License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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Last name, first name (or first initial) and middle initial (if available) of the beneficiary for whom the billing transaction was processed. Billing transactions will display in alphabetical order by the beneficiary's last name.

Patient control number that was submitted on the billing transaction.

TEXTGOESHERE

TEXTGOESHERE

Claim Adjustment Reason Codes (CARCs) provide information about an adjustment and explain why a billing transaction or service line was paid differently than it was billed. A list of the latest codes is available at http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/.

CARC 45 will display on home health final claims subject to the outlier limitation.
CARC 253 indicates a reduction in payment due to sequestration

Remittance Advice Remark Codes (RARCs) provides further explanation of an adjustment already described by the code in the RC field. It is also used to relay informational messages. A list of the latest codes is available at: http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/

The Diagnosis Related Group (DRG) number assigned to the billing transaction. Not applicable to home health and hospice billing transactions.

The outlier payment that was made in addition to the DRG payment (if applicable). Not applicable to home health and hospice billing transactions.

The coinsurance amount for which the beneficiary is responsible. Applicable to home health outpatient therapy billing transactions (34X type of bill).

The dollar amount that the provider owes the beneficiary for overpaid deductible and coinsurance. Not applicable to home health and hospice billing transactions.

An adjustment resulting from a contractual agreement between the payer and payee. This amount reflects the difference between the billed amount and the net reimbursement, minus any other deductions (e.g., sequestration).

Beneficiary's Medicare ID number for whom the billing transaction was processed.

Internal Control Number (ICN), also referred to as the Document Control Number (DCN) is a unique number assigned to the billing transaction when received by CGS.

An outlier code indicates a cost outlier was paid to a hospital provider.

The dollar amount of the funds Medicare pays for 'new technology' drugs and devices.

The dollar amount of Medicare covered charges.

The End-Stage Renal Disease (ESRD) Network Reduction amount. Not applicable to home health and hospice billing transactions.

The dollar amount for which the patient is responsible.

The beginning and ending dates on the processed billing transaction.

The Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).)

The physician's professional component billed on the billing transaction.

The Medicare Secondary Payer (MSP) Primary Payer amount when the primary insurance made payment on the billing transaction.

The dollar amount of charges that are not covered by Medicare.

The dollar amount of interest paid by Medicare. Interest is paid on clean billing transactions that are not paid within the 30-day timeframe.

For home health outpatient services (type of bill 34x), this is the total reimbursement amount for all covered services under the Medicare Physician Fee Schedule (MPFS).
Not applicable to hospice billing transactions.

The status of the billing transaction when it completed processing. The following codes are used by Medicare.

1	Paid as primary
2	Paid as secondary
3	Paid as tertiary
4	Denied (this claim status shows when a claim is denied or rejected).
19	Medicare paid primary and the Medicare Administrative Contractor (MAC) sent the claim to another insurer.
20	Medicare paid secondary and the Medicare Administrative Contractor (MAC) sent the claim to another insurer.
21	Medicare paid tertiary and sent the claim to another insurer.
22	Adjustment to prior claim, reversal to previous payment (this claim status shows when a claim is cancelled (TOB XX8), including RAPs which have been auto-cancelled or cancelled by the provider.
23	Not a Medicare claim and the Medicare Administrative Contractor (MAC) sent claim to another insurer.

Number of home health days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions.

The number of covered home health or hospice days or visits.

The number of non-covered home health or hospice days or visits<

The dollar amount associated with the adjusted DRG code.
Not applicable to home health and hospice billing transactions.

The dollar amount applied to the beneficiary's deductible. Applicable to home health outpatient therapy billing transactions (34X type of bill).

The dollar amount of denied charges. When charges are denied for reasons other than Medical Review, refer the Claim Adjustment Reason Code (CARC) in the RC field and/or the Remittance Advice Remark Codes (RARC) in the REM field for more information.

Indicates a presumptive payment adjustment on a billing transaction.

The net reimbursement for each billing transaction.

Medicare Beneficiary Identifier

The 2 percent payment reduction on billing transactions with dates of service on or after April 1, 2013. The RC field on the remittance will include the Claim Adjustment Reason Codes (CARCs) 253 to explain the adjustment in payment.

Population Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model.

This field represents the amount associated with value code 'Q7' (ISLET Add-On Payment Amount).

Billing transactions are grouped by Fiscal Year. If multiple FYs are present on a single remittance advice, a FY subtotal displays after each group of billing transactions.

Billing transactions for Part A and Part B services will appear on separate pages of the remittance advice, with respective subtotals.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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