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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 websiteExternal 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

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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.

  1. 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.
  2. 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 websiteExternal Website.
  3. 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.
  4. 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.
  5. 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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Part B Interactive Voice Response System

On this page:

ATTENTION: Please be aware that providers will need their billing NPI, PTAN and the last five digits of their tax identification number in order to utilize the IVR or when speaking to a Customer Service Representative.

You may access our IVR by calling the following toll-free telephone number:

Part B providers: 1.866.290.4036

The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims. The IVR is available during and outside normal customer service hours with allowances for system maintenance and mainframe availability. Your NPI and PTAN are needed to obtain information from the IVR or a Customer Service Representative. You can also order duplicate remittance notices, as well as obtain the Medicare Part B deductible status, eligibility, Medicare Secondary Payer information, allowable for procedure codes, denial reasons, outstanding check amounts, NPI and PTAN validation and other claim processing information.

When a claim has completed processing and is being held due to the payment floor, you will not be able to obtain claim detail until the remittance is issued. If you have a business need to receive this information before the remittance is issued, you may want to consider Claim Status Inquiry. Contact the EDI department at 866-276-9558.

CGS requires providers to use the IVR for simple transactions, such as eligibility, deductible, Medicare Secondary Payer, claims status and outstanding check information. This allows our Customer Service Staff to be available when you need dedicated assistance for your complex issues. For callers, if your inquiry cannot be resolved through the IVR, you may reach a customer service representative by calling 1.866.276.9558.

Steps in Using the Interactive Voice Response (IVR) System

Greeting

"You have reached the Interactive Voice Response Access line for CGS Medicare Part B. To ensure excellent customer service, your call may be monitored or recorded for evaluation purposes."

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Main Menu

  • Press "1" for claim status
  • Press "2" for eligibility, deductible and therapy limitation information
  • Press "3" for financial information
  • Press "4" for other inquiries
  • Press "5" for NPI and PTAN crosswalk validation & to verify NPI in PECOS
  • Press "6" for general information
  • Press "7" to repeat information
  • Press "0" for the customer service representative phone number

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National Provider Identifier (NPI)

Enter your NPI followed by the "#" key

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Provider Transaction Access Number (PTAN)

Providers will follow the prompts below:

If you PTAN begins with one or more letters, press "1", otherwise press "2"

After pressing "1":

After pressing "1":

  • Your PTAN consists of a letter-number combination. Enter the first letter.
  • If your PTAN has a second letter press "1", otherwise press two.
  • If your PTAN has a third letter press "1", otherwise press two.
  • Now enter the numbers followed by the "#" key.

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Tax Identification Number

Enter the last 5 digits of your tax identification number followed by the "#" key.

Please note the NPI, PTAN and last 5 digits of the tax identification number must be a valid combination on the crosswalk in order to obtain information.

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Entering PTAN letters

To enter a letter, you will press two keys:

  • First, press the key with the letter.
  • Then press "1", "2", or "3" depending upon the position of the letter on that key.
  • Example: To enter the letter A, press "2" then "1"
    On telephones where Q appears with P, R, and S on key 7 assume that R and S are the second and third positions respectively. Regardless of your telephone type, assume that Q and Z are on the one key. Q would be positioned as the first letter and Z as the second.
    • Example: To enter Z, press "1" then "2".
  • Enter PTAN letters:
     
    A 21
    B 22
    C 23
    D 31
    E 32
    F 33
    G 41
    H 42
    I 43
    J 51
    K 52
    L 53
    M 61
    N 62
    O 63
    P 71
    Q 11
    R 72
    S 73
    T 81
    U 82
    V 83
    W 91
    X 92
    Y 93
    Z 12

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Patient's Medicare Number

  • Press "1" if the Medicare number ends in a letter or letter-number combination.
  • Press "2" if the Medicare number begins with one or more letters.
  • Enter the first 9 digits of the Medicare number.
  • If the letter at the end of the Medicare number is:
     
    A press "1"
    B press "2"
    C press "3"
    D press "4"
    M press "5"
    T press "6"
    W press "7"
    Any other letter press "0" for the customer service representative phone number.
  • If there is a number after the letter, press that number now.
  • If there is nothing following the letter, press "#" pound key.
  • If there is another letter following the letter, press "*" star key.
  • If the second letter is:
     
    A press "1"
    B press "2"
  • If it is any other letter, press "0" for the customer service representative phone number.

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Patient's Name

  • Enter the beneficiary's first initial using the letters on your telephone keypad.
  • Enter the first six digits of the beneficiary's last name followed by the # key.
  • Example 1: Smith will be "7", "6", "4", "8". "4".
  • Example 2: Smith Jr will be "7", "6", "4", "8", "4" "5"

**Hint** Only enter letters. Ignore any spaces and enter the first 6 letters.

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Claim and Redetermination Status

Enter the date of service for this claim. Enter the date in a month-month, day-day, year-year format.

Example: If the date of service is January 25, 2000, enter "0", "1", "2", "5", "0", "0". Enter the date now.

Press"1" for claim status
Press"2" for redetermination status

Claim status

NOTE: The system will give claim information in the following categories:

  • Claim pending
  • Applied to deductible
  • Paid
  • Denied

– The system only advises payment made to the provider.

– Non-assigned paid claim information will not be given.

  • Press "1" for line-by-line information, otherwise press "2" to continue.

    After pressing "1" and line information is given for the first line, press "1" for the next line and for each line until you receive the message there are no more lines for this claim.

  • Press "1" for a duplicate remit, otherwise press "2".

After claim information and/or line-by-line information:

  • Press "1" to check another claim with the same date of service.
  • Press "2" to check for a claim with a different date of service.
  • Press "3" to check on a claim for a different HICN.
  • Press "7" to repeat the claim information
  • Press "9" to get information about a different NPI.

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Redetermination Status

You will receive the following information for the provider and patient information entered:

  • Date of receipt for the redtermination
  • Pending for requests that are not completed
  • Completion date
  • Decision (upheld or reversed) for most redetermination requests

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Eligibility Information

  • Enter the beneficiary's 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter "1", "1. "0". "1". "1". "9", "3", "3")
  • Press "1" for eligibility information.
  • Message: "The most current records we have on file from the Social Security Administration show this beneficiary has Medicare Part A entitlement effective… and Part B entitlement effective…"
  • To verify if this beneficiary is enrolled in a Medicare Advantage Plan, press "1".

    You will receive one of the following messages:

    1. "According to our records there is no Medicare Advantage Plan information available for the Medicare Number you entered."
    2. "The most current records we have on file show this beneficiary is currently enrolled in a Medicare Advantage Plan beginning…."
  • Medicare Advantage Plan DirectoryExternal Website
  • To verify Medicare Secondary Payer information for this beneficiary effective today, press "2".
    • You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:

      "Our records show Medicare is primary for this beneficiary."

      "Our records show Medicare may be secondary to another insurer. For more information contact the beneficiary. When Medicare may be secondary you will also receive the MSP type (for Disability, Working aged and ESRD only)."

  • To verify Medicare Secondary Payer information for this beneficiary for a specified date, press "3".
    • You will be prompted to enter your date.

      You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:

      "Our records show Medicare is primary for this beneficiary."

      "Our records show Medicare may be secondary to another insurer. For more information contact the beneficiary. When Medicare may be secondary you will also receive the MSP type (for Disability, Working aged and ESRD only)."

  • To verify Home Health and Hospice information, press 4.
    • You have chosen to check Home Health and Hospice information for this beneficiary. The most recent Home Health and Hospice episode dates will be given.

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Deductible and Therapy Limitation Information

  • Enter the beneficiary's 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter "1", "1. "0". "1". "1". "9", "3", "3")
  • Press "2" for deductible.
  • Message:

    "The amount of deductible applied for the current calendar year is XX dollar(s) and XX cent(s)."

    After the current year deductible you may press "2" for the previous year applied deductible.

  • Press "3" for the physical therapy limitation.
  • Message:

    "The amount of physical therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).

  • Press "4" for the occupational therapy limitation.
  • Message:

    The amount of occupational therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).

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Financial Information (Outstanding Checks, Pending Claim Totals and Offset Information)

**Note** Pending claims totals are for assigned claims only.

  • Press "1" for outstanding checks released to your NPI within the last month.
  • After receiving information on the first outstanding check, press "1" for the next outstanding check.
  • Press "1" to repeat all check information until you receive the message there are no more outstanding checks.
  • Press "2" for the total assigned claims that are in approved to pay status and are awaiting the payment floor.
  • Press "3" for the total other assigned claims pending.
  • Press"4" for offset information "You will be prompted to enter the FCN from your provider remittance advice"

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Other Inquiries

  • Press "1" for an allowable
  • Press "2" to order a duplicate remittance notice

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Allowable Information

  • Press "1" if the procedure code begins with a letter.
  • Press "2" for all other procedure codes.
  • If the type of service is a number, press "1".
  • If it is a letter, press "2".
  • Enter the type of service.
  • Enter the zip code. (Note this is the 5 digit zip code.)
  • Message: "The current year allowed amount for this procedure code is _________."

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Procedure Codes that Begin With a Letter

  • If the procedure begins with the letter:
     
    A press "1"
    G press "2"
    J press "3"
    M press "4"
    Q press "5"
    R press "6"
    V press "7"
    E press "8"
    B press "9"
    D press "#"
  • Now enter the 4 numbers that follow the prefix.

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Procedure Code Modifier and Type of Service

  • Press "1" if there is a modifier at the end of the procedure code.
  • Press "2" for no modifier.
    • Press 1 for an alpha modifier
    • Press 2 for a numeric modifier

    NOTE: Modifier:

    AH press "1"
    AJ press "2"
    AS press "3"
    TC press "4"
    26 press "5"
    54 press "6"
    55 press "7"
    80 press "8"
    78 press "9"
  • Now enter the type of service
    • Press "1" if it numeric
    • Press "2" if it is a letter
  • Message: "The current year allowed amount for this procedure code is _________. "

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NPI and PTAN Crosswalk Validation

If you have made change to the NPPES system within the last 5-10 business days please note that those changes may not yet be reflected in our system.

Enter your billing NPI.

Enter your billing PTAN.

You will receive one of the following messages:

  • Yes, your NPI and PTAN are currently on the crosswalk in our system.
  • No, your NPI and PTAN are not currently linked in our system. Please visit the NPPES website, https://nppes.cms.hhs.govExternal Website and make sure that the NPI and PTAN are linked. If they are linked there, but are not cross walked in our system, please contact a Provider Customer Service Representative at 1.866.276.9558.

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NPI in PECOS Verification

This option will verify your individual NPI in PECOS.

  • Enter your individual NPI.
  • Enter your individual PTAN
  • Enter the last 5 digists of your tax identification number.

You will receive one of the following messages:

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General Information

The IVR offers a host of self-service options, including claim status, patient eligibility, check status, and more. Remember, CMS requires providers to use the IVR for these simple inquiries.
1-866-290-4036

The IVR is available 24 hours a day, 7 days a week, except for routine system maintenance. However, the most common IVR inquiries also require the IVR to access our online system. The times below represent our online system availability, which means that all IVR options are routinely available during these times:

Monday - Friday: 7:00am - 7:00 pm ET
Saturday: 7:00 am - 4:00 pm ET

Provider Enrollment Correspondence

1-866-276-9558
CGS
PO Box 20017
Nashville, TN 37202

Paper Claims Submission

CGS
PO Box 20019
Nashville, TN 37202

General Correspondence/Appeals

CGS
PO Box 20018
Nashville, TN 37202

Provider Outreach and Education

Provider Enrollment

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Constant Prompts throughout the IVR

The following prompts are constant throughout the IVR:

  • Press "7" to repeat information.
  • Press "8" to return to the main menu.
  • Press "9" for information on a different NPI.

Example: Checking status of a claim for a provider with a letter at the end to the PTAN.
PTAN 11111D, Medicare number 111111111A, date of service 010303

  • Press "1" - claim status.
  • Enter your NPI followed by the # key.
  • Press "1" - PTAN ending with a letter.
  • Press "11111# " - the numeric portion of the PTAN followed by #.
  • Press "3", then "1" - if the letter is a D, press "2" for no second letter.
  • Listen to NPI repeated.
  • Press "1" if the PTAN is correct.
  • Press "1" for a Medicare number that ends in a letter or a letter-number combination.
  • Press "111111111" - the numeric portion of the Medicare number.
  • Press "1" - if the letter at the end of the Medicare number is an A.
  • Enter the patient's first initial.
  • Enter the first 6 digits of the patient's last name.
  • Press "010303" - for the date of service.

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Updated: 02.28.13

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