Fast facts: Responding to CERT additional documentation requests
Read this article for information about responding to CERT documentation requests.
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MLN Connects for June 25, 2026
This edition includes information on the PEPPER relaunch, understanding the telehealth enrollment guide, preventing claim...
Utilizing modifier 91: Repeat clinical laboratory tests
View this article for instructions on how and when to use modifier 91.
How to bill correctly for transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder
First Coast is receiving first-level appeals (redeterminations) based on claim denials for providers not including the ordering...
Hospital off-campus outpatient department reporting requirements
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code...
Inappropriate billing of anesthesia services for epidural steroid injections (ESI) and facet joint injections for pain management
The Office of Inspector General (OIG) conducted a nationwide audit identifying Medicare Part B payments to physicians for...
Credit balance reporting
Details on submitting the credit balance report, submission deadlines, and a tool to check credit balance status.
Understanding radiopharmaceutical fee schedule amounts and billing expectations
Read this clarification regarding how radiopharmaceutical payment limits should be interpreted and how providers are expected to...
2023 payment rates for opioid treatment program (OTP)
This article contains the allowances for opioid treatment program services for service dates January 1 through December 31, 2023...
Claim Reopening Gateway - Help Guide
The Claim Reopening Gateway is an interactive tool that requires no registration or enrollment and offers a quick and easy way...