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Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing the service. The contractor will then al…
Surgeons append modifier 66 to claims indicating they were on a team of surgeons performing a specific procedure on the same patient during the same operative session. Billing modifier 66 requires documentation to support the claim.
Find information on vaccine payment allowances and fee schedules, links to related enrollment for mass immunizers, and more. Recent additions include upcoming vaccine administration coding updates beginning July 1, 2026, for TOFIDENCE® IV i…
Find information on global surgery billing guidance and other related resources.
View materials and listen to recordings from past meetings.
Read this article to learn more about the CERT awareness month campaign focusing on responding to CERT documentation requests.
View targeted probe and educate (TPE) round results for 15271-15278.
The Medicare Part A DDE user manual has been updated to include changes from the October 2025 release and a new section with tips. October 2025 release details include changes to the inquiry menu. Review the change summary chart at the end…
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Access tools and forms related to the prior authorization program, CERT, and provider audit.