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Posting Date: 10/03/2024
Local Coverage Determination Open Meeting
Local Coverage Determination Open Meeting National Government Services is hosting a Proposed Local Coverage Determination Open Meeting on 10/24/2024. Details are available by accessing the Local Coverage Determination Open Meeting [...]
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Posting Date: 10/03/2024
Medicare Secondary Payer Provisions Group and Nongroup Health Plans
Who pays first? This Medicare Secondary Payer learning session will be on the provisions of group health plans that include working aged, disability and end stage renal disease and nongroup health plans that include auto, liability, no-fault, [...]
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Posting Date: 10/03/2024
MLN Connects® Newsletter: October 3, 2024
MLN Connects® Newsletter: October 3, 2024 News HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program Resources & Flexibilities to Assist with the Public Health Emergency in Florida, [...]
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Posting Date: 08/04/2022
Appropriate Usage of Modifier 99
Appropriate Usage of Modifier 99 Table of Contents Appropriate Usage of Modifier 99 Appropriate Usage Inappropriate Usage Related Content [Return to Top] Appropriate Usage of Modifier 99 Modifier 99 indicates multiple modifiers; [...]
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Posting Date: 08/05/2022
Anesthesia Modifiers
Anesthesia Modifiers Use Anesthesia Modifiers Appropriately National Government Services requires placement of pricing modifiers in the first modifier position to process your anesthesia claims correctly. Claims submitted incorrectly will [...]
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Posting Date: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 11/15/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]
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Posting Date: 08/21/2018
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 [...]
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Posting Date: 02/01/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]
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Posting Date: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 04/02/2024
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 [...]
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Posting Date: 03/13/2023
Sacroiliac Joint Injections and Procedures
Sacroiliac Joint Injections and Procedures Table of Contents Sacroiliac Joint Injections and Procedures Diagnostic SIJI Diagnostic SIJI Limitations Therapeutic SIJI Therapeutic SIJI Limitations SIJ Denervation [...]
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Posting Date: 11/13/2020
Initial Episode Clarified for Home Health Face-to-Face Encounter
Initial Episode Clarified for Home Health Face-to-Face Encounter CMS requires a patient receiving HH services under the Medicare HH benefit have a FTF encounter with the certifying physician for the initial episode. CMS has clarified that this [...]
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Posting Date: 10/20/2017
Certification or Recertification of Medicare Covered Home Health Services
Certification or Recertification of Medicare Covered Home Health Services Billing HCPCS Codes G0180 and G0179 of Patient Eligibility for Medicare-covered Home Health Services under a Home Health Plan of Care Physician [...]
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Posting Date: 04/26/2022
Critical Care Services: CPT Codes 99291-99292
Critical Care Services: CPT Codes 99291-99292 Table of Contents Definition Context Providers Who May Perform Critical Care Services and Medical Necessity Palliative and Hospice Patients Full Attention of the Provider and Provider [...]
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Posting Date: 03/29/2022
Critical Care Policy Clarification
Critical Care Policy Clarification The CMS implemented the new policy for critical care services as published in the Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, [...]
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Posting Date: 02/01/2022
Critical Care Tip Sheet
Critical Care Tip Sheet Table of Contents Service and Medical Necessity The Following CMS Billing Consideration Guidelines Apply Provider Time Assessment and Documentation The Following CMS Billing Consideration Guidelines [...]
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Posting Date: 08/30/2022
Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Table of Contents Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Exceptions Date(s) of Service Care Provided in Different Payment Localities 55 Modifier [...]
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Posting Date: 08/04/2022
Modifier 51
Modifier 51 Table of Contents Modifier 51 Definitions Appropriate System Usage Inappropriate System Usage Additional Information Related Content [Return to Top] Modifier 51 Modifier 51 denotes more than one medical/surgical [...]
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Posting Date: 08/05/2022
Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
Modifier 59 and the Subset Modifiers XE, XP, XS, XU – Specific Modifiers for Distinct Procedural Services Table of Contents Continued Use of Modifier 59 after 1/1/2015 Modifier 59 Appropriate Usage Modifier XE Modifier XP [...]
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Posting Date: 08/04/2022
Co-Surgery/Team Surgery/Assistant Surgery Modifiers
Co-Surgery/Team Surgery/Assistant Surgery Modifiers Table of Contents Co-Surgery/Team Surgery/Assistant Surgery Modifiers Co-Surgery (Modifier 62) Team Surgery (Modifier 66) Assistant-at-Surgery Services Assistant Surgery Modifiers [...]
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Posting Date: 08/04/2022
Correct Usage of Modifier 79 for Multiple Procedures
Correct Usage of Modifier 79 for Multiple Procedures National Government Services Medical Review department has identified widespread problems with the use of modifier 79 for multiple procedures. The global surgical package was established by [...]
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Posting Date: 02/14/2024
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 [...]
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Posting Date: 07/07/2021
MSP Right Hand
Helpful Resources BCRC Contact Information Note: Providers should not contact the BCRC to set up new MSP records. Instead, report MSP coding on your MSP and conditional claims. Providers should not contact the BCRC to correct MSP records to [...]
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Posting Date: 10/03/2024
Claim Denials During Hospice Elections Liability Reminder
Claim Denials During Hospice Elections Liability Reminder When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatment and palliative care associated with it in [...]
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Posting Date: 10/02/2024
Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin
Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin L39513 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39513&ver=3&contractorName=1[...]
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Posting Date: 10/02/2024
Pain Management
Pain Management spine, spinal, trigger, injection, ganglion L33622 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=33622 A52863 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52863 A59302 [...]
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Posting Date: 10/02/2024
Vitamin D Assay Testing
Vitamin D Assay Testing Bone Density, Osteopenia L37535 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37535 A57736 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57736 A55852 [...]
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Posting Date: 11/07/2022
Diabetes Self-Management Training
Preventive Services Guide Diabetes Self-Management Training According to the Centers for Disease Control and Prevention, approximately 38.4 million Americans have diabetes and 27.2 million people aged 65 years or older (48.8%) have been [...]
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Posting Date: 10/08/2021
Initial Preventive Physical Examination
Preventive Services Guide Initial Preventive Physical Examination The IPPE is also known as the “Welcome to Medicare Preventive Visit.” The goals of the IPPE are health promotion and disease detection and prevention. Table of Contents [...]
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Posting Date: 10/01/2024
Provider Enrollment: Completing the CMS-855A Paper Application
During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.
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Posting Date: 10/08/2021
Bone Mass Measurements
Preventive Services Guide Bone Mass Measurements Table of Contents Bone Mass Measurements Risk Factors Coverage Guidelines and Frequency Limits Coverage Criteria HCPCS/CPT Coding HCPCS/CPT Codes ICD-10 Codes Diagnosis [...]
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Posting Date: 09/27/2024
Institutional Providers: Revised CMS-855A version (09/24) Medicare Enrollment Application
Institutional Providers: Revised CMS-855A version (09/24) Medicare Enrollment Application Available now is the revised CMS-855A (09/24) paper application that includes a section for SNF to comply with the 2023 Final rule in reporting [...]
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Posting Date: 11/07/2022
Diabetes Screening
Preventive Services Guide Diabetes Screening Table of Contents Diabetes Screening Eligibility for Diabetes Screening Category One Category Two Coverage Criteria and Frequency Limits HCPCS/CPT Coding Diagnosis Coding Cost [...]
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Posting Date: 09/30/2024
Provider Enrollment: Completing the CMS-855B Paper Application
During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group, or supplier.
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Posting Date: 09/30/2024
Provider Enrollment: Reduce Development Requests for Additional Action
Provider Enrollment: Reduce Development Requests for Additional Action In an effort to reduce the request of additional information and/or documentation on provider enrollment applications, verify all required actions are complete prior to [...]
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Posting Date: 09/30/2024
Tobacco Counseling via Telehealth
Tobacco Counseling via Telehealth Health equity in telehealth is the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth helps improve access to healthcare for various [...]
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Posting Date: 10/06/2021
Hepatitis B Virus Vaccine and Administration
Preventive Services Guide Hepatitis B Virus Vaccine and Administration Hepatitis B is a virus that can damage the liver; it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected [...]
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Posting Date: 10/06/2021
Hepatitis B Virus Screening
Preventive Services Guide Hepatitis B Virus Screening Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing [...]
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Posting Date: 10/06/2021
Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
Preventive Services Guide Screening for Sexually Transmitted Infections and HIBC to Prevent STIs Table of Contents Screening for Sexually Transmitted Infections Coverage Criteria High/Increased Risk Factors Frequency Limits [...]
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Posting Date: 09/30/2024
Evaluation and Management Services
Evaluation and Management Services E/M services are professional face to face services rendered by a physician or NPP in various sites or POS. The nature and amount of physician work and documentation will vary by type of service, place of [...]
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Posting Date: 09/30/2024
General Principles of Medical Record Documentation
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 [...]
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Posting Date: 09/30/2024
Related Resources
Related Resources MLN®Booklet: Evaluation and Management Services Guide AMA CPT Guidelines CMS IOM Publication 100-04, Medicare Claims Processing Manual,Chapter 12, Section 30.6 MLN®Fact Sheet: Complying with Medicare [...]
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Posting Date: 09/30/2024
General Principles of Medical Record Documentation
General Principles of Medical Record Documentation The medical record should be complete and legible. The documentation of each patient encounter should include: The reason for the encounter and relevant history, physical [...]
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Posting Date: 09/03/2024
October 2024
In This Issue National Government Services Articles for Part A and Part B Providers Common Working File Host Dark Days for October 2024 Release LCD and Article Updates for August/September 2024 October 2024 EDI Front End Quarterly Release [...]
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Posting Date: 10/04/2024
HCPCS 75580 Returning to Provider With Reason Code 32402
Part A claims being billed with HCPCS 75580 are receiving reason code 32402 when billed with the cardiology revenue code (048X) and cannot process for payment. CMS has determined that claims should be allowed to process when HCPCS 75580 is [...]
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Posting Date: 10/04/2024
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error CMS informed NGS of an issue that occurred on 7/26/2024 impacting some claims from 2021 – 2024 related to the ACO REACH Model. CMS [...]
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Posting Date: 10/04/2024
[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business
[RESOLVED] The Provider Contact Center Is Experiencing Phone Outages for All Lines of Business Our Provider Contact Center Customer Services Representative phone lines were down for all lines of business. Technical support was engaged and the [...]
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Posting Date: 10/04/2024
Cervical Fusion
Cervical Fusion L39770 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39770 A59632 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59632 A59772 [...]
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Posting Date: 10/04/2024
Botulinum Toxins
Botulinum Toxins Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation L33646 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33646 A52848 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5284[...]
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Posting Date: 10/07/2024
Availability of the Essential Medicines Shortage List for the Recently Finalized Separate IPPS Payment for Establishing and Maintaining Access
Availability of the Essential Medicines Shortage List for the Recently Finalized Separate IPPS Payment for Establishing and Maintaining Access On Thursday, 8/1/2024, CMS issued the FY 2025 Medicare Hospital IPPS and LTCH PPS final rule. [...]
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