Clinical Examples
The clinical examples that are provided here are limited to Office or Other Outpatient Services, Hospital Inpatient Services, Consultation, Emergency and Critical Care services. These… Read More »Clinical Examples
Answers for CPC sample Questions
CPC sample question # 1 CPT 26123, 26125, ICD-9-CM 728.6 26123 is used for reporting the Fasciectomy, with release of 1 single digit and 26125… Read More »Answers for CPC sample Questions
List Of All Modifiers
Modifier – as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may… Read More »List Of All Modifiers
North Carolina Medicaid – Billing Guidelines for Vaccines
1. Effective with date of service July 1, 2011, the ONLY immunization administration codes covered for Medicaid recipients in the Health Check age range, 0 through… Read More »North Carolina Medicaid – Billing Guidelines for Vaccines
Medicare Uncompensated Care Payments
CMS distributes a prospectively determined amount of uncompensated care payments to “Medicare disproportionate share hospitals” based on their relative share of uncompensated care nationally. As… Read More »Medicare Uncompensated Care Payments
COVID-19 Frequently Asked Questions (FAQs) – Released May 5, 2020
CMS Releases Additional Medicaid & CHIP COVID-19 FAQs for State Medicaid and CHIP Agencies CMS released additional frequently asked questions (FAQs) to aid state Medicaid… Read More »COVID-19 Frequently Asked Questions (FAQs) – Released May 5, 2020
Revised Guidelines for CPT 99441, 99442 & 99443
Updated May 9, 2020, with information from the 4/30/20 rule CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to… Read More »Revised Guidelines for CPT 99441, 99442 & 99443
MAC will Reprocess the claims – Telephone E&M; Visits
The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes… Read More »MAC will Reprocess the claims – Telephone E&M; Visits
CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes
As a part of President Trump’s Opening Up America Again effort, the Centers for Medicare & Medicaid Services (CMS) announced a new independent Commission that… Read More »CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes
Evaluation and Management (E/M) Effective January 1, 2021
New Patient: (99201 has been deleted. To report, use 99202) 99202 Office or other outpatient visit for the evaluation and management of a new patient,which… Read More »Evaluation and Management (E/M) Effective January 1, 2021
Annual Updates for Flu Vaccine_2019-2020 – Season (Payment Allowance)
This recurring update notification provides the availability of payment allowances for the seasonal influenza virus vaccines as updated on an annual basis, effective August 1… Read More »Annual Updates for Flu Vaccine_2019-2020 – Season (Payment Allowance)
New HCPCS Modifiers Effective from Jan 1, 2020
HCPCS Modifiers: MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected… Read More »New HCPCS Modifiers Effective from Jan 1, 2020
UHC – Reimbursement Update to Vaccines for CPT 90461
As part of the Patient Protection and Affordable Care Act (PPACA) regulations, CPT code 90461 is not reimbursable for vaccines administered to Medicaid members through… Read More »UHC – Reimbursement Update to Vaccines for CPT 90461