cms

  1. A

    Wiki CMS Telehealth changes 2024 ABA Therapy

    Hello, I am working for an ABA Therapy company and stumbled across the MLN for telehealth coding. According to this document and the list of telehealth-approved codes, ABA therapy can not be performed with audio only. Does anyone have any additional information regarding the new telehealth...
  2. C

    Wiki H0006 Alcohol and/or drug services; case management

    H0006 Alcohol and/or drug services; case management I've been asking out state Medicaid about this code and they are saying "CMS changed the NCC edit on this code from 15 mins to per service back on 9/2021." Where would I be able to look this up to verify that H0006 is per session and no...
  3. A

    Wiki CMS Rescinds UDT NCCI Edits

    Good news for my fellow lab billers! CMS has decided to retroactively rescind/delete the urine drug testing NCCI edits back to 7/1/23. I'm not sure what they hoped to accomplish with the edit, but apparently it wasn't the solution they hoped for. If they were looking for ways to put further...
  4. A

    Wiki G2086-G2088 HCPCS Level II 2023 book not in line with CMS Federal Rule

    CMS states: "There are a range of services described by existing coding under the PFS that can be billed for treatment of mental health conditions, including SUDs, such as individual, group, and family psychotherapy. Over the past several years, in collaboration with interested parties and the...
  5. C

    Wiki CMS 99358 (2022)

    Good morning, Do you have any tips on billing this code? Does it have to be on a separate claim to the actual face-to-face encounter? All services were rendered in 2022. Thank you
  6. M

    Wiki Office visit + preventative counseling for MEDICARE patient

    Hello, I do medical billing for a "weight management" doctor (AKA a primary care physician whose niche is providing weight loss medicines and counseling). As some of you may know, Medicare does not accept the typical weight prevention counseling codes other commercial carriers accept...
  7. E

    Wiki PHYSICIAN ORDER REQUIREMENTS

    Does anyone have a CMS link to physician order requirements in the outpatient facility settings? (Think injection, infusions, etc). I am having a hard time presenting anything with specific details; i.e. written diagnosis. Thanks!
  8. jkyles

    Wiki Proposed fee schedule 2022 & other fun summer reading material

    Good morning, Just a heads up that the proposed rule for 2022 is out and includes - among other things - proposed new guidelines for critical care services and split/shared in the facility setting, more on telehealth and of course a preview of the new codes (Table 13). The comment period for...
  9. Z

    Wiki Am I being asked to commit fraud?

    I have a question for those who have been doing this longer than I have. First, let me set the scene. I'm a recently credentialed CPC (Early March 2021) who is working at a third party biller who ships and bills for Remote Patient Management devices. BP Cuffs, Scales, Glucometers, and (soon)...
  10. C

    Wiki Laboratory Billing

    I'm having a difficult time finding the CMS rule stating a clinician's office cannot bill the entirety of a lab procedure when part of that procedure was performed at an independent lab. Is this something I've remembered incorrectly or am I thinking too hard? Can someone please help?
  11. Mtee

    Wiki Medicare A and B billing

    Hello, I am looking for references for what claims forms are billed to Part A and Part B. I think it is that the UB-04 goes to Part A and the CMS-1500 form goes to Part B, but I would love any official reference to verify this. I'm also looking for a list of what services are billed to Part A...
  12. Z

    Wiki Coding R78.81 with F11.10

    I was told by an insurance company that as per CMS Guidelines ICD-10 code R78.81 and F11.10 cannot be billed together. I am having a hard time finding information on the reason why. Does anyone know why these two codes can't be billed together?
  13. E

    Wiki CMS/Medicaid Pay To Provider Question

    Hello, We have been having problems with our billing system where MEDICAID claims are paying to the member's PCP, not the rendering provider. Before going to the manufacturer to get changes to our billing system, is this a Medicaid or CMS rule/regulation? I have searched their website through...
  14. C

    Wiki Health Care Provider Taxonomy or Characteristics Code Set Question

    I understand that the selection of a taxonomy is not contingent upon any certification or license. As taxonomy codes have evolved and the list has expanded, is there a best practice or guiding principle in selection? Are publications available that reference CMS crosswalk, payer claim impact and...
  15. C

    Wiki 10160 vs 49406

    Hello All, hoping someone can assist i have IR providers who do a drainage via YUEH catheter of peritoneal abscess but they remove the catheter following the procedure so normally this would be coded to 10160 but for CMS Medicare they are denying this because of the LCD in place- the dx does...
  16. F

    Wiki Medicare non-payment on remittance advice

    Hello, I bill for a psychiatry office in Florida. Currently, on our remittance advices, we have had a lot of non-payments (they are indicated as paid to the patient on the RA). The CARC and RARC codes don't seem to give any reasons. My best assumption is that these are take backs for...
  17. H

    Wiki ABN forms

    With all of the changes in pain medicine management, our practice will start billing for the urine drug screens (80305). CMS does not currently pay for this so we are considering having the patient's sign an ABN form to cover the cost of the cup. Is anyone in the same situation? The LCD is vague...
  18. K

    Wiki possible limits on billing 96127 emotional/behavioral assessments

    My new boss says that we can only bill for these assessments once per patient. I see that we are allowed only 2 units on a claim but I can't see anywhere where it says bill only once per patient. Anybody out there have any other info on this?
  19. J

    Wiki UB-04 Form - Where does an NDC go?

    Can anyone advise where an NDC would go on a UB-04 form? I have always put in in FL 43 in the revenue description box but I am having a payor push back and they want it in FL 80... has anyone ever put NDC information in that box? Thanks in advance
  20. E

    Wiki 92998 MUE history

    Is there a resource where I can access the MUE limit for 92998 in 2014 and 2015?
  21. C

    Wiki Implantable Cardiac Defibrillator Worksheet

    Does anyone have a form their offices use to assist the physician in documenting their ICD decision making for medical necessity? I have a surgeon who is requesting one and it would be very helpful to not have to start from scratch. I appreciate the help! Cindy
  22. A

    Wiki Home health POS question

    Hello Does anyone have an CMS information that states physicians cannot bill E/M codes 99211-99215 with POS 12 (home). I have seen some doctors bill with this POS and E/M codes and I am not sure if CMS will allow the location to bill with office/outpatient. thanks
  23. P

    Wiki EKG readings done off site

    Good Morning It just came to my attention yesterday that our Cardiologist has taken over doing all the EKG readings for all of our sites. Generally, I don't think this is an issue but I am not well versed in this type of situation and was unable to find anything on the CMS website that...
    • plarabee
    • Thread
    • cms ekgs reading sites website
    • Replies: 0
    • Forum: Cardiology
  24. M

    Wiki Z79.4 Long Term Insulin Use

    Has the guidelines/description changed for Long Term Insulin Use from ICD-9 to ICD 10 to include use of long term DM medication as long term insulin use too? I have received information from several parties that CMS and plan are now including long term DM medication with the code of long term...
    • mamoore56
    • Thread
    • cms insulin medication plan term
    • Replies: 10
    • Forum: ICD-10
  25. M

    Wiki PQRS in ED

    I know PQRS will be changing in the next coming years. But I wanted to see what PQRS codes other ED's report to CMS.
  26. B

    Wiki professional billing- admission date matching the facility's admission date

    Hi, I am trying to find supporting documentation (mainly from CMS) that it is or is not a requirement that the admission date we use matches the facility's admission date. We are hospitalists that bill for the professional components. So if we do an H&P on 1/26/2016 and use admit date 1/26/2016...
  27. C

    Wiki Gazyva

    Has anyone had any experience billing Gazyza? It's a 1,000mg vial-day 1 100mg and day 2 900mg. Trying to find info on CMS site.
  28. C

    Wiki General question Re: Status Indicators

    Does anyone know a source that could provide education on status indicators, aside from the CMS website? Any ideas are appreciated. Thanks
  29. B

    Wiki ICD 10 CM Updates in 2016

    Has anyone seen anything official as to whether or not there will be any updates to ICD 10 CM in October, 2016? All I can find is the CMS notice that updates were frozen until 10/2016. Thanks!
    • BeverPrudh
    • Thread
    • 10/2016 2016 cms icd updates
    • Replies: 1
    • Forum: ICD-10
  30. S

    Wiki Success with Batch Attestation Upload Option for EPs??

    Hello! I was wondering if anyone has had success with the Batch Attestation Upload option for EPs on the CMS EHR website, and can advise as to how it's done for a group of EPs? The option went live last year, but the only instructions CMS has uses an EH as an example. I've called the EHR...
  31. K

    Wiki Bilateral Codes

    Can someone please post the link to CMS that has the page for Bilateral codes? I've looked all over their website and I would prefer taking on an actual Labyrinth instead. The actual link, so that when I click on it it will take me right to the page, not the CMS homepage. Thank you for your help...
  32. S

    Wiki 80301 and 80302 bundled?

    Has anyone seen any information on these codes being bundled? We are billing to some of our Medicaid plans and 80302 pays but 80301 denies stating CCI incidental to or part of primary procedure, CMS medicaid NCCI unbundling? Just looking for any insight into this. Thank you. We use an...
    • skweston
    • Thread
    • 80301 80302 bundled cms medicaid
    • Replies: 1
    • Forum: Anesthesia
  33. J

    Wiki Cms 3 day payment rule question

    i have the article by JustCoding regarding CMS 3 days payment rule. However, it seems to be driven more towards outpatient facilities such as a Hospital's physical therapy facility, which is outpatient, then regular office visits. Would this apply to regular office visits? If the patient was...
  34. A

    Wiki V53.02 as principle dx.

    Forgive me if this has been asked but I was wondering if this code would be used as a principle diagnosis code when a patient has a routine medical device change due to battery depletion, etc. Is there a CMS reference on this subject and would it cause the claim to pay at a reduced rate. Thanks...
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