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 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

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.

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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.
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 website.
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.
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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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April 25, 2024

DME MAC Program Manager Update – Workgroup Collaboration

In earlier articles, we shared how the Noridian and CGS Program Managers oversee a variety of operational and collaborative workgroups. These groups meet monthly to discuss opportunities for process improvements across the DME Medicare Administrative Contractor (MAC) jurisdictions. In this edition, we are pleased to share an update on our ongoing workgroup activities.

All workgroups review CMS Change Requests (CRs), during both the draft and final process, to ensure a common understanding of the requirements. This collaborative approach helps to make sure all DME MACs implement the changes consistently.

Here are just a few workgroup highlights from 2023 and plans for 2024:

All workgroups proactively prepared for the end of the COVID-19 Public Health Emergency (PHE) by taking part in planning sessions with CMS, collaborating on system updates to ensure national consistency, and working closely on education for the supplier community.
To support our DMEPOS suppliers, the DME MACs also collaborate with the A/B MACs to produce educational webinars with a special focus on supporting the reduction in the Medicare Fee for Service error rate. This workgroup presents four webinars each year focused on prescribing practitioner documentation requirements for DMEPOS claims. In 2024, the webinar topics are:
- Documentation requirements for ordering clinicians
- Positive Airway Pressure (PAP)
- Nebulizers
- Lower Limb Orthoses

We are pleased to report that the national 2023 DMEPOS CERT error rate of 22.5% continued its downward trend from 28.6% in 2021 and 25.24% in 2022.

The DME MAC Provider Outreach and Education (POE) teams also work together all year to deliver both collaborative and co-branded education for suppliers. We do this to make sure we educate the supplier community consistently. In 2024, we will continue our successful pattern of presenting webinars for suppliers on the same topics as the A/B MAC series noted above, but with a focus on the supplier documentation requirements. To increase the benefit of collaborative webinars for both prescribing practitioners and suppliers, our contact centers use the webinar material for Customer Service Representative (CSR) training. This enables our CSRs to help suppliers consistently across the DME MAC jurisdictions.
In 2023 the DME MAC Medical Director workgroup supported the supplier community by publishing 92 Joint DME MAC and Pricing, Data Analysis and Coding (PDAC) Publications. These included Local Coverage Determination (LCD) and Policy Article Revisions, Dear Physician/Clinician letters, correct coding and coverage, and open meeting announcements for Proposed LCDs.
Our Medical Review (MR) teams continued their collaboration on the Targeted Probe and Educate (TPE) and Prior Authorization programs, ensuring consistency in processes as the PHE ended.
Throughout the year, our Medical Review teams and Medical Directors take part in Inter-Rater Reliability (IRR) sessions with CMS and other review contractors. We perform IRR assessments on a sample of cases to measure the degree of agreement among reviewers. With multiple contractors performing medical record reviews, it is important to have consistent review practices. The DME MAC Appeals and MR Workgroups also continued their IRR sessions.

MAC Customer Experience (MCE) Survey – We Value Your Feedback

We encourage you to take the survey each time the opportunity presents itself. Whether you see a survey pop up on the website or portal, or you receive a survey invitation after a Provider Outreach and Education (POE) event, please take a few minutes and share feedback.

Surveys give you a direct way to let us know what works well and where we have room for improvement. We are genuinely interested in your comments, and we review every survey response to help us develop initiatives that better serve you.