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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 websiteExternal 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

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. 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.
  2. 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 websiteExternal Website.
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Hospice Sequential Billing

A Notice of Election (NOE) must be submitted to Medicare, and must be processed prior to submitting your first hospice claim. To be considered processed, your NOE must appear in status/location P B9997. Use FISS Option 12 (Claim Inquiry) to verify that your NOE is in status/location P B9997 before billing your first claim.

Claims must also be submitted sequentially. When sequential billing requirements are not followed, the claim will move to your return to provider (RTP) file (status/location T B9997).

To meet the sequential billing requirements, claims must be:

  1. Submitted sequentially – This means that January's claim, for example, must be submitted before February's claim can be submitted. The Fiscal Intermediary Standard System (FISS) will search claim history for a prior claim.

    • If a prior claim is not found in a finalized or suspended status/location (P B9997, R B9997, D B9997 or S XXXXX), the incoming claim will be sent to the RTP file.
    • If the prior claim is in the RTP file (T B9997) and needs correcting, the incoming claim will be sent to the RTP file with reason code 37402. FISS does not search the RTP file (T B9997) for prior claims.

      Note: You must correct the claims out of RTP sequentially. For example if the January claim is in RTP because of an invalid HCPC code, and the February claim was submitted, the February claim would go to RTP because no prior claim was found. You must first correct the January claim. Once the January claim is corrected and moves to a suspended status/location, the February claim can be F9ed out of RTP.

    • If the prior claim is in a suspended status/location (S XXXXX) the incoming claim will move to a suspended status/location until the prior claim has been finalized. Once the prior claim has finalized (P B9997, R B9997, or D B9997), the incoming claim will continue processing.

    At any time while a claim is processing, it may move to the RTP file. CGS suggests monitoring your claims on a regular basis. If a prior claim is in RTP, make any necessary corrections to the claim to allow continued processing. To determine the status/location of your claim, refer to the Checking Claim Status Web page; AND
  2. Submitted consecutively – This means that there cannot be any skip in dates between the prior claim's "TO" date, and the next month's claim's "FROM" date; AND
  3. Submitted monthly – Hospices are required to bill claims monthly (see Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §90External PDF). This means providers should bill only one claim per month, for each patient. The "To" date on the claim must be the last calendar day of the month, unless the patient died, was discharged or revoked hospice during the month.

    In addition, hospice claims must conform to a calendar month (Jan 1 – Jan 31). Claims that span two months (ex. Jan 1-Feb 1) will be sent to the RTP file for you to correct.

We recommend that you follow the steps below to ensure compliance and to avoid sequential billing errors:

STEP 1: Submit the NOE to Medicare.

STEP 2: Use the FISS Option 12 (Claim Inquiry) to verify when the NOE has processed (status/location P B9997). Note: If a claim is submitted before the NOE has processed, your claim will be sent to the RTP file (status/location T B9997).

STEP 3: After the NOE has processed (P B9997), submit the first claim. Ensure the "From" date and the "Admit date" on your claim matches the "From" date and "Admit date" on the NOE. If your patient status code indicates the patient is still a patient (PT ST = 30), the claim's "To" date must be the last calendar day of the month.

STEP 4: Use Option 12 (Claim Inquiry) to verify that your first claim appears in FISS, in a finalized or suspended status/location (P B9997, R B9997, D B9997 or S XXXXX). Claims in RTP (T B9997) are not 'received' claims. Refer to the Checking Claim Status Web page for additional information about Option 12.

STEP 5: After you verify that the claim is in a finalized or suspended status/location, submit the next month's claim. Ensure the "From" date on the claim you are submitting is one day after the "To" date on the previous claim. Ensure the "To" date on the claim you are submitting is the last calendar day of the month (unless the beneficiary died, was discharged, or revoked hospice).

STEP 6: Repeat Steps 4 and 5 for subsequent claims.

Sequential Billing and Transfers

Due to sequential billing requirements, hospices that are transferring a beneficiary to another hospice must submit their last claim (type of bill 8X1 or 8X4), indicating the transfer (patient status code 50 or 51), prior to the receiving hospice submitting their Notice of Transfer (type of bill 8XC). Receiving hospices who submit their claim before the transferring hospice submits their last claim may have their claims canceled. For more information about hospice transfers, refer to the Transferring Beneficiary From/To Another Hospice Agency Web page.

Updated: 09.18.17

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