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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Claims Processing Issues Log

Listed below are current system-related claims processing issues. Updates are made to this log frequently, as soon as information becomes available. We encourage you to review this log often and prior to contacting the Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please contact the Provider Contact Center or use one of our self-service tools.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact
5.30.18	Open	Part B providers in Ohio that may bill CPT codes 0449T or 0450T in ASC or for assistant surgeon	CPT codes 0449T and 0450T were to be end dated on a Category III CPT code edit. TOS F (Ambulatory Surgical Center) and TOS 8 (assistant-at-surgery) were mistakenly left as active.	N/A	CPT codes 0449T and 0450T
Updates	05.13.2018 – Obtaining a list of claims data
MAC Action	We will pull a list of claims billed for TOS F and TOS 8 in Ohio for these codes and adjust.
Provider Action	No action required of you.
Proposed Resolution	Adjust applicable claims

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
2.27.18	Open	Occupational Therapists, Physical Therapists, Speech-Language Pathologists, Ambulance Suppliers	The provisions affecting outpatient therapy services expired 12/31/2017. The new provision required the continued submission of HCPCS modifier KX for services in excess of the prior therapy cap amount for claims with dates of service on and after January 1, 2018. Due to a systems issue, services billed with HCPCS modifier KX in excess of the prior therapy cap amount were denied. CR 10531 also affects payment of 2018 services rendered by Ambulance suppliers. Additional, MPFS claims for localities and States impacted by the Work GPCI Floor fee increase for Dates of Service in CY 2018.	N/A	Therapy Services, Ambulance Services	N/A
Updates	05.29.2018 – Adjustments for Ambulance fee schedule services rendered in 2018 have begun. We will provide another update as other adjustments begin. 05.10.2018 – HCPCS modifier KX adjustments are pending. We will provide an update when the adjustments begin. 04.11.2018 – Contractors have six months to reprocess these claims. 03.29.2018 – Change Request (CR) 10531 (MLN Matters article MM10531) indicated contractors shall automatically reprocess therapy claims with the KX modifier containing dates of service in calendar year 2018, which were denied prior to the implementation of the updated legislative effective dates. In addition, contractors shall automatically reprocess therapy claims with the KX modifier that were denied due to an invalid date provided in instructions. The automatic reprocessing will begin on 4/2/2018 or shortly thereafter. 03.13.2018 – CMS is going to issue instructions on reprocessing claims affected by this legislation.
MAC Action	Follow above directions from CMS
Provider Action	No action required of you.
Proposed Resolution	Reprocess claims beginning 4/2/2018

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
4.19.18	Closed	Providers who submit claims for Molecular Diagnostic (MolDx) testing	Upon retiring the MolDx BioFire Gastrointestinal (GI) Panel, there is question as to whether the test, billed with CPT codes 87507 or 87999, is, in fact, a part of MolDx.	N/A	MolDx CPT codes 87507 and 87999	Closed
Updates	05.18.2018 – Claims identified for Part B have been adjusted. 05.03.2018 – We have obtained all data needed to review. Verifying services submitted with CPT code 87999 are for BioFire test before adjusting and to determine timeframe needed to complete adjustments.
MAC Action	We are currently analyzing data back to 01.01.2017 to determine validity and our next steps.
Provider Action	No action required of you.
Proposed Resolution	Adjust affected claims

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
03.14.18	Closed	Those who submit claims for Molecular Diagnostic (MolDX) test	Our processing system is denying codes for mismatch MolDX/no MolDX ID submitted on the claim.	N/A	Lab codes for MolDX: CPT codes 81105-81595, 87505-87507, 87631-87633, 86152-86153, 0001U-0023U, 0001M-0010M	N/A
Updates	04.06.2018 – The affected claims identified have been adjusted. 03.23.2018 – The issue has been addressed and claims started processing correctly as of 03.16.2018. Adjustments will be made to affected claims.
MAC Action	Investigating system issue to determine resolution.
Provider Action	No action required of you.
Proposed Resolution	CGS will pull affected claims and adjust them.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
2.27.18	Closed	Various Part B Providers	Change Request (CR) 10262 addressed the January 2018 CWF update to Skilled Nursing Facility (SNF) Consolidated Billing edits. As a result, changes to the editing inadvertently are causing claims for non-therapy, ambulance services to or from dialysis facilities and physicians professional services to deny in error. Refer to MM10262 for additional information.	N/A	Ambulance and Physician Professional services	02.28.18
Updates	02.28.18 – CGS is working to identify all claims denied in error to mass adjust.
MAC Action	The CWF Maintainer has been contacted and advised of the issue.
Provider Action	Until a corrective action occurs, if an overpayment has already been requested, it is recommended for a provider to submit an appeal. When appealing, please include a copy of the demand letter. This will prevent the incorrect recoupment of funds. It is also recommended to hold future claim submissions that meet the criteria outlined to prevent erroneous denials.
Proposed Resolution	Awaiting to learn of a solution.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
01.16.18	Closed	Providers who submit therapy services	CMS is instructing contractors to hold claims for dates of service in 2018, submitted for therapy services and containing HCPCS modifier KX, until further notice.	N/A	Therapy services	02.28.18
Updates	02.28.18 – All claims held have been released. 01.30.2018 – Starting January 25, 2018, CMS will immediately release for processing held therapy claims with HCPCS modifier KX with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with HCPCS modifier KX and implement a "rolling hold" of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with HCPCS modifier KX received that day and release for processing the held claims received on January 11, 2018. Similarly, on February 1, 2018, CMS will hold all therapy claims with HCPCS modifier KX received that day and release for processing the held claims received on January 12, and so on. Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt
MAC Action
Provider Action	N/A
Proposed Resolution	Waiting for additional direction from CMS

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
01.25.2018	Closed	All providers	The Interactive Voice Response (IVR) system is not calculating the QMB deductible and coinsurance amounts correctly.	NA	NA	02/12/2018
Updates	02.14.2018 – This issue has been resolved.
MAC Action	01.25.2018 – CGS is working to resolve this issue.
Provider Action	02.14.2018 – Providers can now use the IVR (1.866.290.4036) to obtain a breakdown of the deductible and coinsurance amounts. 01.25.2018 – At this time, please contact the Part B Provider Contact Center (PCC) at 1.866.276.9558 for assistance in getting a breakdown of the deductible and coinsurance amounts.
Proposed Resolution

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
01.24.18	Closed	Primarily Independent Clinical Labs	Effective for claims with line item dates of service on and after January 1, 2018, contractors shall not bundle or roll up individually billed lab test HCPCS code to a lab panel HCPCS code or an ATP code.	N/A	G0058, G0060, 80048, 80053, 80069, 82040, 82248, 82251, 82330, 82435, 82550, 82947, 83615, 84100, 84155, 84450, 84478, 84550, G0059, 80047, 80051, 80061, 80076, 82247, 82250, 82310, 82374, 82465, 82565, 82977,84075, 84132, 84295, 84460, 84520, 80072, 83718, 85651, 86430, 86694, 86709, 86777, 87340, 80049, 80074	01.25.18
Updates	CGS has identified some of the system settings to turn off lab panel HCPCS were not set correctly. CGS has corrected the settings.
MAC Action	System updates were corrected and CGS will adjust the impacted claims.
Provider Action	N/A
Proposed Resolution	System issues were corrected.

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact	Date Resolved
01.01.18	Closed	Part B Providers/ Suppliers	Claims held due to the January 2018 release	N/A	All 2018 dates of service	01.17.18
Updates	N/A
MAC Action	All claims released 01.17.18
Provider Action	N/A
Proposed Resolution	N/A

Date Reported	Status	Provider Type Impacted	Description of Issue	Reason Codes	Claim Coding Impact
11.15.2017	Closed	All providers	Payers secondary to Medicare aren't able to process some of your direct billed claims due to patient responsibility deductible and coinsurance amounts on the Medicare Remittance Advice (RA) showing zero. Claims automatically crossed over from Medicare to secondary payers aren't impacted.	N/A	N/A
Updates	03.16.2018 – Per CR10494, CGS will initiate adjustments for QMB claims with a date of receipt prior to 12.08.2017. The adjustment is to produce "replacement" Medicare RAs that providers can submit to supplemental payers to coordinate benefits as necessary. All adjustments will be complete by December 20, 2018.
MAC Action	N/A
Provider Action	Providers may want to hold QMB claims and submit them after December 8. Reference the CMS QMB Remittance Advice Issue announcement for additional information.
Proposed Resolution	On December 8, 2017, CMS systems will revert back to the previous display of patient responsibility for QMBs on the Medicare RA.

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