Preventive Services: Flu and PPV Vaccines

During this webinar, we will review the coverage, coding and billing guidelines under Medicare Part B for Influenza and Pneumococcal Pneumonia Virus vaccinations.

Clinical Trial Services and Modifiers Q0 and Q1

Clinical Trial Services and Modifiers Q0 and Q1 Table of Contents Clinical Trial Services and Modifiers Q0 and Q1 Q0 and Q1 Modifiers Use in Approved Clinical Trials Modifier Q0 Modifier Q1 Clinical Service Billing May Include [...]

National Coverage Determination 190.3 - Cytogenetic Testing: Discretionary Diagnoses

National Coverage Determination 190.3 – Cytogenetic Testing: Discretionary Diagnoses Under NCD 190.3, Cytogenetic Testing, CMS allows contractors discretion in coverage of specific Indications. “As this policy indicates, individual A/B MACs [...]

"What If" and Scenario Questions

"What If" and Scenario Questions Physician offices often contact us with different scenarios and "what if?" questions regarding coding and documentation for a particular service(s). Providers ask the contractors for a definitive response on [...]

Medically Unlikely Edits Billing and Processing

Medically Unlikely Edits Billing and Processing Table of Contents Medically Unlikely Edits Billing and Processing Notes on MUE Processing Instructions MUE Program Inquires Related Content [Return to Top] Medically Unlikely Edits [...]

Acceptable Electronic Signatures Reminder

Acceptable Electronic Signatures Reminder Table of Contents Acceptable Electronic Signatures Reminder Examples of Acceptable Electronic Signature Examples [Return to Top] Acceptable Electronic Signatures Reminder CMS issued [...]

Avoid Processing Delays by Following Proper Submission Guidelines

Avoid Processing Delays by Following Proper Submission Guidelines Table of Contents Avoid Processing Delays by Following Proper Submission Guidelines Claims Appeals Responding to an ADR Consider Submission via NGSConnex or Electronic [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

IDTF Procedure Codes (65 KB)

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

PECOS: View and Manage Reassignments through Group Enrollment

During this webinar, we’ll provide an understanding of how to view and manage reassignments through the group enrollment in Provider Enrollment, Chain and Ownership System (PECOS), including to add or terminate reassignments. Individual [...]

Original Medicare Coverage Costs

Original Medicare Coverage Costs Important Links Medicare News Fact Sheet Your Medicare Costs Your Medicare Benefits Your Medicare Coverage Your Medicare Coverage for Home Health Services Your Medicare Coverage for Hospice Care [...]

Physician Fee Schedule Look-Up

Care Management: 2024 Health Equity Services

As part of a continued series, NGS is raising awareness on the benefits of care management. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in 2024, caregiver training, principal [...]

Billing Cardiac Rehabilitation Session and Session Limitations

Billing Cardiac Rehabilitation Session and Session Limitations CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended [...]

Care Management: Cognitive Assessment

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on cognitive assessment, which is a separate service that may be billed for patients when you have recognized potential [...]

Care Management: Behavioral Health Integration and Psychiatric Collaborative Care Management

As part of a continued series, National Government Services (NGS) is raising awareness on the benefits of care management. During this webinar, we’ll discuss behavioral health integration and psychiatric collaborative care management. This [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Care Management: Transitional Care Management Services

As part of a continued series, we’re raising awareness of the benefits of care management. During this webinar, we’ll focus on transitional care management services for Medicare patients. We’ll share resources and review proper billing [...]

LCD and Article Updates for August/September 2024

LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the [...]

FQHC PPS Basic Billing and Reimbursement

Are you a Federally Qualified Health Center (FQHC) provider that would like to learn about basic billing and reimbursement under the FQHC prospective payment system (PPS)? This webinar will include claim and payment examples for new providers/ [...]

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For Americans with diabetes or high blood pressure—the [...]

Common Working File (CWF) Host Dark Days for October 2024 Release

Common Working File Host Dark Days for October 2024 Release For the upcoming October 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 10/3/2024, and Dark Days starting Friday, 10/4/2024 through Sunday, 10/6/2024 [...]

Part B Medicare Administrative Contractor Overview for Dental Providers

The purpose of this webinar is to introduce dental providers to National Government Services and explain our role as the Medicare Administrative Contractor for Jurisdictions 6 and K. We’ll also share helpful resources related to coverage, [...]

Submitting Part B Medicare Secondary Payer Claims Appropriately

During this Medicare Secondary Payer (MSP) learning session, we'll teach you how to submit your MSP claims with the appropriate loops and segments. We'll review the MSP billing requirements for paper and electronic claims and conditional [...]

September 2024

In This Issue National Government Services Articles for Part A and Part B Providers Introducing the All-New Medicare University! Removal of Facet HCPCS Codes  National Government Services Articles for Part A Providers [...]

MLN Connects® Newsletter: August 29, 2024

MLN Connects® Newsletter: August 29, 2024 News CMS Roundup (August 23, 2024) Physicians, Teaching Hospitals, & Non-Physician Practitioners: Review Your Open Payment Data by December 31 Claims, Pricers, & Codes Home Health [...]

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only

Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com. Suppliers who can enroll in as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers

CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers Review the standards on page 2 and follow the instructions printed on the CMS-20134 application Section General Guidelines Section 1: Basic [...]

Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits

Physicians and Nonphysician Practitioners in Private Practice (Sole Owner or Sole Proprietor) With or Without any Reassigned Benefits Revalidation instructions for sole proprietor using SSN or EIN: Download CMS-855I. Complete Sections 1, [...]

Approved Pending Regional Office Review

Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS.   National Government [...]

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Physical/Occupational Therapy Billing

Join us as we review billing guidelines for physical and occupational therapy. We'll review when to apply the KX modifier and the importance of appropriate medical documentation. National Government Services has a Local Coverage Determination [...]

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy

CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]

Professional Services During a Patient Hospice Election

Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]

Proper Use of Taxonomy Codes

Proper Use of Taxonomy Codes A taxonomy code is a unique ten-character code that designates your classification and specialization and enables providers to identify their specialty at the claim level. CMS developed a crosswalk of [...]

Common Reciprocal Billing Questions and Answers

Common Reciprocal Billing Questions and Answers If a practice, the same specialty as ours, wants us to take calls for them for two weeks, can we bill under their number as a reciprocal billing arrangement? Answer: No. In a reciprocal [...]

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans

Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]

Unlisted and Not Otherwise Classified Procedure Codes

Unlisted and Not Otherwise Classified Procedure Codes Table of Contents Unlisted and Not Otherwise Classified Procedure Codes Proper Billing for NOC Procedures Electronic Claims Paper Claims The following tips will help you bill [...]

Fiscal Year/Calendar Year Claim Split

Fiscal Year/Calendar Year Claim Split Part A/B Type of Bill Fiscal Year Split Calendar Year Splint Part A – 11X, 21X prospective payment system (PPS*) No No Part A – 11X, 18X, 21X, non-PPS Yes [...]

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]

Medicare Coverage for Living Organ Transplant Donors

Medicare Coverage for Living Organ Transplant Donors Table of Contents Coverage Hospital Guidelines Physician Guidelines Billing Guidelines Transplant Centers Physicians and Surgeons Related Content [Return to Top] Coverage [...]

Nonphysician Practitioners Billing for Surgical Procedures

Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]

Answers to Common Fee-for-Time Compensation Arrangements Questions

Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid

Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]

Proper Billing for Finger and Toe Procedures

Proper Billing for Finger and Toe Procedures When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to [...]

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements

Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Table of Contents Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Fee-For-Time Compensation [...]

Kidney Transplant Services

Kidney Transplant Services Table of Contents Kidney Transplant Services Physician Services Pretransplant Services Immunosuppressive Drugs Cadaver Donor Updated CMS-1500 Claim Form Guidelines [Return to Top] Kidney Transplant [...]

Claim Submission Instructions

Claim Submission Instructions Use the instructions on the Billing/Payment section of the CMS Opioid Treatment Program (OTP) web pages. Reviewed 9/3/2024

Billing and Payment for Dual Eligible Beneficiaries

Billing and Payment for Dual Eligible Beneficiaries A person who is eligible for both Medicare and Medicaid at the same time is “dually eligible”. Medicare is the primary payer for OTP services delivered to dually eligible beneficiaries. [...]

Resources

Resources CMS Opioid Treatment Program webpage CMS Roadmap to Address the Opioid Epidemic SAMHSA (Substance Abuse and Mental Health Services Administration) MLN® Fact Sheet: A Prescribers Guide to Medicare Prescription Drug (Part D) [...]

Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427

Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427 National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this [...]

Coding and Billing for OTP Services

Coding and Billing for OTP Services Table of Contents Coding and Billing for OTP Services Coding for OTP Weekly Bundles New for 2024 HCPCS Code G0137 Separate Add-on Codes Frequency of Use and Billing Billing Cycles [Return [...]

Surgical Pathology Billing Tips

Surgical Pathology Billing Tips CPT Codes: 88300-88399 Surgical pathology is the study of tissues removed from living patients during surgery to help diagnose a disease and determine a treatment plan. Surgical pathology involves gross and [...]