare

CPT 99459 Pelvic Examination Billing for Medicare National Government Services has received several inquiries regarding the use of CPT 99459, which was added to CPT coding for 2024 as an add-on code service. This means the code is only payable [...]

Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77

Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Table of Contents Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Example of the Proper Use of OC 27 Example of the Proper Use of OC 27 with OSC 77 [...]