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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Online Tools & Calculators

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist Medicare (Providers or Suppliers) with submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although every reasonable effort has been made to provide effective resources to assure correct claim submission, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information provided by these tools. CGS is not responsible for any human or mechanical errors or omissions.

Self-Service Guide – NEW!

A convenient source for information about all of our self-service tools and calculators, this booklet PDF may be downloaded for easy reference.

ABN
Advance Beneficiary Notice of Noncoverage (ABN) Form Instructions Tool

The Advance Beneficiary Notice of Noncoverage (ABN) Form Instructions Tool provides DME Suppliers an easy way to view instructions for each item on the ABN form form.

ADR
ADR Tool

The ADR Tool lets you enter the ADR number from your denial letter to obtain additional information about the requested documentation.

ADR Timeliness Calculator

The ADR timeliness calculator will assist you in determining the date ADR documentation must be received in order to meet the time frame for submission.

Appeals
ALJ Appeals Status RequestExternal Website

The Office of Medicare Hearings and Appeals (OMHA) has made a link available so you can check the status of your appeal hearing before the Administrative Law Judge (ALJ). Scroll to the bottom of the page and click on "PROCEED TO AASIS." You will be directed to the ALJ Appeal Status Information System Inquiry page. Enter the ALJ Appeal Number (e.g. 1-############), referenced on the Acknowledgement Letter or Notice of Hearing from the Office of Medicare Hearings and Appeals in the appropriate cell. Next, answer the security/validation question then click "Submit Inquiry." The resulting page will give you the status of the appeal in question. Please note, the system will allow you to enter up to ten (10) appeal numbers - follow the instructions on the page.

Appeals Decision Tree

Do you need to submit a request for redetermination or request a reopening? Use the Appeals Decision Tree for guidance on the correct action to take.

Appeals Time Limit Calculator

I would like to submit my Redetermination Request today. Will it meet the 120 day timeliness requirement?

Calculators
CPM Device Date Span Calculator

This calculator determines the date span for DME MAC coverage of CPM devices based on the dates of surgery, onset, and discharge.

Enteral Nutrition Calculator

The Enteral Nutrition Calculator assists suppliers in determining the proper units of service required to submit a claim for Medicare payment consideration.

End Stage Renal Disease 30 Month Coordination Period Calculator

This tool calculates the 30 month coordination period prior to Medicare becoming the primary insurance for ESRD beneficiaries.

Nebulizer Medication Calculator

The Nebulizer Calculator gives DME suppliers the ability to input the strength of the ordered drug, the size of the vial dispensed (if applicable) and the frequency the medication is taken daily. The calculator will display the maximum number of units that can be billed in a 30 or 90 day period.

New! Overpayment Interest Calculator

Enter the Date on the Demand Letter, the Date the check is being mailed, the Overpayment Amount and the Interest Rate and find the Total Amount Due.

Parenteral Nutrition Solution Lipids (B4185) Calculator

This calculator is designed to assist suppliers in billing the correct units of service for HCPCS code B4185. For lipids, one unit of service of code B4185 is billed for each 10 grams of lipids provided. 500 ml of 10% lipids contains 50 grams of lipids (5 units of service); 500 ml of 20% lipids contains 100 grams (10 units of service); 500 ml of 30% lipids contains 150 grams (15 units of service).

CERT
CERT Claim Identifier Tool

This CERT Claim Identifier Tool has been designed to aid Medicare suppliers obtain the results of their CERT review. You may search this database by CID.

CGS Medicare Mobile App
CGS Medicare Mobile App

The CGS Medicare mobile app offers several features, including LCDs, Physician Letters, CGS Wizard, and more!

Charts
Orthotics Chart

This Orthotics Chart is designed to show the differences between off-the-shelf, custom-fit, and custom-fabricated orthoses. Suppliers will be able to see the requirements for each type compared side by side. Links to the Policy Articles and the DMEPOS Quality Standards are included in the event that more information is needed.

Claim Submissions and Denials
5010 277CA Reject Code Lookup Tool

The Reject Code Lookup Tool provides explanations for the edit code(s) returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement for an electronically submitted claim.

Advanced Modifier Engine (AME)

The Advanced Modifier Engine was designed by CGS to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations. The tool includes Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) commonly billed HCPCS with billing scenarios. Based on the specific HCPCS entered and the billing scenario, the tool recommends modifiers for claim submission.

CGS Wizard

CGS Wizard contains detailed processed claim information for all claims submitted to Jurisdiction B including ADR status, medical review decisions, education and resources! All you need to use the tool is a 14-digit Claim Control Number (CCN).

Claim Denial Resolution Tool

This tool has been developed to provide the supplier community guidance on how to address Claim Submission and Denials in the most efficient manner. Enter the Reason Code and Remark Code (if applicable) from your Remittance Advice into the search fields. The tool will provide the remittance message for the denial and the possible causes and resolution. Please Note: This tool is available for claim denial assistance with the common denials and may not address every scenario.

Claim Documentation Divider Sheets

Claim Documentation Divider Sheets standardize the process so you no longer need to create your own cover sheets for your documentation.

Claims Timely Filing Calculator

This tool will assist in determining the claim timely filing limit for the billed service(s).

CMS 1500 Claim Form Instructions Tool

The CMS 1500 Claim Form Instructions Tool provides DME Suppliers an easy way to view instructions for each item on the claim form. Simply hover your cursor over a specific field, and instructions will pop up.

Consolidated Billing Tool

This tool was developed to assist suppliers with determining if a specific DMEPOS item is payable for beneficiaries in a Skilled Nursing Facility, during a Home Health Episode, or while enrolled in Hospice.

HCPCS Lookup

The HCPCS Lookup Tool allows you to view the description of individual HCPCS codes.

KE & KY Modifier Tool

The KE/KY Modifier Tool will help suppliers determine the appropriate use of the KE and/or KY modifiers. The KE and KY modifiers are used to indicate options/accessories used with a non-competitive bid base.

KX Table

The information listed in this chart may not include all of the coverage criteria for a given product/service. You may refer to the corresponding LCD for further coverage requirement information.

Medicare Secondary Payer Lookup

Unsure if Medicare should pay as the primary or secondary insurer for your patient? By answering a few simple questions this tool will help you determine if Medicare is the primary or secondary insurer.

Modifier Finder Tool

This Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information.

Ordering/Referring Provider Denial Job Aid

If you have received a claim rejection/denial due to a missing/incomplete/invalid ordering provider name and/or NPI, you must correct and resubmit your claim in order for payment to be considered. Use the following chart for guidance on correcting your claim.

New! Remittance Advice Tutorial

The Remittance Advice Tutorial has been developed to assist suppliers in reading the Standard Paper Remittance Advice. Many of the descriptions will also apply to the Electronic Remittance Advice, though they may not appear in the same order.

Same/Similar Tool

With the Same/Similar tool, suppliers can determine if an item may be considered the same as, or similar to, equipment already in possession of the beneficiary when billing base items. Just enter the HCPCS code in the search field to view the results!

Disclaimer: This tool is a guide only. Lower Limb Prosthetics HCPCS codes, some HCPCS codes that are not part of a LCD policy, and HCPCS codes associated with accessories and supplies have been excluded from this tool. Although every reasonable effort has been made to ensure the accuracy of this tool, there may be situations in the claim history that will still cause a claim to allow or deny in a same/similar situation. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. The tool is not claim or beneficiary specific. Please utilize the myCGS web portal for beneficiary specific utilization information.

Consolidated Billing/Part A
Consolidated Billing Tool

This tool was developed to assist suppliers with determining if a specific DMEPOS item is payable for beneficiaries in a Skilled Nursing Facility, during a Home Health Episode, or while enrolled in Hospice.

HCPCS
HCPCS Lookup

The HCPCS Lookup Tool allows you to view the description of individual HCPCS codes.

New! Same/Similar Tool

With the Same/Similar tool, suppliers can determine if an item may be considered the same as, or similar to, equipment already in possession of the beneficiary when billing base items. Just enter the HCPCS code in the search field to view the results!

Disclaimer: This tool is a guide only. Lower Limb Prosthetics HCPCS codes, some HCPCS codes that are not part of a LCD policy, and HCPCS codes associated with accessories and supplies have been excluded from this tool. Although every reasonable effort has been made to ensure the accuracy of this tool, there may be situations in the claim history that will still cause a claim to allow or deny in a same/similar situation. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. The tool is not claim or beneficiary specific. Please utilize the myCGS web portal for beneficiary specific utilization information.

MBI
Medicare Beneficiary Identifier (MBI) and Beneficiary Name to Number Converter

CGS offers two converter tools in one! Convert the 11 digit alpha/numeric Medicare Beneficiary Identifier (MBI) to receive the characters necessary to enter using your telephone keypad when accessing information via the Interactive Voice Response (IVR) system.

You can also convert the beneficiary’s name to a number to assist with the IVR. This tool converts the beneficiary's first initial of their first name and first six letters of their last name for the IVR beneficiary name validation process.

Medicare Secondary Payer (MSP)
MSP Line Level Calculator

The MSP Calculator will assist you in determining the line by line claim payment for covered services when Medicare is the secondary payer.

MSP Lookup

Unsure if Medicare should pay as the primary or secondary insurer for your patient? By answering a few simple questions this tool will help you determine if Medicare is the primary or secondary insurer.

Modifiers
Advanced Modifier Engine (AME)

The Advanced Modifier Engine was designed by CGS to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations. The tool includes Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) commonly billed HCPCS with billing scenarios. Based on the specific HCPCS entered and the billing scenario, the tool recommends modifiers for claim submission.

KE & KY Modifier Tool

The KE/KY Modifier Tool will help Suppliers determine the appropriate use of the KE and/or KY modifiers. The KE and KY modifiers are used to indicate options/accessories used with a non-competitive bid base.

Modifier Finder Tool

This Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information.

Repair Modifiers Tool

This self-service tool should only be utilized to determine the modifiers for use when billing a replacement for wheelchair accessories incident to a repair.

Order/Referring Job Aid
Ordering/Referring Provider Denial Job Aid

If you have received a claim rejection/denial due to a missing/incomplete/invalid ordering provider name and/or NPI, you must correct and resubmit your claim in order for payment to be considered. Use the following chart for guidance on correcting your claim.

PECOS
Provider Enrollment, Chain, and Ownership System (PECOS)External Website

This link will connect you with the enrollment tool for the Medicare Provider Enrollment, Chain and Ownership System (PECOS).

Positive Airway Pressure (PAP)
Positive Airway Pressure (PAP) Tool

This tool was created for suppliers who provide or bill PAP devices and accessories for Medicare beneficiaries with obstructive sleep apnea. Type in a HCPCS code from the Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCD (L33718) and get all related information about that particular HCPCS code (description, billing frequency, etc.).

Power Mobility Devices (PMD)
Power Mobility Devices Denial Help Aid

View categories of denials associated with claims for power mobility devices. Select the denial reason(s) listed in your claim denial letter to find additional explanations and key references from Medicare policies.

Power Mobility Devices Weight Requirements Tool

This tool provides weight requirements and coding options for a variety of power mobility base HCPCS codes.

Prior Authorization
Prior Authorization Look-Up

This tool was created to look up codes subject to Prior Authorization.

Listserv
Join/Update Listserv

By joining the CGS electronic mailing list, you can get immediate updates on all Medicare information, including: Medicare publications, important updates, workshops, and medical review information.

Site Map
Site Map

Need help finding your way around our site? This resource will help.

Therapeutic Shoes for Persons with Diabetes Activity Timeline
New! Therapeutic Shoes for Persons with Diabetes Activity TimelinePDF

This TSD activity timeline is designed to assist suppliers in obtaining proper documentation from the Certifying Physician & Ordering Physician Practitioner within the required timeline. It also assists the supplier to meet the supplier activity timelines and requirements outline in the Local Coverage Determination (LCD) and Policy Article (PA).

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