skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:

By clicking Continue below you agree to the following:

LICENSE FOR USE OF "PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY" (CPT), FOURTH EDITION End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American Medical Association (AMA).

All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials:
Local Coverage Determinations (LCDs),
Local Medical Review Policies (LMRPs),
Bulletins/Newsletters,
Program Memoranda and Billing Instructions,
Coverage and Coding Policies,
Program Integrity Bulletins and Information,
Educational/Training Materials,
Special mailings,
Fee Schedules;

internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website. Applicable FARS/DFARS restrictions apply to government use.

AMA Disclaimer of Warranties and Liabilities CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.

CMS Disclaimer: The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

AMA - U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a )June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

ADA CURRENT DENTAL TERMINOLOGY, (CDT)
End User/Point and Click Agreement: These materials contain Current Dental Terminology (CDTTM), Copyright © 2016 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ON THE BUTTON LABELED "DECLINE" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the ADA website.

Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use.

ADA DISCLAIMER OF WARRANTIES AND LIABILITIES: CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement.

CMS DISCLAIMER: The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

End Disclaimer


This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email addresses must be separated by a semicolon.]

Billing news

Modified: 4/19/2024
This article informs you and your vendors about changes that will allow you to request reopening of claims electronically.
Modified: 10/1/2024
Avoid negative impacts to your claims by providing the medical records for the T codes claim submissions indicated in this article.
Modified: 10/1/2024
Effective September 19, avoid negative impacts to your claims by providing medical records with your initial claim submissions of the laboratory and pathology codes indicated in this article.
Modified: 9/30/2024
This article will assist Medicare Part A providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 9/30/2024
This article will assist Medicare Part B providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 9/22/2024
Modified: 9/12/2024
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with reason code 34963. Read on for more information.
Modified: 9/4/2024
This article provides guidance to avoid inappropriately billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing, including deductibles, coinsurance, and copayments.
Modified: 8/28/2024
To promote consistency in the claim submission process, follow these instructions when billing HCPCS code C9899.
Modified: 8/12/2024
CMS has issued the deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [CR13365]
Modified: 8/9/2024
The Code of Federal Regulations requires that, with certain exceptions, diagnostic tests covered under the Social Security Act and payable under the physician fee schedule must be performed under the supervision of an individual meeting the definition of a “physician.”
Modified: 8/4/2024
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
Modified: 7/15/2024
Effective July 2, Medicare will pay for Kisunla for monoclonal antibodies directed against amyloid for the treatment of Alzheimer's disease. Please review this article and pay close attention to the billing instructions detailed within.
Modified: 7/11/2024
This information outlines the process for the 935 recoupment.
Modified: 6/22/2024
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read this article for more information.
Modified: 6/21/2024
Read the following article for the most common billing requirements for end-stage renal disease related services.
Modified: 6/7/2024
Are you providing outpatient therapy services on institutional claims and receiving reason code 34963 indicating the attending physician is invalid? Read this article for assistance to resolve your claim returns.
Modified: 6/6/2024
Read this article to learn more about radioactive diagnostic agents for positron emission tomography of prostate-specific membrane antigen positive lesions in men with prostate cancer.
Modified: 6/6/2024
View this page to easily locate information related to drugs and biologicals, such as billing and coding guidelines, related policy information, IOMs, and resources.
Modified: 5/29/2024
Medicare applies a MPPR to the payment of select therapy services. The reduction applies to HCPCS codes contained on the list of “always therapy” services, regardless of the type of provider or supplier furnishing the services. Find out the details here.
Modified: 5/18/2024
To determine if a claim was medically reviewed, providers should submit the requests correctly. [Provider Outreach and Education]
Modified: 5/18/2024
To determine if a claim was medically reviewed, providers should Submit the requests correctly. [Provider Outreach and Education]
Modified: 5/18/2024
Read this article to learn how to resolve claim rejects for reason code 34963. [First Coast Provider Outreach and Education]
Modified: 5/18/2024
First Coast rejects claims returned to a provider more than three times with reason code 70RTP. Read this article to learn more about this reason code.
Modified: 5/15/2024
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with substance use disorders. This article addresses institutional billing requirements for these new services.
Modified: 5/15/2024
As a result of the termination of the public health emergency (PHE) on May 11, 2023, CMS will no longer pay for certain HCPCS codes for COVID-19 laboratory tests.
Modified: 5/15/2024
Modified: 5/8/2024
View information related to the 340B Drug Payment Policy Remedy
Modified: 5/7/2024
Most services billed to Medicare must reflect the exact date the service was performed for or provided to the patient. This article discusses situations where there have been questions from the provider community. [SE17023]
Modified: 5/3/2024
Are you sending hardcopy mail to submit your requests to First Coast? Avoid the wait. There are faster and easier ways to send your requests to us. Learn about the electronic options available for you.
Modified: 4/29/2024
The MPPR on diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the same session on the same day. Find out the details here.
Modified: 4/26/2024
This article will assist providers with proper billing relating to the Mpox vaccine and laboratory codes. Note: This article was updated September 6 to advise providers to include the product code on claims.
Modified: 4/26/2024
Reminder regarding correct reporting of micro or minimally invasive glaucoma surgery (MIGS)
Modified: 4/25/2024
Documentation is required to process claims for ventricular assist device (VAD) supplies. View this article regarding how to avoid delays when billing VAD supplies.
Modified: 4/24/2024
Medical documentation from ordering physicians plays a vital role in validating medical necessity of ordered laboratory tests.
Modified: 4/20/2024
First Coast reminds providers that CMS updated MLN12124, which was initially released in March 2021, addressing NCD 90.2, Next Generation Sequencing (NGS), and the expiration of certain ICD-10 codes.
Modified: 4/19/2024
Effective June 21, both the standard and expedited PAR coversheets are updated with new fields to improve the prior authorization request (PAR) process. The new fields include the facility fax number, the physician fax number, and a field relating to the implanted spinal neurostimulator.
Modified: 4/18/2024
Providers may be billing these services incorrectly. Please review this article and pay close attention to the billing loop and segment information detailed within. The NCT number has been added to the instructions.
Modified: 4/17/2024
How to bill for skin substitute coes A2001-A2010
Physicians and non-physician practitioners who perform procedure codes CPT 15271-15278 (application of skin substitute) may bill separately for skin substitute codes A2001-A2010.
Modified: 4/13/2024
Data indicates that many providers are not submitting proper diagnosis codes to support the medical necessity for tetanus vaccinations.
Modified: 4/13/2024
This article assists with billing requirements for cochlear implant batteries L8621-L8624.
Modified: 4/12/2024
Are you submitting claims with procedure codes that aren't valid for Medicare? First Coast returns these claims to providers. Read this article to learn more about unprocessable claims.
Modified: 4/11/2024
Important information you must know when billing for Prolia® (denosumab) injections, J0897.
Modified: 4/1/2024
Instructions for billing digitization of glass microscope slides, CPT codes 0751T-0763T.
Modified: 3/16/2024
This article is a reminder for all outpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 3/15/2024
Based on claims reviewed by the recovery audit contractor (RAC), First Coast has identified top denials for services within the category of vein ablation (codes 36475 and 36478) relating to endovenous radiofrequency ablation and laser treatment for lower extremity varicose veins. Common findings indicate that medical necessity and documentation requirements are often not supported within the medical records submitted.
Modified: 3/5/2024
Review this article for guidance on billing the home administration code M0201 when administering the COVID-19 vaccine.
Modified: 2/29/2024
First Coast would like to ensure providers performing biopsy services understand how to properly bill and code for these procedures. Recent data indicates improper billing so we want to provide clarification of top issues we identified.
Modified: 2/25/2024
Important information you should know before billing J9035 for Avastin (bevacizumab).
Modified: 2/22/2024
The requirements for the submission of claims under reciprocal billing and fee-for-time compensation arrangements are the same for assigned and non-assigned claims. This article shows when these requirements apply.
Modified: 1/3/2024
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
Modified: 10/25/2023
CMS has issued the 2023 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. 2023 KX modifier thresholds are also available. [MM12903]
Modified: 10/23/2023
Learn about First Coast's electronic submission options.
Modified: 10/23/2023
Learn about First Coast's electronic submission options.
Modified: 1/3/2023
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 4.625 % is in effect January through July 2023. [Publication 100-04, Chapter 1, Section 80.2.2]
Modified: 6/15/2022
Services designated as “inpatient only” are not appropriate to be furnished in a hospital outpatient department.
Modified: 1/6/2022
This article is a reminder for all inpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 12/1/2021
CMS has issued the 2022 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12507]
Modified: 3/10/2021
CMS has issued the 2021 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12024]
Modified: 12/15/2020
Transmittal 10486, dated November 19, 2020, is being rescinded and replaced by transmittal 10520, dated December 14, 2020, to revise the implementation date from December 14, 2020, to December 21, 2020. All other information remains the same. [CR11642]
Modified: 11/14/2020
Medicare claims processing systems will accept HCPCS code U0001 on April 1, 2020, for dates of service on or after February 4, 2020.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.