Billing
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 34554 if modifier ER, PO, or PN is billed on all service lines, and…
COVID-19 roster billing for Part B providers
A standard roster form for COVID-19 vaccination and mAb infusion has been created. This article provides information for billing the vaccine, infusion, and administration codes.
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 bill for these items.
First Coast supports Part B billing awareness during the month of June
Keep the momentum going -- navigate Part B post-payment claim scenarios! Attend the Medicare Navigator Part B Billing series and gain the tools to submit compliant redeterminations, correct claims…
Cardiac and pulmonary rehabilitation programs
Medicare pays for cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR), and pulmonary rehabilitation (PR) programs if specific criteria are met. These criteria include coverage…
Crossover claims: Supplemental insurance and Medigap plans
Read this article for more information on claims being crossed over to supplemental insurance and Medigap plans.
Referring and reference laboratories
View this outline of key definitions, billing responsibilities, and claim submission requirements for referred laboratory services to ensure correct reporting, avoid duplicate billing, and maintain…
Referring and reference laboratories
View this outline of key definitions, billing responsibilities, and claim submission requirements for referred laboratory services to ensure correct reporting, avoid duplicate billing, and maintain…
New high-cost cell-based gene therapy drug Encelto approved for use in the ambulatory surgical center (ASC) setting
Medicare approved the groundbreaking new cell-based gene therapy drug, Encelto, for use in the ambulatory surgical center setting, effective for claims with dates of service on or after October 1,…
Process for CPT category III T codes
Review the revised listing of CPT category III T codes that require documentation to avoid negative impacts to your claims.