Medical review

View TPE round results for drugs and biologicals (HCPCS J7318-J7329, J7331-J7332).

View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).

CMS annually updates the durable medical equipment prosthetics, orthotic, and supplies (DMEPOS) for DME MAC and Part B MAC jurisdictions list.

Access tools and forms related to the prior authorization program, CERT, and provider audit.

Access tools and forms related to the prior authorization program, CERT, and provider audit.

CMS has implemented the prior authorization program for certain repetitive, scheduled non-emergent ambulance transports in Florida, Puerto Rico and the US Virgin Islands. Learn more about the program…

This checklist is an aid to assist skilled nursing facilities with responding to medical record documentation requests.

Find guidance on ordering DME-related supplies.

Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate.

Effective for dates of service July 1, 2020, and after, hospital outpatient department (HOPD) providers will need to obtain prior authorization (PA) for panniculectomy, excision of excess skin and…