How to assist us
| Types of services |
Supporting documentation |
| New technology |
- Education about the new technology
- A clinical vignette that describes a typical patient, procedure, and/or device
- What specialties are mainly involved in performing the procedure and any specialty guidelines that have been published
- What services may be considered integral when performing the procedure
- Physician time involved
- Direct and indirect costs
- Any supporting materials submitted to the CPT Panel and/or RUC
- Level of physician effort
- Potential crosswalk codes for comparison
- Product life expectancy
- Published literature
- Random Clinical Trial (RCT) results
- Bibliography
- Articles
- Society guidelines
|
| New drugs |
- Education about the new drug
- Average Wholesale Price (AWP) and/or Wholesale Acquisition Cost (WAC)
- Notify us when published or changes are made
|
| New codes |
- Education about the new product or procedure
- A clinical vignette that describes a typical patient, procedure, and/or device
- What specialties are mainly involved in performing the procedure and any specialty guidelines that have been published
- What services may be considered integral when performing the procedure
- Physician time involved
- Direct and indirect costs
- Any supporting materials submitted to the CPT Panel and/or RUC
- Level of physician effort
- Potential crosswalk codes for comparison
- Product life expectancy
- Published literature
- Random Clinical Trial (RCT) results
- Bibliography
- Articles
- Society guidelines
|
- Contractor fees are developed when sufficient information is received.
- Otherwise claims suspend for individual consideration based on the medical record.
- Codes requiring medical documentation upon claim submission are listed in one of our educational articles:
- Once a contractor fee is in the processing system, it is available in our fee schedule look up tool.
References
• CMS ASP Pricing Files
• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, section 20
• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 17
