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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Important Information About the Enrollment Process

BEFORE YOU SUBMIT AN APPLICATION:

You MUST have a National Provider Identifier (NPI). An NPI is required for a change of information or to apply for a new Medicare number. Your application will be delayed if you fail to provide an NPI with your original submission. See below for additional details.
You MUST agree to accept Electronic Payment. This federally-mandated requirement applies to established providers submitting a change of information that are not already set up for electronic payment, as well as all new enrollees. An Electronic Funds Transfer Authorization Agreement (EFT) form must be included with your application request. Your application will be delayed if you fail to include a completed EFT Agreement with your original submission. See below for additional details.

Providers' Responsibilities in the Enrollment Process

Providers are responsible for submitting a COMPLETE AND ACCURATE enrollment application. You must comply with all the directions on the enrollment applications. Incomplete or inaccurate applications cannot be processed.

Providers who submit an incomplete application will receive a letter within 30 days requesting the missing items required to complete processing. If a provider does not respond timely to this request for additional information, the application may not be processed.

How to Submit a Paper Provider Enrollment Application

All enrollment applications/forms must be submitted via regular mail to:

J15 — Part B Provider Enrollment
CGS Administrators, LLC
PO Box 20017
Nashville, TN 37202

Special mail handling can delay the delivery and processing of your application.

Current Enrollment Process Details

To obtain the most current versions of the CMS-855 applications, please download the forms from the CMS website.
All new enrollments or changes to existing provider information must include the individual National Provider Identifier (NPI) in the designated sections of the application. If an individual is joining a group, the group NPI is also required. To apply for an NPI, you can access the NPI application form from the CMS website. If you need additional information regarding the NPI you may contact the enumerator company (Fox Systems) directly by calling 1-800-465-3203, or e-mail them at: customerservice@npienumerator.com.
At the time of initial enrollment or a change to existing provider information, an Electronic Funds Transfer Authorization Agreement (CMS-588) must be submitted. The CMS-588 form can be downloaded from the CMS website.
If a provider wants to enroll as a Participating Provider (PAR), the Participation Provider Agreement (CMS-460) must be included with the enrollment application. The provider has up to 90 days after enrollment to submit a PAR Agreement. The current PAR Agreement form can be downloaded from the CMS website.

Providers should attach an actual copy of their medical/professional license to their initial enrollment applications. An "internet copy" is not acceptable.

Reminders

Individual practitioners joining a group are not required to submit an Electronic Funds Transfer Agreement (EFT) (CMS-588). For groups not currently set up for EFT, only one EFT agreement is required for the entire group.

Common Errors that Delay the Enrollment Process

A Physician Assistant submits a CMS-855R instead of a CMS-855I application.
The CMS-855R application is missing the date the supplier and/or individual started rendering services at that location.
A Provider fails to submit the CMS-855R when reassigning benefits.
Section 3, Final Adverse Legal Actions, is not completed by checking the yes/no boxes on the CMS-855B, 855I or 855O forms.
Voided check or bank letter is not submitted with the CMS-588 Electronic Funds Transfer Agreement.
The CMS-855I application does not include the NPI within Section 1A.
IRS documentation is not submitted. If applying under a Tax Identification Number, you must submit IRS documentation. Acceptable documentation includes a CP575 (a computer-generated letter), a Form 990, a quarterly tax coupon or other IRS correspondence that contains the applicant's legal name and tax identification number. A W-9 and SS-4 Form are not acceptable.
Copy of Masters in Nursing degree and/or national certification not received with the CMS-855I application for Nurse Practitioner or Clinical Nurse Specialist.
Group/Organization legal busines name identified on the CMS-855 application(s) does not match the legal business name within the Group/Organization’s PECOS enrollment record.