Ophthalmology
Information pertaining to ophthalmology services, including links to LCDs/NCDs, education, CMS IOMs, and other resources.
Telehealth service modifiers
Telehealth modifiers should be submitted with distant site telehealth services. Patient must be present and participating in...
Fast facts: CERT claim sampling and review process
Read this article for information about CERT claim sampling and the review process.
Are air ambulance services payable when a patient requires a transfer from one hospital to another hospital?
Yes, air ambulance services are payable from hospital to hospital, if it meets medical appropriateness criteria and the transferring hospital does not have adequate facilities to provide the medical services needed by the patient. We, at First Coast, will only reimburse to the nearest available medically appropriate facility.
Reference
Telehealth enrollment scenarios – extended address waiver through December 31
During the COVID-19 public health emergency (PHE), CMS allowed providers to render telehealth services from their home without...
MLN Connects for March 27, 2025
This edition includes information on extension of Medicare provisions, HCPCS codes and clinical laboratory improvement amendment...
Hospital outpatient department (OPD) prior authorization (PA) exemption process reminders
Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted...
Quarterly update to the Medicare Physician Fee Schedule (MPFS) - April 2025
These changes will be implemented April 7, effective for services January 1 and after.
Medicare Diabetes Prevention Program (MDPP) 2025 changes
Effective January 1, CMS has removed the MDPP bridge payment (HCPCS code G9890) from the 2025 fee schedule and updated the...
2025 payment rates for home infusion therapy (HIT)
Download this zipped file compressed file for the locality adjusted rates for home infusion therapy for 2025.