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CGS Administrators, LLC

Serving the states of AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV and the U.S. territories Puerto Rico and the Virgin Islands

May 30, 2019

Billing Reminder on Narratives and Date Spanning Claim Dates

Most DMEPOS accessory/supply items provided on a recurring basis can be dispensed with a three month supply. Those include, but are not limited to, PAP or RAD accessories, nebulizer inhalation medication, urological supplies, and ostomy supplies. When billing more than one month's supply of these items, include a narrative in the NTE segment of the electronic claim indicating the number of months you are billing. If you bill a three month supply of PAP accessories (i.e., mask, tubing, cushions), simply add "90 days" or "three months". This helps CGS claims processors to properly verify the quantities billed.

There are a few exceptions to the three-month maximum rule. Only a one-month quantity of supplies may be dispensed for the following:

Additionally, CGS has seen a spike in the number of claims that have been rejected for lack of date spans on claims. As a reminder, the following DMEPOS items require a date span on all claims submitted to the DME MACs:

Please remember to span the dates of service using "From" and "To" dates on any electronic or paper claim for the items listed above. The "From" date is when the items were provided to the Medicare beneficiary. The "To" date is the last date the supplies are expected to be used. For example, if you are providing a three-month supply (January – March 2019) of diabetic testing supplies for a beneficiary, the "From" date on the claim would be "01/01/2019" and the "To" date would be "03/31/2019."

Please remind your billing staff of the preceding information to make your DME claim process easier and more efficient for all.

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