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

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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.
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Hospice Cap Process

This page outlines the process for hospices to file a self-determined aggregate cap.

Timeline
Terminated Providers
PS&R Reports
Form & Instructions
Calculation for New Hospices
Submitting Cap Determinations
Cap Overpayments
Confirmation

Timeline

Hospices must file a self-determined aggregate cap 3 – 5 months after the end of each cap year (no earlier than December 31st and no later than February 28th).

Terminated Providers

Providers who terminate from the Medicare program in the following cap year (i.e., 2025) must submit both current year (i.e., 2024) and final (terminating) self-determined cap reviews at the same time. After we process the current year self-determined cap submission, we will complete all necessary final cap reviews for your agency.

The statutory cap amount for 2025 is $34,465.34.

PS&R Reports

To prepare the cap calculation, obtain your Provider Statistical & Reimbursement (PS&R) Summary and Hospice Cap reports from the CMS website per these instructions.

CGS doesn't send copies of PS&R reports since hospices are responsible for obtaining them directly. However, if you're unable to obtain the reports, you may contact Tom Bisbee at 615.660.5560 for assistance.

Form & Instructions

Complete the Provider Self-Determined Aggregate Cap Limitation form per these instructions.

Calculation for New Hospices

For new hospices that enter the Medicare program and don't participate for an entire cap year, the initial cap calculations must cover a period of at least 12 but less than 24 months.

Example: A hospice enters the program on September 1, 2023. The first cap period is September 1, 2023, through September 30, 2024.

Order PS&R Summary and Hospice Cap reports from the agency's tie-in date to September 30th of the second cap year (i.e., September 1, 2023 – September 30, 2024).
To obtain the correct beneficiary count from the Hospice Cap report, add the count from the 2023 and 2024 cap years.
Calculate a prorated Hospice cap amount by completing each gray-shaded box in the Prorated Cap Amount form.

Submitting Cap Determinations

Send your completed Provider Self-Determined Aggregate Cap Limitation form, cover letter, and all supporting documents to one of the following:

Mailing Address

Email Address

Fax Number

Part A/HHH Audit & Reimbursement
CGS Administrators, LLC
PO Box 20015
Nashville, TN 37202

SDHOSPICECAPS@cgsadmin.com

615.660.5983

Attn: Tom Bisbee

IMPORTANT NOTE: If CGS doesn't receive the self-determined cap within 7 days of the February 28th due date, we will issue a Past Due letter and suspend payments.

Cap Overpayments

For any overpayment amount calculated as a result of the self-determined cap, send a check made payable to CGS with a cover letter that explains what the payment is for to:

CGS
P.O. Box 957124
St. Louis, MO 63195-7124

If you don't submit the overpayment at the same time as the self-determined aggregate cap, CGS will demand the overpayment reported on the self-determined aggregate cap.

Confirmation

Upon receipt of a self-determined aggregate cap, CGS will:

Perform a cursory review for obvious errors.
Send a confirmation letter within 45 days.
Perform a final review at a later date.

Updated: 12.23.24