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Online Tools

Important: All information within this section was current at the time of publication. Suppliers are reminded to refer to LCDs and Policy Articles for official instructions.

ADR Timeline Calculator | ALJ Appeals Status Request | ANSI Denial Guide | Appeals Time Limit Calculator |CGS Go Mobile | CERT Claim Identifier Tool | Claims Timely Filing Calculator | CMS 1500 Claim Form Instructions Tool | CPM Device Date Span Calculator | Documentation Identification Tool | Enteral Nutrition Calculator | HCPCS Lookup | IVR Beneficiary Name to Number Converter | Join/Update Listserv | KE & KY Modifier Tool | KX Table | Modifier Finder Tool | MR Wizard | MSP Lookup | Nebulizer Medication Calculator | Ordering/Referring Provider Denial Job Aid | Power Mobility Devices Denial Help Aid | PECOS | Repair Modifier Tool

Additional Documentation Request (ADR) Process

This page has been developed to help explain the ADR Process.

ALJ Appeals Status RequestExternal Website

The Office of Medicare Hearings and Appeals (OMHA) has made a link available so you can check the status of your appeal hearing before the Administrative Law Judge (ALJ). Scroll to the bottom of the page and click on "PROCEED TO AASIS." You will be directed to the ALJ Appeal Status Information System Inquiry page. Enter the ALJ Appeal Number (e.g. 1-############), referenced on the Acknowledgement Letter or Notice of Hearing from the Office of Medicare Hearings and Appeals in the appropriate cell. Next, answer the security/validation question then click "Submit Inquiry." The resulting page will give you the status of the appeal in question. Please note, the system will allow you to enter up to ten (10) appeal numbers - follow the instructions on the page.

ANSI Denial Guide

This tool has been developed to provide the supplier community with guidance on how to address claim denials in the most efficient manner. This tool does not capture all scenarios, but the most common. Suppliers are strongly encouraged to review all aspects of a claim denial and to respond accordingly.

Appeals Time Limit Calculator

I would like to submit my Redetermination Request today. Will it meet the 120 day timeliness requirement?

CERT Claim Identifier Tool

This CERT Claim Identifier Tool has been designed to aid Medicare suppliers obtain the results of their CERT review. You may search this database by CID.

CGS Go Mobile

CGS is keeping you connected with our free CGS GO Mobile app! Now, you can access and share our Dear Physician Letters, view your ADR status and MR WIZARD online decisions, read LCDs, related policy articles and more! Download today!

Claims Timely Filing Calculator

This tool will assist in determining the claim timely filing limit for the billed service(s).

CMS 1500 Claim Form Instructions Tool

The CMS 1500 Claim Form Instructions Tool provides DME Suppliers an easy way to view instructions for each item on the claim form. Simply hover your cursor over a specific field, and instructions will pop up.

CPM Device Date Span Calculator

This calculator determines the date span for DME MAC coverage of CPM devices based on the dates of surgery, onset, and discharge.

Documentation Identification Tool

CGS has created the Documentation Identification Tool to assist you in submitting the different types of documentation needed to support your claim.

Enteral Nutrition Calculator

The Enteral Nutrition Calculator assists suppliers in determining the proper units of service required to submit a claim for Medicare payment consideration.

HCPCS Lookup

The HCPCS Lookup Tool allows you to view the description of individual HCPCS codes.

IVR Beneficiary Name to Number Converter

The IVR Beneficiary Name to Number Converter is a great tool to assist with the IVR. This tool converts the beneficiary's first initial of their first name and first six letters of their last name for the IVR beneficiary name validation process. The IVR Beneficiary Name to Number Converter is a great tool to assist with the IVR.

Join/Update Listserv

By joining the CGS electronic mailing list, you can get immediate updates on all Medicare information, including: Medicare publications, important updates, workshops, and medical review information.

KE & KY Modifier Tool

The KE/KY Modifier Tool will help Suppliers determine the appropriate use of the KE and/or KY modifiers. The KE and KY modifiers are used to indicate options/accessories used with a non-competitive bid base.

KX Table

The information listed in this chart may not include all of the coverage criteria for a given product/service. You may refer to the corresponding LCD for further coverage requirement information.

Modifier Finder Tool

This Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information.

MR WIZARD

The MR WIZARD denial explanation tool provides the most detailed medical review denial explanations available anywhere. All you need to use the tool is a 14-digit Claim Control Number (CCN).

MSP Lookup

Unsure if Medicare should pay as the primary or secondary insurer for your patient? By answering a few simple questions this tool will help you determine if Medicare is the primary or secondary insurer.

Nebulizer Medication Calculator

The Nebulizer Calculator gives DME suppliers the ability to input the strength of the ordered drug, the size of the vial dispensed (if applicable) and the frequency the medication is taken daily. The calculator will display the maximum number of units that can be billed in a 30 or 90 day period.

Ordering/Referring Provider Denial Job Aid

If you have received a claim rejection/denial due to a missing/incomplete/invalid ordering provider name and/or NPI, you must correct and resubmit your claim in order for payment to be considered. Use the following chart for guidance on correcting your claim.

Power Mobility Devices Denial Help Aid

View categories of denials associated with claims for power mobility devices. Select the denial reason(s) listed in your claim denial letter to find additional explanations and key references from Medicare policies.

Provider Enrollment, Chain, and Ownership System (PECOS)External Website

This link will connect you with the enrollment tool for the Medicare Provider Enrollment, Chain and Ownership System (PECOS).

Repair Modifier Tool

CGS has created an aid to assist suppliers in determining the appropriate modifiers for claim submission. The RB modifier aid includes frequently billed wheelchair replacement codes and modifier suggestions, including the KU modifier. The list is not all inclusive or indicative of coverage. Suppliers are responsible for ensuring all requirements are met for the appropriate use of modifiers.

Site Map

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