Billing
Billing instructions for implanted prosthetic devices with HCPCS code C9899: Reason code 32354
To promote consistency in the claim submission process, follow these instructions when billing HCPCS code C9899.
New Fiscal Intermediary Shared System (FISS) consistency edit to validate attending physician NPI
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.
Goniotomy procedures performed in conjunction with insertion of a glaucoma drainage device is considered not reasonable and necessary
View this reminder regarding correct reporting of micro or minimally invasive glaucoma surgery (MIGS).
Multiple procedure payment reduction on the professional component and technical component of certain diagnostic imaging procedures
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.
Payment of codes for chemotherapy administration and nonchemotherapy injections and infusion
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read this article for more information.
Responding to additional documentation requests (ADRs)
This article explains how to respond to ADRs.
Allowing electronic submission of medically denied cancel claims
To determine if a claim was medically reviewed, providers should submit the requests correctly.
Multiple procedure payment reduction
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…
Allowing electronic submission of medically denied cancel claims, reason code 30941
To determine if a claim was medically reviewed, providers should submit the requests correctly.
Payment of codes for chemotherapy administration and nonchemotherapy injections and infusion
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read this article for more information.