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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 websiteExternal 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.

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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

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. 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.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
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Supplier Interactive Voice Response (IVR) System

CGS DME MAC Jurisdiction C has an Interactive Voice Response (IVR) System at 866.238.9650 with multiple options to assist you. The IVR is available 24 hours a day, seven days a week with the exception of system upgrades or routine maintenance. The IVR menu options that require system access are available Monday - Friday 6:00 AM - 9:00 PM and Saturday 6:00 AM - 4:00 PM CT (please note that some options which access the Common Working Files may have shorter availability).

The IVR offers information regarding claim status, pending claims, redetermination status, beneficiary eligibility, Certificate of Medical Necessity (CMN) status for same or similar equipment inquiries, Skill Nursing Facility (SNF)/inpatient hospital stay information, hospice information, diabetic supply claims, diabetic shoe claims, pricing, outstanding checks, the last five checks issued, offsets, and Electronic Funds Transfer (EFT) application status. It also offers general information, such as customer service hours of operation. Our customer service representatives are available at 866.270.4909 Monday - Friday from 7:00 AM CT/8:00 AM ET - 5:00 PM CT/6:00 PM ET for inquiries that cannot be handled through the IVR.

For an abbreviated/quick reference version of the information below, refer to our IVR Flow ChartPDF.

Current features of the IVR:

Option 1 – Beneficiary Information

Press 1 – Beneficiary Medicare Eligibility Information

  • Part A entitlement date
  • Part B entitlement date
  • Most recent entitlement reason, if available
  • Deductible current and previous year
  • Medicare Advantage Plan enrollment information
  • Medicare Secondary Payer information

Press 1 – SNF/Inpatient Hospital Stay

  • SNF or inpatient hospital facility claim on file for the date of service entered
  • The National Provider Identifier (NPI) of the facility and the website address for National Plan and Provider Enumeration System (NPPES) for inpatient claims
  • The admission date
  • Type of discharge and date of discharge

Press 2 – Hospice Information

  • Start and end date of the most current hospice episode

Press 3 – Home Health Information

  • Start and end date of the most current home health episode
  • The National Provider Identifier (NPI) of the home health agency and the website address for National Plan and Provider Enumeration System (NPPES)
  • The patient status

Press 2 – CMN Status

  • Initial, recert, or revision date
  • Length of need
  • Previous supplier's phone number for rented items
  • Last rental date billed for rented items
  • Total months paid for rented items

Press 3 – Oxygen CMN Status

  • Most current stationary CMN information
  • Most current portable CMN information
  • Initial, recert, or revision date
  • Length of need
  • Previous supplier's phone number
  • Last paid date with modifier
  • Total number of paid claims per modality
  • Other oxygen CMNs on file

Press 4 – Diabetic Supplies and Diabetic Shoes Information

  • Claims on file for lancets and test strips billed within 90 days before and after the date of service entered
  • Claims on file for other diabetic supplies billed within six months before and after the date of service and procedure code entered
  • Claims on file for diabetic shoes billed within the calendar year entered
  • Claims on file for diabetic shoe inserts billed within the calendar year and procedure code entered

Option 2 – Claim Information

Press 1 – Claim Status Inquiry (pending, on the payment floor, denied, paid, and/or applied to deductible)

  • Line by line explanation of the payment/denial
  • Expected payment amount and check date for claim on the payment floor
  • Appeal rights on denied claims
  • Multiple Medicare numbers
  • Multiple NPI numbers

There is no limit to the number of claims you can check in the IVR!!

Press 2 – Pending Claim Information

  • Payment floor information
    • Total number of claims
    • Total submitted amount
    • Total expected payment
  • Pending claims at Common Working File (CWF)
    • Total number of claims
    • Total submitted amount
  • Other pending claims
    • Total number of claims
    • Total submitted amount

Press 3 – Redetermination Information

  • Redetermination status (pending, reversed, partially reversed, upheld, or dismissed)

Press 4 – To order a duplicate remittance notice

Press 5 – Ordering/Referring Provider Information

Option 3 – Payment Information

Press 1 – Pricing

Press 2 – Check Information

  • Outstanding check information
    • Check date
    • Check amount
  • Last five checks issued
    • Check date
    • Check amount

Press 3 – Offset Information

  • Claim details of original overpayment
  • Original overpayment letter date and current offset balance

Press 4 – EFT Application Status (pending, approved, rejected and the reason why it is rejected.)

Option 4 – General Information

Press 1 – Information on Your Appeal Rights

Press 2 – Customer Service Hours of Operation

Press 3 – Call Center Closure Schedule

Quick tips on accessing information through the IVR:

To enter a Provider Transaction Access Number (PTAN), formerly known as your supplier number:

Enter the 10-digit number followed by the # key.

The IVR will repeat the number entered. Press 1 if the number entered is correct. If you would like to reenter the number, press 2.

To enter a beneficiary's Medicare number:

Press 1 for the Medicare Beneficiary Identifier (MBI).

To enter an MBI:

Press * to indicate you are entering a letter.

To enter a letter, you will need to press 2 keys.

  1. Press the key that contains the letter on your telephone key pad.
  2. Press 1, 2, or 3 to indicate the position of the letter on the telephone key pad (i.e., to enter the letter A, press 2 1).
    1. Assume letter Q is located on the 1 key pad. Q is the first position (i.e., to enter the letter Q, press 1 1).

Press 2 for the Healthcare Insurance Claim Number (HICN).

If the Medicare number begins with a letter, press 1. Then,

  • If the prefix letter is A, press 1.
  • If the prefix letters are CA, press 2
  • If the prefix letters are MA, press 3.
  • If the prefix letters are PA, press 4.
  • If the prefix letters are WA, press 5.
  • If the prefix letters are WD, press 6.
  • If the prefix letters are WCA, press 7.
  • If the prefix letters are WCD, press 8.

If it is any other letter(s) press 9.

  • If the prefix letter is H, press 1.
  • If the prefix letters are JA, press 2.
  • If the prefix letters are MH, press 3.
  • If the prefix letters are PD, press 4.
  • If the prefix letters are PH, press 5.
  • If the prefix letters are WH, press 6.
  • If the prefix letters are WCH, press 7.

Enter the 6 or 9 numbers following the prefix, followed by the # key.

If the Medicare number begins with a number, press 2. Then,

Enter the nine-digit Medicare number.

The system will then prompt you to enter the alpha character at the end of the Medicare number.

  • If the letter is A, press 1.
  • If the letter is B, press 2.
  • If the letter is C, press 3.
  • If the letter is D, press 4.
  • If the letter is M, press 5.
  • If the letter is T, press 6.
  • If the letter is W, press 7.
  • If it is any other letter(s), press 8 .
    • To enter a letter, you will need to press two keys. Press the key that contains the letter on your telephone key pad. Then press 1, 2, or 3 depending on the position of the letter on the telephone key pad (i.e., to enter the letter A, press 2 1). Assume letters Q and Z are located on the 1 key. The Q is in the first position and the Z is in the second position (i.e., to enter the letter Z, press 1 2).

    If the letter is followed by a number, press 1. If the letter is followed by another letter, press 2. If no number or letter follows the letter, press the # key.

To enter a date of service, use MM/DD/YY format (e.g., 010107).

To enter a Financial Control Number (FCN) number:
Enter the FCN number including any sequence number followed by the # key. Exclude the first two zeros of FCN located on an overpayment letter.

To enter the beneficiary's first initial:
Enter the beneficiary's first initial by using the letters on your telephone keypad (i.e., for A, enter 2).

To enter the beneficiary's last name:
Enter the first six letters of the beneficiary's last name by using the letters on your telephone keypad, followed by the # key (i.e., for Smith, enter 76484#). Include any suffixes, such as ”Jr.” or “III” if included in first 6 letters (i.e., for Smith Jr. enter 764845#). Exclude any special characters, such as a hyphen or apostrophe.

The corresponding letters of the telephone keypad numbers are:

  • If the letter is A, B, or C, enter 2.
  • If the letter is D, E, or F, enter 3.
  • If the letter is G, H, or I, enter 4.
  • If the letter is J, K, or L, enter 5.
  • If the letter is M, N, or O, enter 6.
  • If the letter is P, Q, R, or S, enter 7.
  • If the letter is T, U, or V, enter 8.
  • If the letter is W, X, Y, or Z, enter 9.

Beneficiary Information (Option 1)

For eligibility information, press 1. To verify Medicare eligibility for a beneficiary, you must provide your NPI, PTAN, last five digits of tax identification number (TIN), the beneficiary's Medicare number, date of birth, and the beneficiary's name. This option will provide the Medicare Part A and B entitlement date and term date, the most recent reason for entitlement, the current and previous year deductible remaining, Medicare Advantage Plan information, home health episode information, and Medicare secondary payer information.

Press 1 to receive SNF/Inpatient hospital information for the same beneficiary. If a facility claim is on file for the date of service entered, the IVR will provide the NPI of the facility and the website address for NPPES, if the beneficiary was still inpatient, the admission date, and the type and date of discharge, if the beneficiary was discharged.

Press 2 to receive hospice information for the same beneficiary. The IVR will provide the start and end date of the most current Hospice episode on file.

Press 3 to receive home health information for the same beneficiary. The IVR will provide the start date and end date for the most current Home Health episode on file, the NPI of the home health agency and the website address for NPPES, and the patient status.

You may press 1 or 2 at any time after the beneficiary information is entered.

For CMN status, press 2. You must provide your NPI, PTAN, last five digits of TIN, the beneficiary's Medicare number, the beneficiary's name and date of birth, and the procedure code. This option will provide CMN information on file for the procedure code entered and CMN information on any similar equipment on file for a beneficiary. The IVR will provide the initial, recert, or revision date, the length of need, the previous supplier's phone number, the last rental date billed, and the total months paid for rented items. If there is more than one same or similar CMN on file for the procedure code entered, the IVR will prompt you to listen to all related CMNs.

For oxygen CMN status, press 3. You must provide your NPI, PTAN, last five digits of TIN, the beneficiary's Medicare number, and the beneficiary's name and date of birth. This option will provide the most current oxygen CMN information on file by modality (stationary or portable). The IVR will provide the initial, recert, or revision date; the length of need; the previous supplier's phone number; the last paid date with modifier; and the total number of paid claims per modality. If there is more than one same or similar CMN on file for the modality chosen, the IVR will prompt you to listen to all related CMNs.

Press 1 to receive stationary oxygen information.

Press 2 to receive portable oxygen information.

For diabetic supplies and diabetic shoes information, press 4. You must provide your NPI, PTAN, last five digits of TIN, the beneficiary's Medicare number, and the beneficiary's name and date of birth. If you select 1 for diabetic supplies, this option will provide claims on file for lancets and test strips billed within 90 days before and after the date of service entered. The IVR will return the procedure code billed, the date of service, the number of services, the NPI of the billing supplier, and state if the service was not approved for payment. You may also opt to check claims for other diabetic supplies. You may enter the last four digits of the procedure code, and the IVR will check for claims for that code billed within 6 months before and after the date of service entered.

If you select 2 for diabetic shoes, this option will check for diabetic shoe claims billed within the calendar year entered. The IVR will return the procedure code billed, the date of service billed, the number of services, the NPI of the billing supplier, and state if the service was not approved for payment. You may also opt to check claims for diabetic shoe inserts. You may enter the last four digits of the procedure code and the IVR will check for claims for that code billed within the calendar year entered.

Claim Information (Option 2)

For claim status, press 1. To receive claim status, you must enter your NPI, PTAN, last five digits of TIN, the beneficiary's Medicare number and name, and the date of service. (See instructions above on entering this information.) After getting the status of a claim, you may choose from the following:

    • For line by line information on the claim, press 1. (Appeal rights and denial information on non-covered claims will be given.)
    • To continue, press 2.
    • To order a duplicate remittance notice on the claim, press 1.
    • To continue, press 2.
    • To receive claim information on another claim for the same date of service, press 1.
    • To receive claim information on this Medicare number for a different date of service, press 2.
    • To receive claim information on a different Medicare number, press 3.
    • To have this information repeated, press 7.
    • To return to the main menu, press 8.
    • To receive information on a different PTAN, press 9.

For pending claim information, press 2. You will need to enter your NPI, PTAN, and last five digits of TIN.

Press 1, and the total amount of claims, the total submitted amount, and the total expected payment amount for the claims currently on the payment floor will be provided.

Press 2, and the total amount of claims and the total submitted amount for the claims pending at the CWF will be provided.

Press 3, and the total amount of claims and the total submitted amount for other pending claims will be provided.

For redetermination information, press 3. To verify redetermination information, you must provide your NPI, PTAN, and the last five digits of your TIN.

To receive redetermination status, you must provide the beneficiary's Medicare number, the beneficiary's name, and the Document Control Number (DCN) or Claim Control Number (CCN), Internal Control Number (ICN) of the claim that is being appealed. The IVR will provide the status of your redetermination request, including whether it is pending, reversed, partially reversed, upheld, or dismissed.

For a duplicate remittance notice, press 4. You will need your NPI, PTAN, last five digits of TIN, and the payment report date. You will receive a duplicate remittance notice in the mail.

For ordering/referring provider information, press 5. You will need your NPI, PTAN, last five digits of TIN, and the NPI and last name of the ordering/referring provider. This option will verify if the ordering/referring provider is currently enrolled in Provider Enrollment, Chain and Ownership System (PECOS).

Payment Information (Option 3)

For the Medicare allowed amount on a specific procedure code, press 1. You must provide your NPI, PTAN, last five digits of TIN, specify the state where the beneficiary resides, and the HCPCS code and modifiers. The current Medicare allowed amount will be provided.

To enter letters for a state code:

  • Using the letters on your touchtone telephone, enter the first letter of the state where the beneficiary resides. For example: If the beneficiary resides in Alabama, press the 2 key.
  • Select the state desired by entering the number provided by the IVR. For example: For Alabama, press 1; for Arkansas, press 2; for Colorado, press 3. (Only the states serviced by Jurisdiction C will be available.)

To enter the HCPCS code you're looking for:

  • If the procedure code begins with A, press 1.
  • If the procedure code begins with B, press 2.
  • If the procedure code begins with E, press 3.
  • If the procedure code begins with K, press 4.
  • If the procedure code begins with J, press 6.

Enter the next 4 digits of the procedure code.

If there is a modifier at the end of the procedure code, press 1. Otherwise, press 2.

If the procedure code is followed by a modifier:

  • If the modifier is NU, press 1.
  • If the modifier is RR, press 2.
  • If the modifier is UE, press 3.
  • If the modifier is KFRR, press 4.
  • If the modifier is KFNU, press 5.
  • If the modifier is KO, press 6.
  • If the modifier is KP, press 7.
  • If the modifier is KQ, press 8.
  • If the modifier is MS, press 9.

For check information, press 2. You will need to enter your NPI, PTAN, and the last five digits of your TIN.

Press 1 for the outstanding checks on file for the last month, including the check date and check amount.

Press 2 for the last five checks issued to the PTAN entered. This includes the check date and check amount.

For offset information, press 3. You will need to enter your NPI, PTAN, the last five digits of your TIN, and the FCN number located on your Medicare remittance notice. You will have the option to receive claim detail information on the original overpayment and/or the original overpayment letter date and current offset balance amount. The claim detail information includes the beneficiary's Medicare number, overpayment amount, and dates of service for each claim involved in the original overpayment. Claim detail information is available for FCNs that contain 34 claims or less. If the FCN contains more than 34 claims, you may request a copy of the original overpayment letter by faxing your request to 615.782.4477.

For EFT application status, press 4 – You will need to enter your NPI, PTAN, and the last five digits of your TIN. This option will provide the status of your EFT application, including whether it is pending, approved, or rejected, and the reason why it is rejected.

General Information (Option 4)

For information about your appeal rights, press 1. Information about what services are eligible for a review, the elements that should be included in a review request, and the proper party to a review is provided.

For customer service hours of operation, press 2. The IVR provides the hours of operation and telephone number of the customer service line.

For Call center closure schedule, press 3. The IVR provides the scheduled closure of the call center.

To repeat these choices, press 7.

To return to the main menu, press 8.

To get information about another NPI/PTAN, press 9.

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