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CGS Connect®

Welcome to CGS Connect® for Jurisdiction B! Our unique, concierge-level service provides professional review and evaluation of pre-claim documentation before suppliers submit an initial claim to Medicare.

CGS Connect® offers a broad range of benefits, including

  • Reducing claim denials related to documentation errors
  • Reducing appeals
  • Receiving one-on-one education on correct required documentation submissions

This voluntary program provides suppliers with a higher level of assurance that supporting documentation meets the necessary requirements to process a claim for payment consideration.

How It Works

Clinical reviews of medical records are currently limited to the following policy groups:

  • Ankle Foot Orthosis & Knee Ankle Foot Orthosis (L1902, L1906, L1930, L1971, L4360, L4361, L4396, and L4397)
  • Commodes (E0163 and E0165)
  • Continuous Glucose Monitors (E2103 and A4239)
  • Continuous Positive Airway Pressure (CPAP) (E0601)
  • CPAP Accessories (A7030 and A7034)
  • Enteral Nutrition (B4035)
  • External Infusion Drugs/Pumps (J2260, J1559, and J3285)
  • Glucose Testing Supplies (A4253, A4256, A4258, and A4259)
  • Hospital Beds (E0260, E0261, E0294, E0301, E0303)
  • Manual Wheelchairs (K0001, K0002, K0003, and K0004)
  • Immunosuppressive Drugs (J7507 and J7518)
  • Nebulizer and Related Drugs (J7605, J7606, and J7686)
  • Oxygen (E1390) *initial beneficiary claims only
  • Respiratory Assist Devices (E0470 and E0471)
  • Spinal Orthosis (L0450 - L0647 and L0651)
  • Surgical Dressings (A6196, A6197, A6021, A6212, and A6010)
  • Therapeutic Shoes for Persons with Diabetes (A5500). Inserts provided with the A5500 will be included in the review.
  • Urological Supplies (A4351, A4352, and A4353)

When you request a clinical review through CGS Connect®, our professional Medical Review clinicians will evaluate your pre-claim documentation and provide guidance based on their applied medical knowledge of policy-based requirements. When necessary, the clinician will contact you directly to discuss their evaluation and recommendations. In all cases, you will be provided with documented, detailed feedback regarding your submission. You will then have the opportunity to correct the errors in the documentation (if possible) before submitting the claim for processing. CGS Connect also accepts subsequent submissions for a review after the supplier has had the opportunity to make improvements. Subsequent submissions must be received within 30 days of the initial request.


If a supplier requests the documentation review after the equipment has been delivered, CGS will respond in writing within 15 days. CGS will notify whether the documentation is either "supported" or "unsupported," and if "unsupported," they will explain why the documentation didn't meet Medicare guidelines.

If a supplier requests the documentation review before the equipment has been delivered, CGS will respond with a letter within 10 days. For new suppliers to the program, CGS will attempt a phone call for the first "unsupported" decision for each HCPCS code.

If your request is deemed "unsupported," you may provide further documentation and submit a subsequent request. CGS must receive the subsequent request within 30 days of initial request. Please submit all supporting documentation with your subsequent request(s). For subsequent requests, the "supported" or "unsupported" decision will be sent via letter.

Getting Started

To request a professional pre-claim review of your documentation, simply complete the CGS Connect® Request FormPDF. Review the CGS Connect® Request Form InstructionsPDF for submission details.

Additional Information

Note: CGS Connect® is not a prior approval or authorization program. Participation in CGS Connect® does not exempt suppliers from the audit process. Our review and recommendations under the CGS Connect® program are for educational purposes only and do not guarantee payment for services billed. CGS Connect® offers professional evaluation of pre-claim documentation, and it provides individualized education to prevent future documentation-related errors.

Revised: 02.13.24


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