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.

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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")

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Reopenings for Minor Errors and Omissions

Important! We are making changes to help process your requests faster and more accurately. Starting August 1, 2026:

We won’t accept reopening requests by fax.
We won’t accept any handwritten requests.
If you mail your request, you must use the new Reopening Request Form starting August 1, 2026. Reopening Request Form Instructions

Overview

If you made a minor error or omission in filing a claim, you can likely submit a reopening request to correct the error rather than file a redetermination appeal.

You have one year to request a reopening from the date on your Remittance Advice (RA).

Methods to request a reopening

myCGS® Web Portal – submit instantly online!
Telephone
Written Reopenings

Can be Handled as a Reopening (Examples)	Cannot be handled as a Reopening (Examples)
Mathematical or computational mistakes	Not reasonable and necessary (not medically necessary) claim denials – MUST be appealed through redeterminations
Transposed procedure or diagnosis codes	Claims denied by another review contractor – Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), Medical Review (MR), Recovery Audit Contractor (RAC), and Comprehensive Error Rate Testing (CERT) – MUST be appealed through redeterminations
Inaccurate data entry	Requests to extend the date for the end of the 13-month rental period due to a break in service/break in need, or to start a new capped rental period, can be appealed through redeterminations, or you can submit a new claim with the appropriate narrative information for the break in service or break in need
Misapplication of a fee schedule	Unprocessable/Returned claims (such as ANSI code 16) – resubmit the claim with the corrected information
Computer errors	Addition, change, and/or removal of KX, GA, GY, and/or GZ modifiers – MUST be appealed through redeterminations
Incorrect data items, such as the use of a modifier or date of service	Recoupment requests which should be submitted to overpayment recovery
Claims denied for being filed after the claim filing time limit	Corrected PTANs

Because some issues are more complicated than others and may require more research or consulting medical staff, the DME MAC reserves the right to decline the clerical error reopening and request that you submit a written redetermination.

Click below to learn more details about different submission types.

myCGS Reopenings

The fastest and easiest way to submit a reopening request is through the DME myCGS web portal.

If you are not using the myCGS portal, get started by following steps in the Registration Guide.
If you are registered for the myCGS portal, refer to the "Reopenings" section of "Chapter 6 – Reprocessing" in the myCGS User Guide for detailed submission instructions.

Telephone Reopenings

Call 844.240.7490 (Monday through Friday, from 7 am – 5 pm CT)

Use the telephone reopening process to resolve minor errors or omissions involving:

Units of service
Service dates
Healthcare Common Procedure Code System (HCPCS) coding
Modifiers (excluding the KX, GA, GY and/or GZ modifier)
Place of service

Wait to call the telephone reopening line until you receive your Medicare remittance notice. No action can be taken until a final claim determination is issued.

Callers should consult the Jurisdiction B DME MAC Supplier Manual and applicable medical policy guidelines before calling. Failure to have appropriate information available when you call the telephone reopening line may result in an unfavorable decision.

The telephone reopening line is not a resource for questions about the status of a claim, general Medicare payment, or coding. Suppliers can obtain a claim status report by using the myCGS web portal or find information on the Interactive Voice Response (IVR) system or Claim Status Inquiry (CSI).

Suppliers must have the following information before placing the call for a telephone reopening:

Your PTAN, NPI and last five digits of TIN
The Medicare Claim Control Number (s) (CCN) and reason for denial
Date(s) of Service
Medicare Beneficiary Identifier (MBI)
Any additional information to support why you believe the decision is not correct. This includes having the correct procedure code(s), modifier(s), units of service, etc.

All medical information provided to the DME MAC must be documented in the patient's file and available to the DME MAC, should an audit be required.

If a previous reopening decision has been issued, suppliers must submit a written redetermination.

To effectively service all callers, each call is limited to five claim issues. Calls involving multiple PTANs are limited to 3 claim issues.

The following issues are examples of what cannot be handled on the telephone reopening line:

Claims denied for being filed after the claim filing time limit
Unprocessable/Returned claims (such as ANSI code 16) – resubmit the claim with the corrected information
Medicare Secondary Payer (MSP)/other insurance involvement issues – A secondary payer is an insurance plan that covers medical expenses only after a primary insurer has made payment on a claim
Any claim that requires additional documentation
Addition, change, and/or removal of KX, GA, GY, and/or GZ modifiers
Inquiries related to denial of payment based on entitlement
Questions that are general in nature and not claim specific
Requests to extend the date for the end of the 13-month rental period due to a break in service/break in need, or to start a new capped rental period, can be appealed through redeterminations, or you can submit a new claim with the appropriate narrative information for the break in service or break in need
Claims denied by another review contractor – Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), Medical Review (MR), Recovery Audit Contractor (RAC), and Comprehensive Error Rate Testing (CERT) – MUST be appealed through redeterminations
Not reasonable and necessary (not medically necessary) claim denials MUST be appealed through redeterminations

Disclaimer: If any of the above changes, upon research, are determined to be too complex, the phone representative will inform the caller that these need to be sent in writing with the appropriate documentation as a written reopening or as a redetermination.

Written Reopenings

Suppliers should use the Medicare Reopening Request Form to mail or fax a Reopening request. Starting August 1, 2026, we will no longer accept reopening requests by fax or handwritten reopening requests.

New! Reopening Request Form– Required on or after August 1, 2026
Reopening Request Form Instructions
Reopening Request Form – Accepted until August 1, 2026

For further assistance, read Chapter 13 of the DME MAC JB Supplier Manual.

Mailing Address:

CGS – Jurisdiction B Written Reopenings
PO Box 20007
Nashville, TN 37202

For a reopening with an underpayment, fax the request to 615.660.5978. For a reopening with an overpayment, fax the request to 615.782.4508.

Note: You can access the very same Reopenings Form within the myCGS® Web Portal and submit your request online. This method is fast, easy, and paperless.

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")

Reopenings for Minor Errors and Omissions

Resources

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