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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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Submitting Claims for Untimely Notices of Election (NOEs)

Hospice notice of election (NOE) must be submitted to and accepted by CGS within 5 days after the hospice admission to be considered timely.

To determine the receipt date of the NOE, use the Claim Inquiry option (FISS Option 12) to view the NOE. The 'REC DT' field will indicate the date the NOE was received. In order for the NOE to be timely, the REC DT must be no more than 5 days after the admit date (ADM DT).

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If the NOE is not received timely, those days from admission to the day before the NOE was received, are considered noncovered, and the provider is financially liable for those days.

NOTE:  When days are non-covered due to not filing a timely NOE, report two lines for the affected level of care. For example, for billing period with 31 days of routine home care where the first 5 days are non-covered due to not filing the NOE timely, report the 0651 revenue code line with 5 units and all non-covered charges, and another 0651 revenue code line with 26 units and all covered charges. 

In addition to the usual hospice claim information, a claim reporting an untimely NOE should include the following on FISS Page 01, FISS Page 02 and FISS Page 04:

FISS Page Field Name Description
01 SPAN CODES/ DATES Enter '77' along with the dates of the noncovered days (date of admission to day before NOE received)
(ex. 77 MMDDYY MMDDYY) Note: If the claim does not include OSC 77 and/or the dates reported with OSC 77 are incorrect, the claim will be returned to the provider (RTPd).
02 REV Enter the level of care revenue code for the covered or noncovered days
02 HCPCS Enter the appropriate HCPCS (Q50XX) for the place of service
02 MODIFS Enter a 'KX' only if you are Requesting an Exception for the untimely NOE.
02 TOT UNIT Enter the total units that were covered or noncovered
02 COV UNIT Leave this field blank
02 TOT CHARGE Enter the total charge for the covered or noncovered days
02 NCOV CHARGE Enter the total charge for the noncovered days
02 SERV DATE Enter the hospice admission date (this will match the "TO" date of the claim)
04 REMARKS Effective with claims received on or after November 16, 2016, that include a 'KX' modifier, providers may clearly indicate all circumstances and time frames that supports the exception request for filing an untimely NOE. CGS will research the case and may grant the exception without requesting additional documentation. If the information in the REMARKS field is not clear, CGS will request documentation by generating a non-medical review additional development request (non-MR ADR). Refer to the Requesting an Exception for an Untimely NOE Web page for more details.

Example Claim:

Admit Date = 10/10/YY
NOE receipt date (REC DT) = 10/16/YY
Noncovered days = 10/10/YY – 10/15/YY

Example of FISS Page 01

Note: This information is in addition to the usual information required on FISS Page 01

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Example of FISS Page 02

Note: This information is in addition to the usual information required on FISS Page 02.

In this example, 1010YY-1015YY are noncovered. These days are billed as noncovered.

  • The total units for the noncovered days are reported in the TOT UNIT field.
  • No covered units (COV UNIT) are reported.
  • The total charges for the noncovered days are reported in the TOT CHARGE field.
  • The noncovered charges are reported in the NCOV CHARGE field.
  • The SERV DATE on the noncovered line is the date of admission.

The remaining level of care days (1016YY and forward) are billed as usual.

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Important: In addition, all revenue code lines with a SERV DATE that falls between the OSC 77 dates must be reported as noncovered.

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All revenue code lines with a service date (SERV DATE) on/after the NOE was received are reported as usual (reported as covered).

Example of FISS Page 04

If the information in the REMARKS field does not clearly provide all circumstances and time frames, CGS will request documentation via the non-medical review additional development request (non-MR ADR) process. Refer to the Requesting an Exception for an Untimely NOE Web page for details.

Billing Hints:

  • Ensure that the total level of care days reported (noncovered days + covered days) equals that time period reported on the claim.
  • Ensure that the total units (TOT UNIT) for the noncovered days equals the number of days reflected by the dates reported with the OSC 77.
  • If you have submitted your claim with the 'KX' modifier to request an exception, ensure that the REMARKS field on FISS Page 04 clearly indicates all circumstances and time frames supporting your request. If it is not clear, CGS will request additional information. Refer to the 'Requesting an Exception for an Untimely NOE' Web page for additional information.
  • If you submit your claim through a billing service or clearinghouse, there may be limited character space available in the REMARKS field to include all the circumstances and time frames. If no remarks are submitted, or if it is not clear, CGS will generate a non-MR ADR request for documentation supporting your exception request. Providers may also consider entering claims into FISS via Direct Data Entry (DDE) which provides adequate character space.

Updated: 03.01.21

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