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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.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.



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.


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 easily view claim denial information and helpful education on specific claims. 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.

Infusion Therapy Drug Billing Calculator

Calculate the units of service for external infusion pump drugs J1559, J1569, and J1575.

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.

New Rental Period Decision Tree

Answer a few simple questions to decide if a new rental period may be started for rented oxygen, parenteral, enteral or other capped rental items.

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 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.

Specialty Evaluation for Wheelchairs Lookup

Enter any HCPCS code to determine whether or not the wheelchair or wheelchair option, accessory, or seating requires a specialty evaluation performed by a licensed/certified medical professional (LCMP).

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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