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Jurisdiction 11 Part B
Frequently Asked Questions

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How can I search local coverage determinations (LCD) for a specific CPT/HCPCS code?08/21/2015
My claim for post-operative services billed with modifier 55 was rejected, what information was missing?08/19/2015
Why was the post-operative care service I billed with modifier 55 underpaid?08/19/2015
Are we required to complete the ICD Indicator field in Item 21 of the CMS-1500 (02/12) claim form?08/18/2015
My paper claim was returned with a letter because I submitted a PTAN on the claim. Why wasn't my claim processed?07/22/2015
Who are the medical directors for Palmetto GBA?07/01/2015
Are Critical Access Hospitals (CAHs) subject to the outpatient therapy caps and thresholds in 2013?06/19/2015
As a non-participating provider, why can I not charge up to the limiting charge if I accept assignment?06/19/2015
Can a travel allowance fee be charged for medically necessary specimen collection from a nursing home or homebound patient?06/19/2015
Can an Anesthesiologist Assistant (AA) append HCPCS modifier QZ to an aesthesia service?06/19/2015
Can an attending physician and an office physician both submit a claim for their services?06/19/2015
Can an audiology service performed by an audiologist (technician) be submitted under the ENT physician's provider number when the ENT physician is out of the office on vacation? Could this be an example of 'incident to' services?06/19/2015
Can I appeal an outpatient therapy threshold prior authorization decision?06/19/2015
Can I submit an established patient code if the minimal documentation requirements are not met for a new patient code?06/19/2015
Can I submit ICD10 test files with my existing Submitter ID or do I have to obtain a new one?06/19/2015
Can physical and occupational therapists both provide services to one patient at the same time?06/19/2015
Can providers of the same specialty/same group bill for critical care add on codes on the same date of service?06/19/2015
Can the modifier that indicates 'increased procedural services' be submitted with an E/M service when a physician spends an extended amount of time with a patient?06/19/2015
Can we fax a primary payer's Explanation of Benefits (EOB) for Medicare Secondary Payer (MSP) claims using the fax attachments for electronic claims process described in the Medicare Advisory?06/19/2015
Can you clarify the minimum amount of time to establish the apnea-hypopnea index (AHI)? Is it two hours of recorded time or two hours of sleep time?06/19/2015
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?06/19/2015
Do I need to send documentation for prolonged care code with each claim?06/19/2015
Does Palmetto GBA consider Coumadin or Heparin a 'drug requiring intensive monitoring for toxicity'?06/19/2015
Does Palmetto GBA cover electromagnetic wound therapy when delivered using MicroVas?06/19/2015
Does Palmetto GBA monitor the use of locum tenens HCPCS modifier Q6?06/19/2015
How do you determine that a problem is a new problem or if it just an exacerbation of an established problem?06/19/2015
How should I submit claims for the 'off-the-shelf' form of drugs administered via implanted pump?06/19/2015
How should I submit compounded drugs administered via implanted pump?06/19/2015
I have a Physician Quality Reporting System (PQRS) code, formerly PQRI code, that is being returned as unprocessable, why?06/19/2015
I submitted a claim with an add-on procedure code during the postoperative period. Why was it returned as unprocessable due to a missing or invalid modifier?06/19/2015
If a child has chronic asthma and I document that parents in the home smoke, would that qualify as social history?06/19/2015
If a patient is a minor, can I receive 'credit' for 'review and summarize old records and/or history obtained from others?06/19/2015
If a patient is admitted to observation late in the evening but not discharged until the following day, do I have one or two observation days?06/19/2015
If a physician talks with a patient about a do not resuscitate (DNR) order and documents his or her discussion, would this be a high-level risk management option under medical decision making even though their prognosis may not be poor?06/19/2015
If an established patient exhibits symptoms from which the physician diagnoses the condition and begins treatment by performing a minor procedure on the same day, can we bill an evaluation and management (E/M) service?06/19/2015
If I order a diagnostic test in the office and I independently review the image, tracing or specimen do I receive three points (one for ordering the test and two for independently reviewing)?06/19/2015
If the physician documents that 'the patient was a difficult historian' without further elaboration, is this documentation sufficient?06/19/2015
My claim was denied with remittance messages N362 (The number of Days or Units of Service exceeds our acceptable maximum) and 151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services). What does that mean?06/19/2015
My claim was returned with the message 'the procedure code is inconsistent with the modifier used or a required modifier is missing.' I submitted two modifiers, and they should both be valid for the procedure code. Why was my claim rejected?06/19/2015
New Therapy Cap Process: Frequently Asked Questions06/19/2015
Our group submitted two claims for office visits for two group providers. Why was the second one denied? (This applies to hospital visits also.)06/19/2015
Our physician will be out for 60 continuous calendar days. Will Medicare allow two different locum tenens physicians to substitute for the same regular physician?06/19/2015
Telephone calls are not a billable service for providers. Does this rule apply to nurse practitioners?06/19/2015
We received a denial on the second initial consultation that was performed. Why wasn't the second consultation paid?06/19/2015
What are the Medicare requirements for shared services?06/19/2015
What should I do when Medicare Part B is denying claims indicating the patient is enrolled in hospice when the patient states they are no longer receiving hospice benefits?06/19/2015
What would constitute the complete single system exam?06/19/2015
How should we calculate the time for time-based psychotherapy services for the purposes of submitting claims?06/18/2015
I have heard that Medicare payments for mental health services will change over the next few years. How will these payments be calculated and what will change?06/18/2015
What clinical documentation, when requested, is required to be submitted to support 'reasonable and necessary' for psychotherapeutic services?06/18/2015
What documentation should be included with a Recovery Audit Contractor (RAC) appeal?06/18/2015
What is the Recovery Audit Contractor (RAC) appeal process?06/18/2015
When submitting psychotherapy services for medical review, what documentation is required?06/18/2015
Am I an Independent Diagnostic Testing Facility (IDTF)?06/16/2015
Am I violating the Health Insurance Portability and Accountability Act (HIPAA) privacy rules by sending documentation to the CERT Documentation Contractor (CDC) and/or AdvanceMed?06/16/2015
Are consultation codes deleted for Medicare Advantage plans as well as Medicare fee-for-service?06/16/2015
Are health care providers required to comply with the CERT contractor's request for medical records?06/16/2015
Are observation codes submitted by the hour or by the calendar date?06/16/2015
Are we required to submit our Medicare Secondary Payer (MSP) claims electronically?06/16/2015
Are you required to submit therapy codes with both the GP and the GY HCPCS modifiers?06/16/2015
Can a chiropractor use a manual device to assist with manipulation?06/16/2015
Can a clinical pharmacist (Pharm D) perform an Annual Wellness Visit (AWV)?06/16/2015
Can a nurse practitioner perform the initial hospital visit?06/16/2015
Can a provider bill Medicare for missed appointments and receive reimbursement?06/16/2015
Can an emergency department visit be submitted if the physician consults with the ER physician over the phone but does not actually come to the emergency department?06/16/2015
Can an independent diagnostic testing facility (IDTF) that functions as a mammography center receive Medicare reimbursement for percutaneous breast biopsy procedures and metallic localization clip placement?06/16/2015
Can Dr. B. submit an initial visit in the following scenario? An ER physician sends a patient to be admitted and lists Dr. A. as the admitting physician. A resident performs the history and physical (H&P), followed by Dr. B., who sees the patient, reviews the H&P, and writes his notes. Dr. A. never sees or bills for any service for the patient.06/16/2015
Can I call the Telephone Reopening Line to correct claims that were rejected as unprocessable?06/16/2015
Can Psychotherapy Codes be Billed as Incident To?06/16/2015
Can the interpretation of an EKG be billed by the teaching physician if the residents are doing both the reading and interpretation?06/16/2015
Can time be used as a basis for E/M code selection in regards to add-on psychotherapy services?06/16/2015
Can we bill a patient for a service that denied due to MUE? Should we issue an Advance Beneficiary Notice (ABN) to the patient in this case?06/16/2015
Can we submit an appeal if we disagree with an Medically Unlikely Edit (MUE) denial?06/16/2015
Can you clarify the exact timeframe between Annual Wellness Visits (AWVs)? Is it 365 days from the date of the last AWV or 11 months, etc.?06/16/2015
CMS Questions and AnswersOpen in New Window06/16/2015
Do I need to complete a new provider enrollment form if I am making a change to my credentialing information?06/16/2015
Do I need to enroll all of my offices in PECOS to continue ordering/referring for Medicare beneficiaries if I have offices in multiple states?06/16/2015
Do I need to submit a claim to Medicare for statutorily excluded services?06/16/2015
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?06/16/2015
Do subsequent visits need new treatment plans?06/16/2015
Does a beneficiary need to sign an Advance Beneficiary of Noncoverage (ABN) for every visit?06/16/2015
Does Medicare cover hand therapy or pet therapy?06/16/2015
Does Medicare Part B cover Emend for postoperative nausea and vomiting (PONV)?06/16/2015
Does Medicare pay for unit dose medications for the COPD patients if they are in a nursing home facility?06/16/2015
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?06/16/2015
Does Medicare reimburse for ambulance transportation to and from a physician's office?06/16/2015
For outpatient therapy, how do I discharge or close out a reporting episode when the patient unexpectedly stops therapy? My patient called and said he does not think he needs any more therapy but came back in four weeks later for a different functional limitation. How do I close out the previous reporting episode before starting the new one?06/16/2015
How can I determine what codes/procedures are bundled with a certain code in the CCI edits?06/16/2015
How do I change my address with Medicare since our practice is moving?06/16/2015
How Do I Find a Form?06/16/2015
How do I register for listservs?06/16/2015
How does a chiropractor submit a claim for an office visit and X-rays to Medicare for the denial of statutorily excluded services for the patient's secondary insurance company?06/16/2015
How does the CERT process work?06/16/2015
How is a claim selected and reviewed as part of the CERT process?06/16/2015
How is compliance with the CERT contractor's request for medical records beneficial to providers?06/16/2015
How is the CERT paid claims error rate determined?06/16/2015
How long does the CERT contractor have to review the medical records?06/16/2015
How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?06/16/2015
How often are CARCs and RARCs updated?06/16/2015
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last updated on 9/01/2015
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