Update history: LCD and article updates
View the most recent updates for our LCDs and articles. An LCD has been posted for notice to become effective May 17.
Articles
Article Type
Category
Targeted probe and educate (TPE) round results: Evaluation and management services - outpatient office visits
View TPE round results for evaluation and management services - outpatient office visits.
Targeted probe and educate (TPE) round results: Drugs and biologicals (HCPCS J7318-J7329, J7331-J7332)
View TPE round results for drugs and biologicals (HCPCS J7318-J7329, J7331-J7332).
Hospital outpatient department (OPD) prior authorization exemption process
Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to...
Prior authorization program for repetitive, scheduled non-emergent ambulance transports (RSNAT)
CMS has implemented the prior authorization program for certain repetitive, scheduled non-emergent ambulance transports in...
Ambulance Prior Authorization Documentation Requirements
Review this checklist to learn about the documentation requirements to ensure an affirmed decision on your prior authorization...
View NCDs
CMS develops NCDs to describe circumstances for Medicare coverage nationwide for an item or service. NCDs generally outline the...
Fast facts: CERT vaccine and roster billed claims
Read this article to learn more about CERT reviews for vaccine and roster billed claims.
Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services
CMS is implementing a five-year demonstration project for the prior authorization of certain services provided in Ambulatory...
Blepharoplasty, eyelid surgery, brow lift, and related services
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly...