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

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

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.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 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. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly 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 to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
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.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

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Did You Know? – Customer Service

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When e-mailing CGS, what information can we send to be HIPAA (Health Insurance Portability and Accountability Act) compliant, but provide enough information to answer the question?
- When emailing CGS, include the claim number (DCN) in your email. Do not include any personal information, including, but not limited to, Social Security numbers, Medicare ID number, claim specific data, or Medicare Summary Notices (MSNs).
  
  The Part A Kentucky and Ohio Online Help Center offers an online HIPAA compliant tool/form for e-mailing inquiries.
  
  Reviewed 09/22/2021
Can the PCC tell us the date that the patient's MSP file has been updated?
- No, The MSP files are updated by the CMS Benefits Coordination and Recovery Center (BCRC) (formerly know as the COBC). The PCC representative is not able to determine the exact update made to the beneficiary file.The PCC representative will be able to confirm the status of the records displayed at the time of the call. The information is subject to change based on the updated provided by claim submission and the beneficiary.
  
  For current beneficiary eligibility information including MSP records, use the HIQA record until CMS terminates the FISS eligibility queries (HIQA, HIQH, ELGA, ELGH and HUQA). At that time, the HIPAA Eligibility Transaction System (HETS) will replace the Common Working File (CWF) Medicare Beneficiary Health Insurance Eligibility Queries. We encourage providers to access HIQA for the most current beneficiary MSP records.
  
  Reviewed 09/22/2021
How can we be made aware if a fax has been received from our office?
- - Use the appropriate fax number based on the type of information you are sending. Refer to the Jurisdiction 15 Contact Listing for correct fax numbers.
  - If you are unable to reach one of our fax lines, please retry during off-peak hours (before 9:30 a.m. CT), Please do not fax items during the night, as this process will impact PHI safeguards put in place at CGS.
  - Attempt to keep the size of your faxes to a minimum by faxing documentation needed for each case/request separately, rather than combining your case requests in one fax.
  - A 'sent successful' message will appear on a printed copy from your fax machine.
  Note: depending on the department, there may be a process in place to notify the provider when a fax is received.
  
  Reviewed 09/22/2021
If we bring up a topic on an ACT and we are told to send examples to someone at CGS, what is the best method to do this (to provide enough information and yet protect PHI)? For example, I brought up an issues related to the 3-day payment window on a recent ACT call. We ended up submitting all these as appeals, but would we have been able to simply e-mail or fax information to have them resolved? If so, what information should be sent, to whom, where? Or will we also need to file those as appeals?
- During an ACT, if a representative asks for examples for research purposes, you will be instructed to give your direct contact information so the issue can be discussed verbally. We may ask you to email certain information, such as a claim number. Claim numbers are appropriate and sufficient for us to begin the research process. If we need additional information, we will contact you directly.
  
  Please note: it is still important for you to follow the formal appeals process for any denials you are disputing (that have appeal rights). We are happy to research examples of potential problems; however, filing a formal appeal request (using our J15 Part A Redetermination form) protects your further appeal rights and ensures that your denial will be reviewed independently. You can also submit a first level redetermination request via the myCGS® portal.
  
  Reminders:
  - When emailing any inquiry to CGS, do not include any personal information, including, but not limited to, Social Security numbers, Medicare ID number, claim specific data, or Medicare Summary Notices (MSNs).
  - There may be times when CGS representatives will ask you to call the Provider Contact Center (PCC) at 1.866.590.6703. This is due to Section 921 of the Medicare Modernization Act (MMA), which instructs MACs to follow certain customer service requirements. Customer service funding is based on the correct reporting of the inquiry workload. Reference: CMS Change Request (CR) 3376 for customer service requirements.
  - As always, for an initial inquiry, the PCC should be your first point of contact.
  Reviewed 09/22/2021
Is there an e-mail address or contact person for coding or clinical coding questions?
- Providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries. CSRs cannot make coding determinations for you. If you inquire about interpretation of procedural and diagnostic coding, CGS is instructed to refer you to the entities that have responsibility for those coding sets. The four primary entities to which you may be referred for questions about coding are:
  - The American Medical Association (AMA). The AMA offers CPT Assistant. Information about these resources is available at http://www.ama-assn.org/.
  - ICD-10-CM related questions are handled by the American Hospital Association's Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org/.
  - Level II Healthcare Common Procedure Coding System (HCPCS) codes related to Durable Medical Equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC and the services it provides is available at https://www.dmepdac.com/
  - The American Hospital Association's Coding Clinic for HCPCS responds to questions related to CPT-4 codes for hospital providers and Level II HCPCS codes, specifically A-codes for ambulance service and radiopharmaceuticals, C-codes, G-codes, J-codes, and Q-codes (except for HCPCS codes Q0136 through Q0181), for hospitals physicians and other health professionals who bill Medicare. Details about this resource are available at http://www.ahacentraloffice.org/.
  Additional information regarding these resources is available at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html
  
  Reference:
  - CMS Medicare Contractor Beneficiary and Provider Communications Manual (Pub. 100-09), chapter 6, section 30.1.1.
  Reviewed 09/22/2021
Will you explain the escalation process you use in the PCC? Sometimes, we need to speak with someone more experienced, and we have found that this process does not always seem to be consistent.
- CGS follows a PCC triage procedure as described in CMS guidelines. According to the guidelines in the Medicare Contractor Beneficiary and Provider Communications Manual (Pub. 100-09), chapter 6, sections 30.1 and 30.2, the contact center shall be able to route general inquiries within the PCC to the system or person best equipped to respond, with a minimal degree of transfer.
  
  Note: All CSR in the Part A PCC receive the same training. If the representative is unable to resolve the issue, a callback is offered. If the callback is unable to resolved and requires other operational assistance then it is possible for the inquiry to be transferred without intervention to the provider to the next level for assistance. We work as a team to resolve issues.
  
  It is appropriate to ask for a supervisor callback if you find the process is not working or if you are not receiving consistent answers. If a supervisor is unavailable, a callback will be offered which will be returned within 48 hours.
  
  Reviewed 09/22/2021

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")

Did You Know? – Customer Service

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