Prior authorization program for certain hospital outpatient department services - claim submission guidelines
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any...
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Claims adjusted in error due to an issue that affected some professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model
CMS is aware of an issue that occurred on July 26 that affected some 2021-2024 professional claims for the Accountable Care...
Intensive outpatient program (IOP) billing requirements for institutional services
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with...
Prior authorization for ambulance transports is for repetitive transports
A repetitive service is defined as medically necessary ambulance transportation that is furnished three or more times during a...
COVID-19 vaccine and monoclonal antibody billing for Part B providers
This article will assist Medicare Part B providers with proper billing relating to COVID-19 vaccine and monoclonal antibody...
Prior authorization: Facet joints and cervical fusion
CMS has removed CPT codes 64492 and 64495 from the listing of codes requiring prior authorization. View our article to learn...
Ambulance modifiers
Ambulance modifiers identify the place of origin and destination of the ambulance trip and must be included on all ambulance...
Prior authorization fax coversheet
CMS is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or...
Prior authorization (PA) for hospital outpatient department (OPD) services: tips and reminders
The following are tips and reminders that will assist providers in avoiding a delay or dismissal of a prior authorization...
Hospice: New requirement for physicians who certify patient eligibility
Physicians who certify patient eligibility for hospice services must enroll in Medicare or opt out effective for claims...