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.

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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

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Eligibility

Inpatient

The "Inpatient" sub-tab includes Inpatient, Skilled Nursing Facility (SNF), and Psychiatric Benefit Data sections. The Inpatient section provides hospital inpatient benefit and billing information. The SNF section provides SNF benefit and billing information.

NOTE: While the Psychiatric Benefit Data section now displays in myCGS, the data is not yet available in CMS' HIPAA Eligibility Transaction System (HETS) 270/271 system that we are required to access for eligibility.

The system will return hospital inpatient default deductibles based on the requested start year when the following occurs:

No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date (range)
Entitlement period and request date period overlap
Part A entitlement start year is less than the requested start year

In addition, the system will continue to return the hospital inpatient default deductible remaining amounts, inpatient co-payment days, and SNF co-payment days based on the beneficiary's Part A entitlement start year when the following occurs:

No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date (range)
Entitlement period and request date period overlap
Part A entitlement start year is less than or equal to the requested start year

NOTE: Depending on the date(s) range requested, multiple inpatient and SNF spells might be displayed. The data returned on this screen is directly impacted by timely submission of claims by the provider. The data returned is compiled from claims that have been processed by the Common Working File (CWF). To make sure you see all the information, enter a date range in the inquiry screen.

If a single hospital inpatient/SNF spell spans more than one calendar year, myCGS will return the daily co-payment amounts associated with the beginning year of the spell.

If there is no hospital inpatient/SNF spell within 60 days of the requested date(s) of service, myCGS will return default values for Part A spell data.

Screenshot

The table below describes the "Inpatient" sub-tab fields:

Part A Deductible

Field Name	Description
Start/End Date	The beginning and end date for the calendar year requested.
Deductible Amount	The Medicare Part A deductible amount applied to each spell of illness that occurs during the calendar year.

Inpatient Spell of Illness Detail

Field Name	Description
Start Date (DOEBA)	The date of earliest billing activity for the spell of illness
End Date (DOLBA)	The date of latest billing activity for the spell of illness
Billing NPI	The billing NPI of the hospital and/or SNF. You may refer to the NPPES NPI Registry to find the facility's contact information.
Type	Displays the type of provider identified in the Billing NPI field

Screenshot

Days Allowed

Identifies the number full and co-insurance days allowed for hospital, skilled nursing facility (SNF), Lifetime Reserve, and Lifetime Inpatient Psychiatric Hospital based upon the calendar year requested. The co-insurance amounts are displayed for each, as well.

Days Remaining

Field Name	Description
DOEBA	The date of earliest billing activity for the spell of illness
DOLBA	The date of latest billing activity for the spell of illness
Full Days	The number of inpatient full days allowed for the calendar year requested
Co-insurance Days	The number of inpatient full co-insurance days allowed for the calendar year requested
Billing NPI	The billing NPI of the hospital and/or SNF. You may refer to the NPPES NPI Registry to find the facility’s contact information.

Part A Free Services

Field Name	Description
STC Codes	The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes."
Value	The patient's portion of responsibility for a benefit, represented as a percentage
Start/End Date	The start and end dates of the benefit period