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Jurisdiction 11 Part B
Frequently Asked Questions



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A patient is transported by ambulance to hospice prior to the initial assessment and development of the plan of care. Change Request 6778 states this transport would be covered under the ambulance benefit, not the hospice benefit. What destination modifier do I use?04/15/2014
Appeals: What happens to an incomplete redetermination request?04/15/2014
Can a single visit be counted as both the IPPE and an AWV?04/15/2014
Can other medical services be performed at the same time as an AWV? If so, how are they coded?04/15/2014
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.?04/15/2014
Do I submit the rendering National Provider Identifier (NPI) number when submitting ambulatory surgical center (ASC) claims?04/15/2014
Does Medicare publish a listing of skilled nursing facilities, non-skilled nursing facilities and residential facilities?04/15/2014
Does Medicare reimburse for ambulance transportation to and from a physician’s office?04/15/2014
I have an ambulatory surgical center (ASC) claim for brachytherapy treatment planning that was returned as unprocessable. The message states the claim was processed in accordance with ASC guidelines, but this code is on the ASC list of ancillary services that are separately payable. Why wasn’t the claim processed?04/15/2014
I have received a denial for my submission of specialty care transport HCPCS code A0434. What could be wrong?04/15/2014
I received a denial for my submission of a specialty care transport code. What could be wrong?04/15/2014
If a patient is being transported to a wound care center located within a hospital or on hospital grounds, which destination modifier would be used when filing the claim?04/15/2014
If our claim denies for a Medically Unlikely Edit (MUE), do we have to submit a first level appeal (Redetermination) or can we submit a Clerical Error Reopening Request form instead?04/15/2014
Is the Annual Wellness Visit (AWV) the same as a beneficiary's yearly physical?04/15/2014
Is there a deductible or coinsurance/copayment for the Annual Wellness Visit (AWV)?04/15/2014
May we fax documentation in response to Additional Documentation Request (ADR) letters using the fax attachments for electronic claims?04/15/2014
My claim for 'external circulation assist: each additional 24 hours,' was denied stating an add-on code cannot be submitted by itself (it is on the same claim as the service for 'external circulation assist: initial 24 hours,')?04/15/2014
My paper claim was rejected with message N34, incorrect claim form/format for this service. What is wrong with my claim form?04/15/2014
Some nursing facilities provide all three types of services (skilled care, non-skilled care and residential care) at the same facility. How do we verify what area of that facility the patient resides in so we know what modifier to use when filing our claims?04/15/2014
The CO-97 denial is 'Patient was an inpatient on the date of service'. Some hospital facilities do not understand why we bill them for our transports in order for us to get paid for our services. Is the hospital responsible for the payment of the transports while the patient is an inpatient?04/15/2014
What are the appropriate procedure codes for the first and subsequent AWVs?04/15/2014
What are the guidelines for placement of cardiac pacemakers and defibrillators?04/15/2014
What documentation is required for transtelephonic monitoring?04/15/2014
What HCPCS modifier should be used when transporting patients to and from satellite offices/urgent care centers owned by a large hospital? Since these are satellite offices of the hospital, why wouldn’t they be considered the 'hospital' and be filed with HCPCS modifier 'H?'04/15/2014
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last updated on 4/01/2014
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