LICENSES AND NOTICES

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.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  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.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 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. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly 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 to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. 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 CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. 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.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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Tools & Calculators

The tools below are interactive resources, where a supplier can input information and receive answers/outputs that will help them navigate DMEPOS billing.

Tool

Description

ABN Form Instructions Tool

Hover your mouse over the image of the Advance Beneficiary Notice (ABN) to view descriptions and instructions for completing the form.

ADR Tool

Enter the Additional Documentation Request (ADR) number from your letter to view who requested the information, a list of documentation requested, and links to additional information.

ADR Timeliness Calculator

Enter the date from the Additional Development Request (ADR) letter, and this calculator displays the date the claim documentation must be received.

Advanced Modifier Engine (AME)

Select a DMEPOS category, HCPCS code, scenario, and sub-scenario, and the AME will recommend modifiers for claim submission.

ALJ Appeals StatusExternal Website

This link connects you to the U.S. Department of Health and Human Services (HHS) Appeals Status Lookup. Enter the Office of Medicare Hearings and Appeals (OMHA) Appeal Number or the Reconsideration Medicare Appeal Number to receive status information for Medicare Administrative Law Judge (ALJ) claim appeals at the OMHA.

Appeals Decision Tree

Use the Appeals Decision Tree for guidance on determining the next steps for an appeal.

Appeals Time Limit Calculators

Enter the initial determination date on your remittance advice or overpayment demand letter to view the timely filing limit for your redetermination request.

Enter the date on your redetermination decision letter for the timely filing limit for your reconsideration request.

Beneficiary Name to Number Converter

Enter the beneficiary's name to convert letters to numbers for using your telephone keypad when calling CGS Customer Support or the Interactive Voice Response (IVR).

CEDI Reject Code LookupExternal website

This link connects you to the Common Electronic Data Interchange (CEDI) tool to view easy-to-understand descriptions associated with the edit codes from the Status Information segment (STC) of the 277CA – Claim Acknowledgement.

CERT CID Tool

Enter the Comprehensive Error Rate Testing (CERT) Claim Identifier (CID) to obtain completed CERT review results.

CGM Supply Allowance Billing Calculator

Enter the last date of service to calculate the next date of service that can be billed for continuous glucose monitors (CGMs) monthly supply allowance.

CGS Medicare Mobile App

The CGS Medicare mobile app offers several features, including local coverage determinations (LCDs), physician letters, the CGS Wizard, disaster resources, and more.

CGS Wizard

Enter the 14-digit Claim Control Number (CCN) to view processed claim information and medical review decisions. A user ID and password are not required since the tool does not provide any protected health information (PHI).

Claim Denial Resolution Tool

Enter the American National Standards Institute (ANSI) Reason Code from your Remittance Advice (RA) to view detailed information for the claim denial and possible causes and resolutions.

Claims Timely Filing Calculator

Enter the date of service to calculate the date of the timely claim filing limit.

CMS 1500 Claim Form Instructions Tool

Hover your mouse over the image of the form to view descriptions and instructions for completing the paper claim form.

Consolidated Billing Tool

Enter a valid HCPCS code to see if the item is payable for beneficiaries in a skilled nursing facility (SNF), during a home health episode, or while enrolled in hospice.

CPM Date Span Calculator

Enter the date of surgery, onset of use, and discharge date to determine the date span for coverage of continuous passive motion (CPM) devices.

DMEPOS Fee Schedule Search Tool

Select the applicable Jurisdiction B state and quarter, and enter a HCPCS to view the fee amount from the CMS DMEPOS and Fee Schedule Files. This tool does not include fee amounts for competitive bid items furnished in former Competitive Bidding Areas (CBAs) or Single Payment Amounts (SPAs).

Enteral Nutrition UOS Calculator

Enter the date span and calories per day to calculate the proper units of service (UOS) to report on the claim.

ESRD Coordination Period Calculator

Enter the End Stage Renal Disease (ESRD) benefit beginning date to calculate the end of the 30-month coordination period and Medicare primary payer start date.

HCPCS Lookup

Enter a HCPCS code to view the description.

KE & KY Modifier Tool

Select the appropriate beneficiary location and date of service, then enter the accessory and base codes to determine when to use the KE and/or KY modifiers for options/accessories used with a non-competitive bidding base.

MBI Letters to Numbers Converter

Enter the Medicare Beneficiary Identifier (MBI) to convert letters to numbers for use on your telephone keypad when calling CGS Customer Support or the Interactive Voice Response (IVR).

Modifier Description Tool

Search this database by modifier or keyword to view the modifier description and additional billing information.

Monthly Rental Payment Calculators

Enter the HCPCS code and fee schedule amount to estimate monthly rental payments for capped rental items or complex rehabilitative power wheelchairs (PWC) and wheelchair options/accessories.

MSP Decision Tree

Answer a few simple questions to determine if Medicare should pay as the primary or secondary insurer.

MSP Line Level Calculator

Calculate the line-by-line claim payment for covered services when Medicare is the secondary payer (MSP) by entering the Medicare allowed amount, deductible applied, primary insurance allowed, Obligated to Accept (OTA), and primary payment amount.

Nebulizer Drug Calculators

Select the name of the nebulizer drug and enter prescription information to calculate the maximum number of units that can be billed in a 31-day period and 90-day period.

Overpayment Interest Calculator

Enter the date on the demand letter, date the check is being mailed, overpayment amount, and interest rate to calculate the total amount due.

PAP Tool

Enter a Positive Airway Pressure (PAP) HCPCS code to view information from the PAP Devices for the Treatment of Obstructive Sleep Apnea LCD (L33718)External Website including the description, billing frequency, and more.

Parenteral Nutrition DIF Expiration Date Calculator

Enter the initial date and the length of need from the DME information form (DIF) to calculate the DIF's expiration date.

Parenteral Nutrition Lipids UOS Calculator

Enter the date span and prescription information to calculate the correct UOS for HCPCS codes B4185 or B4187.

PMD Weight Requirements Tool

Search by HCPCS codes to view applicable beneficiary weight limitations for power mobility devices (PMDs), or search by the beneficiary's weight to view applicable HCPCS codes.

Prior Authorization Code Lookup

Enter any HCPCS code to determine if prior authorization is required.

PECOSExternal Website

This link connects you to the Provider Enrollment, Chain, and Ownership System (PECOS) enrollment tool.

Remittance Advice Instructions Tool

Hover the mouse of the image of Standard Paper Remittance Advice (SPR) to view information and descriptions. Many of the descriptions will also apply to the Electronic Remittance Advice (ERA), though they may not appear in the same order.

Same/Similar Code Lookup

Enter a HCPCS code in the search field to view a list of other HCPCS codes that may be considered the same as or similar to the base item entered.

Site Map

View an outline of the JB website.

WOPD Code Lookup

Enter any HCPCS code to see if the code is included on the Required Face-to-Face (F2F) Encounter and Written Order Prior to Delivery (WOPD) List.

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