Emergency Department

Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]

Behavioral/Mental Health Services

Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Answer: As of 1/1/2025, CMS has permanently extended permission for behavioral and mental [...]

Consultations

Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]

Update-CMS Delay of Skin Substitutes Effective Date

Update-CMS Delay of Skin Substitutes Effective Date As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin [...]

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?