skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:

Disclaimer

LICENSE FOR USE OF "PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY" (CPT), FOURTH EDITION End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American Medical Association (AMA).

All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials:
Local Coverage Determinations (LCDs),
Local Medical Review Policies (LMRPs),
Bulletins/Newsletters,
Program Memoranda and Billing Instructions,
Coverage and Coding Policies,
Program Integrity Bulletins and Information,
Educational/Training Materials,
Special mailings,
Fee Schedules;

internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website. Applicable FARS/DFARS restrictions apply to government use.

AMA Disclaimer of Warranties and LiabilitiesCPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.

CMS DisclaimerThe scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

AMA - U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a )June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

ADA CURRENT DENTAL TERMINOLOGY, (CDT)
End User/Point and Click Agreement: These materials contain Current Dental Terminology (CDTTM), Copyright © 2016 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ON THE BUTTON LABELED "DECLINE" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the ADA website.

Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use.

ADA DISCLAIMER OF WARRANTIES AND LIABILITIES: CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement.

CMS DISCLAIMER: The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

End Disclaimer



This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]

Answers

Modified: 1/26/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 9/11/2022
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 11/23/2022
Modified: 11/23/2022
Question relating to CMS guidelines regarding use of ABN in relation to ambulance services.
Modified: 11/27/2022
FAQ regarding signature requirements on ambulance claims
Modified: 11/27/2022
The AMA – CPT E/M Office Revisions – Level of medical decision making table indicates *Each unique test, order, or document contributes to the combination of two or combination of three in Category 1.
Modified: 1/3/2023
Questions and answers pertaining to Medicare Part A/B appeals and redeterminations.
Modified: 1/25/2023
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 10/25/2022
Modified: 1/13/2023
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 10/20/2022
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 12/13/2022
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 1/4/2023
Modified: 11/27/2022
This field is not required to use the score sheet. It was added to allow the user to enter the patient name, or any other patient-specific identifying information for printing and/or filing purposes only.
Modified: 12/30/2022
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Modified: 12/30/2022
Modified: 1/25/2023
Question and answer pertaining to services which can be billed "incident to" another provider's service.
Modified: 10/26/2022
Question and answer referencing mailing address for CMS-1500 paper claim form.
Modified: 1/30/2023
Question and answer pertaining to Medicare enrollment applications.
Modified: 10/6/2022
Question and answer pertaining to early offset of a demanded debt.
Modified: 1/5/2023
Modified: 1/3/2023
Review
Modified: 1/26/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 1/26/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 12/28/2022
Modified: 12/28/2022
Question and answer pertaining to entering place of service (POS) codes on claims.
Modified: 12/28/2022
Question and answer regarding the indication of an anti-markup diagnostic service on a claim.
Modified: 1/17/2023
Question and answer pertaining to indicating provider numbers on claims.
Modified: 1/17/2023
Question and answer regarding the indication of rendering physician billing numbers on claims.
Modified: 12/28/2022
Question and answer about reporting service facility location information on a claim.
Modified: 1/3/2023
Modified: 1/17/2023
Modified: 11/23/2022
How to avoid RUCs [First Coast Education Action Team]
Modified: 12/23/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were rejected as unprocessable with tips and resources to help you avoid many of these errors. [First Coast Education Action Team]
Modified: 12/16/2022
Modified: 12/28/2022
Question and answer pertaining to timely filing of claims.
Modified: 12/28/2022
Modified: 12/13/2022
Modified: 11/22/2022
Modified: 12/28/2022
Modified: 12/13/2022
Modified: 12/28/2022
Modified: 12/13/2022
Modified: 12/15/2022
Questions and answers pertaining to ambulance services.
Modified: 1/13/2023
Modified: 12/22/2022
Question and answer regarding denial reason code 54MUE.
Modified: 11/24/2022
Modified: 10/20/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Modified: 1/13/2023
[First Coast Education Action Team]
Modified: 1/13/2023
[First Coast Education Action Team]
Modified: 1/13/2023
[First Coast Education Action Team]
Modified: 1/27/2023
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Modified: 11/24/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Modified: 12/13/2022
Question and answer pertaining to ANSI code OA-18.
Modified: 1/13/2023
[First Coast Education Action Team]
Modified: 11/11/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims denied with tips and resources to help you avoid many of these errors.
Modified: 1/26/2023
Modified: 10/4/2022
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 1/12/2023
Modified: 1/18/2023
Modified: 1/18/2023
Modified: 1/13/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 12/29/2022
Submitted in response to provider E/M inquiries
Modified: 12/30/2022
Submitted in response to provider E/M inquiries
Modified: 12/29/2022
Submitted in response to provider E/M inquiries
Modified: 12/30/2022
Submitted in response to provider E/M inquiries
Modified: 10/4/2022
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 11/22/2022
Modified: 1/12/2023
[CR 6417]
Modified: 12/24/2022
Questions and answers pertaining to the 2% reduction in Medicare payments due to federal sequestration.
Modified: 12/22/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/22/2022
Here is a question relating to use of GY modifier on ambulance claims, if dual diagnosis requirement still applies.
Modified: 1/5/2023
Modifier 24 FAQ #6
Modified: 11/27/2022
Modified: 12/22/2022
Question and answer pertaining to services which can be billed incident to another provider's service.
Modified: 1/13/2023
Modified: 12/16/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 1/13/2023
Modified: 1/24/2023
return documentation, medical records
Modified: 1/13/2023
Modified: 9/3/2022
Modified: 1/12/2023
Question and answer pertaining to how providers can determine when Medciare is the secondary payer. [CMS website]
Modified: 1/13/2023
TPE selection process
Modified: 1/13/2023
return documentation, medical records
Modified: 1/13/2023
Modified: 1/21/2023
Question and answer pertaining to how Medicare secondary payment is determined.
Modified: 1/6/2023
error rate
Modified: 9/2/2022
Modified: 1/20/2023
Question and answer pertaining to Internet-based PECOS.
Modified: 10/1/2022
Modified: 1/13/2023
review results
Modified: 1/13/2023
Modified: 10/1/2022
Modified: 1/13/2023
education call attempts
Modified: 12/16/2022
Modified: 11/23/2022
Modified: 11/29/2022
Changed traditional Medicare for original Medicare as per 11.28.22 email Writing style updates for POE
Modified: 10/25/2022
Answer to the question regarding a timetable for coding inpatient cost outlier claims.
Modified: 1/13/2023
Modified: 12/24/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/15/2022
Question regarding changes made to consolidated billing for ambulance transport for skilled nursing facility residents according to transmittal MM10550.
Modified: 1/17/2023
Modified: 10/20/2022
Questions and answers pertaining to Medicare secondary payer claims.
Modified: 1/3/2023
Questions and answers pertaining to specific modifiers.
Modified: 1/3/2023
Questions and answers pertaining to specific modifiers.
Modified: 1/3/2023
Questions and answers pertaining to specific modifiers.
Modified: 1/3/2023
Modifier 24 FAQ #2
Modified: 1/26/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 12/22/2022
E/M FAQ question number 13
Modified: 1/12/2023
Modified: 1/23/2023
Modified: 1/18/2023
Modified: 1/6/2023
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Modified: 10/1/2022
Modified: 11/27/2022
The worksheet will only provide a suggested code for the E/M level of service. A note will populate alerting you that the service may qualify for additional prolonged services with a link to the prolonged service information.
Modified: 9/28/2022
Question and answer pertaining to Medicare enrollment applications.
Modified: 1/26/2023
Question and answer pertaining to Internet-based PECOS.
Modified: 1/18/2023
Questions and answers pertaining to Part A provider enrollment issues, including electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 10/4/2022
Question and answer pertaining to providers that need to enroll in a different state using Internet-based PECOS.
Modified: 1/18/2023
Modified: 1/5/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 11/16/2022
Modified: 1/5/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 12/28/2022
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 1/5/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 11/24/2022
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims. [First Coast's Education Action Team]
Modified: 1/26/2023
[First Coast Provider Outreach and Education]
Modified: 1/17/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 12/23/2022
Modified: 10/20/2022
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 12/22/2022
Question and answer pertaining to CARC CO 144
Modified: 10/20/2022
When responding to a CERT request for medical records, can records from a referring or consulting physician be included? [First Coast Provider Outreach and Education]
Modified: 12/30/2022
Modified: 12/23/2022
Revised, no comments
Modified: 11/10/2022
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 11/10/2022
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 12/29/2022
To help you increase the number of claims that pass through edits and into processing, here are the top reasons for rejected claims as well as tips and resources to help you avoid many of these errors.
Modified: 1/26/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 1/5/2023
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 1/26/2023
Questions and answers pertaining to hospice.
Modified: 11/22/2022
Questions and answers pertaining to verifying beneficiary eligibility.
Modified: 12/22/2022
Question and answer pertaining to Medicare enrollment applications.
Modified: 12/16/2022
Modified: 12/23/2022
Modified: 10/21/2022
Questions and answers pertaining to operating physician’s NPI was missing.
Modified: 11/24/2022
Questions and answers regarding reasons for returned to provider (RTP) and rejected claims.
Modified: 10/20/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Modified: 11/23/2022
To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors.
Modified: 10/25/2022
Question and answer cost outlier claims.
Modified: 12/14/2022
Modified: 11/27/2022
Modified: 12/22/2022
Modified: 1/26/2023
Modified: 1/18/2023
Modified: 11/27/2022
It is suggested to score both the time and medical decision making to allow billing of the highest scoring component.
Modified: 11/27/2022
The worksheet allows for multiple start and end times to be entered. The worksheet will calculate the total time. Be sure to click “add” to enter multiple start and end times.
Modified: 11/27/2022
The office/outpatient scoring allows you to enter the total time or start and end times.
Modified: 1/26/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 11/24/2022
Modified: 1/25/2023
Answers to questions pertaining to Part B provider enrollment issues, including application status, electronic funds transfer (EFT), CMS 855 forms, and PECOS.
Modified: 1/19/2023
Content review
Modified: 1/3/2023
Review
Modified: 1/12/2023
Question and answer pertaining to a duplicate primary payment.
Modified: 1/12/2023
Question and answer pertaining to an overpaid claim.
Modified: 1/5/2023
Question and answer pertaining to receiving an overpayment letter.
Modified: 1/12/2023
Question and answer pertaining to what form providers use to notify Medicare of a MSP overpayment.
Modified: 12/9/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 11/24/2022
Question and answer pertaining to a redetermination or reconsideration appeal requested.
Modified: 10/28/2022
TPE appeals
Modified: 10/28/2022
Modified: 1/12/2023
Question and answer pertaining to what if an MSP refund is made but the other insurer’s EOB is not sent with the payment.
Modified: 1/12/2023
Question and answer pertaining to what providers must do when refund is not made when notifying Medicare of a DPP.
Modified: 1/5/2023
Question and answer pertaining to an overpayment refund that cannot be made at one time.
Modified: 1/12/2023
Question and answer pertaining to what MSP is.
Modified: 1/13/2023
Modified: 1/13/2023
Modified: 1/5/2023
Question and answer pertaining to what providers must do when a duplicate primary payment is received.
Modified: 1/13/2023
Modified: 12/8/2022
Modified: 1/13/2023
resources, policies, references
Modified: 10/25/2022
Question and answer to cost outlier claims.
Modified: 10/25/2022
Answer to the question of when OSC 70 should be used for cost outlier claims.
Modified: 4/24/2022
LCD, NCD
Modified: 12/22/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/21/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/21/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 1/25/2023
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/16/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 1/25/2023
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 1/25/2023
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/21/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/22/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/21/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/21/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 12/24/2022
Questions and answers pertaining to Medicare fee schedules and fee schedule-related issues.
Modified: 1/13/2023
additional documentation request
Modified: 12/16/2022
Question and answer regarding the indication of referring provider information on claims.
Modified: 11/12/2022
Question and answer pertaining to what the MSP Contractor is, formally known as BCRC.
Modified: 11/27/2022
The icons are clickable informational links to assist you with understanding the term used in the score sheet.
Modified: 9/2/2022
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.