Effective date of provider termination
 Voluntary TerminationAccording to 42 CFR 489.52, a provider that wishes to terminate its agreement to participate in the Medicare program may do so by: (1) filing with CMS a written notice stating its...
View ArticleMust required Date elements EMC 837
Required Data Element RequirementsThe following Medicare-specific, return as unprocessable requirements in this section and the following two sections are in addition to requirements established under...
View ArticleBilling for Allogeneic Stem Cell Transplants - Revenue code 0819
1. Definition of Acquisition Charges for Allogeneic Stem Cell TransplantsAcquisition charges for allogeneic stem cell transplants include, but are not limited to, charges for the costs of the following...
View ArticleCompleting CMS 838 for - Credit balance
Medicare Credit Balance Report – Provider InstructionsGeneralThe Paperwork Burden Reduction Act of 1995 was enacted to inform you about why the Government collects information and how it uses the...
View ArticleWhy referral required for Enrollment
Why is Ohio Medicaid requiring Ordering, Referring, and Prescribing Providers (ORP Providers) to enroll as Ohio Medicaid providers?This is being done in order to comply with program integrity...
View ArticleOrdering/Referring Physician Documentation Responsibility
Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program. (f) Maintaining and providing access to documentation.(1) A provider or a...
View ArticleCPT CODE 88182, 88184, 88187, 88189
Procedure  Codes and DescriptionGroup 1 Paragraph: Note: The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in...
View ArticleCPT code j1569, j1459, J1572, J1599 - Injection immune globulin
Procedure codes and DescriptionJ1459INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MGJ1556INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MGJ1557INJECTION, IMMUNE...
View ArticleCPT CODE 82306, 82652 - Vitamin D Hydroxy
Procedure Codes and DescriptionGroup 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural (CPT) codes.Group 1 Codes:82306VITAMIN D; 25...
View ArticleCPT 95811, G0399, 95803 - Home sleep testing
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:G0398HOME SLEEP STUDY TEST (HST) WITH TYPE II PORTABLE MONITOR, UNATTENDED; MINIMUM OF 7 CHANNELS: EEG, EOG, EMG, ECG/HEART RATE, AIRFLOW, RESPIRATORY...
View Articlecpt 96360, 96361 - hydration therapy
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:96360Hydration iv infusion init96361Hydrate iv infusion add-onCoverage Indications, Limitations, and/or Medical NecessityIndicationsThe clinical...
View ArticleCPT 93224, 93225, 93228 , 93229 - ECG monitoring WEM
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:93224Ecg monit/reprt up to 48 hrs93225Ecg monit/reprt up to 48 hrs93226Ecg monit/reprt up to 48 hrs93227Ecg monit/reprt up to 48 hrs93228Remote 30 day...
View ArticleCPT FOR Neurophysiology evoked potential NEP
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:92585Auditor evoke potent compre92586Auditor evoke potent limitGroup 2 Paragraph: N/AGroup 2 Codes:95925Somatosensory testing95926Somatosensory...
View ArticleCT abd CPT CODES 74176- 74178
CPT/HCPCS CodesGroup 1 Codes:72192Ct pelvis w/o dye72193Ct pelvis w/dye72194Ct pelvis w/o & w/dye74150Ct abdomen w/o dye74160Ct abdomen w/dye74170Ct abdomen w/o & w/dye74176Ct abd & pelvis...
View ArticleCPT CODE 96910, 96912, 96920
CPT/HCPCS Codes:96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B96912 Photochemotherapy; psoralens and ultraviolet A (PUVA)96913 Photochemotherapy...
View ArticleDenial code N290 AND N257
NPI: Troubleshooting RejectionsDenial Reason, Reason/Remark Code(s)N257: Information missing/invalid in Item 33 - Missing/incomplete/invalid billing provider supplier primary identifierN290:...
View ArticleCPT 99026, 99027, 99360, 99464
CPT Code DescriptionNon-Reimbursable99026 Hospital mandated on call service; in-hospital, each hour99027 Hospital mandated on call service; out-of-hospital, each hour99360 Standby service, requiring...
View ArticleTime span code billing guidelines - 93268 , 93272, 94005
REIMBURSEMENT GUIDELINESTime Span CodesOxford will reimburse a CPT or HCPCS Level II code that specifies a time period for which it should be reported (e.g., weekly, monthly), once during that time...
View ArticleCPT code 36005, 36010, 36011, 33282, 33284
36005 Injection procedure for extremity venography 0.95 $328 $5036010 Introduction of catheter, superior or inferior vena cava 2.18 $492 $11436011 Selective catheter placement, venous system; first...
View ArticleHome Health revenue codes 0420, 0430, 0424, 0421
Revenue Code DescriptionHome Health Care Visits0642 Home iv therapy services-iv site care, central line0643 Home iv therapy services- IV start/change, peripheral line0644 Home iv therapy...
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