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.
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 website.
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CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. 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 CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. 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.

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Claims: How Do I…?

How do I submit documentation with my claim?

If you with to submit documentation or attachments with an electronic claim, you may use the Paperwork (PWK) process. The electronic claim should identify the documentation using the PWK Segment at the claim level (Loop 2300) or line level (Loop 2400). For additional information, refer to the Paperwork (PWK) Implementation: Submitting Additional Documentation with Electronic Claims article on the CGS website.

What is the best way for me to check the status of my claim?

Providers are required to use self-service technology, such as the Interactive Voice Response (IVR) system or the myCGS® web portal to access claim status and beneficiary eligibility information. Customer Service Representatives (CSRs) will refer providers to these resources when calling for claims status or eligibility information. Exceptions will be made if your experience technical difficulties.

Interactive Voice Response (IVR) – Use the IVR to check the status of a specific claim by calling 1.866.290.4036 and select Option 1. You will need your facility's NPI, PTAN, and the last 5 digits of the provider TIN. Refer to the CGS J15 Part B IVR User Guide for additional information. Use the IVR and CTI Converter Tools self-service option. This tool converts letters to numbers for easy entry using your telephone keypad.

myCGS Web Portal – myCGS® can also be used to check the status of claims. Refer to the myCGS® User Manual, Chapter 2: Claims Tab for detailed instructions. If you are not registered to access myCGS, refer to the Chapter 1: Overview of myCGS for additional information.

How do I access eligibility information for a Medicare patient?

Interactive Voice Response (IVR) – Use the IVR to check the eligibility of a Medicare beneficiary by calling 1.866.290.4036 and select Option 2. Refer to the CGS J15 Part B IVR User Guide for additional information. Use the IVR and CTI Converter Tools self-service option. This tool converts letters to numbers for easy entry using your telephone keypad.

myCGS Web Portal – myCGS® also provides eligibility information. Refer to the myCGS® User Manual, Chapter 4: Eligibility Tab for detailed instructions. If you are not registered to access myCGS, refer to the Chapter 1: Overview of myCGS for additional information.

I need to check to see why my claim denied as a duplicate.

Review the following resources to determine if your claim was previously paid/processed. Claims may have processed, but not paid because the payment was applied to the patient's deductible. In addition, please check with your clearinghouse/vendor for any billing issues with duplicate submissions.

Interactive Voice Response (IVR) – Use the IVR to check the status of claims with specific dates of service by calling 1.866.290.4036 and select Option 1. You will need your facility's NPI, PTAN, and the last 5 digits of the provider TIN. Refer to the CGS J15 Part B IVR User Guide for additional information. Use the IVR and CTI Converter Tools self-service option. This tool converts letters to numbers for easy entry using your telephone keypad.

How do I find Medicare Advantage Plan contact information?

Medicare Advantage Plan contact information can be found by accessing the Centers for Medicare & Medicaid Services (CMS) MA Plan Directory. From the Downloads list, select and open the most recent MA Plan Directory ZIP. CGS suggests that you open the second Excel file. Once open, you can perform a find (Ctrl-F) to find the Plan ID along with the contact information.

MA plan information can also be accessed from the myCGS® Web Portal, under the Eligibility Tab, then under Plan Coverage. For additional information, refer to the following myCGS® resources.

How do I know which modifier to use?

Use the CGS Part B Modifier Finder Tool for assistance with using modifiers correctly. You can search by modifier or keyword, or you can view the entire listing of modifiers.

Where can I find information about Bundling/Reduced Claims?

CGS suggests that you check the National Correct Coding Initiative (NCCI) Edits and the CMS PTP Coding Edits, as well as a CPT Coding booklet before submitting your claim.

If your claim reduced 210a and the claim causing reduction has been corrected, you may contact the Part B Provider Contact Center at 1.866.276.9558, select Option 1.

If your claim did not pay but corrections have been made to the other claim you can simply submit a new claim.

For additional information, you may also refer to the CMS resources for information on the National Correct Coding initiative (NCCI).