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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Jurisdiction C Contact Information

Department

How to Contact

Forms/Instructions

Customer Support

Interactive Voice Response (IVR): 866.238.9650

Phone: 866.270.4909

Hearing Impaired/TTY: 888.204.3771

Written Inquiries Fax: 615.782.4490

Mailing Address:
CGS – Jurisdiction C Written Inquiries
PO Box 20010
Nashville, TN 37202

Online Help Center

Phone Calls: Please be prepared to provide all pertinent information related to your inquiry at the beginning of the call, including:

  • NPI
  • PTAN
  • Last five digits of your tax ID number (TIN)
  • The beneficiary's Medicare Beneficiary Identifier (MBI), DOB, and DOS
  • Your name and phone number

Written Inquiries: Please state your question or concern as clearly as possible, including all pertinent information:

  • NPI number
  • PTAN
  • If appropriate, the beneficiary's name, Medicare Beneficiary Identifier (MBI), and date of service.
  • Your name and phone number
  • Last five digits of Tax ID

Note: We are unable to respond to email inquiries containing sensitive information such as MBI or Tax ID.

Customer Support Webpage

Additional Documentation Request (ADR)

Fax: 615.782.4624

Mailing Address:
CGS – Jurisdiction C Medical Review
PO Box 20010
Nashville, TN 37202

Refer to the ADR Process for more information.

Advanced Determination of Medicare Coverage (ADMC)

myCGS Web Portal: Click here to get started

Fax: 615.782.4647

Mailing Address:
CGS – Jurisdiction C ADMC
PO Box 20010
Nashville, TN 37202

ADMC Request FormPDF

ADMC Webpage

Claim Submission (Paper CMS-1500 Claim Forms only)

Mailing Address:
CGS – Jurisdiction C Claims
PO Box 20010
Nashville, TN 37202

Refer to Claim Submission and Paper Claims for more information about how to use and obtain paper claim forms from the U.S. Government Bookstore—Purchase Paper Claim FormsExternal Website.

See also: Electronic Claims

Electronic Funds Transfer (EFT)

Mailing Address:
CGS – Jurisdiction C EFT
PO Box 20010
Nashville, TN 37202

Electronic Funds Transfer (EFT) Authorization FormExternal PDF
NOTE: This form must be mailed in with original signatures and banking information.

Overpayments & Refunds

Fax: 615.782.4477

Mailing Address:
CGS – Jurisdiction C Overpayments
PO Box 955152
St. Louis, MO 63195-5152

Offset Request FormPDF
Overpayment Recovery Request FormPDF
Voluntary Overpayment Refund FormPDF

Refer to Overpayment Recovery for more information.

Prior Authorization

myCGS Web Portal: Click here to get started

Fax: 615.664.5960

Mailing Address:
CGS – Jurisdiction C Medical Review Prior Authorization
PO Box 24890
Nashville, TN 37202-4890

esMD: (indicate document type "8")

Prior Authorization (PA) Submission FormPDF

Refer to Prior Authorization for more information.

Redeterminations (Appeals)

myCGS Web Portal: Click here to get started on redetermination request submission.

Fax: 615.782.4630

Redeterminations Mailing Address:
CGS – Jurisdiction C Redeterminations
PO Box 20009
Nashville, TN 37202

Overpayment Appeals Fax: 615.664.5907

Overpayment Mailing Address:
CGS – Jurisdiction C Overpayment Appeals
PO Box 23917
Nashville, TN 37202

Refer to Appeals for detailed instructions on appealing claims and overpayments.

Redetermination Completion GuidePDF
Redetermination Request (Level 1)PDF

Reopenings (Claims Corrections & Adjustments)

myCGS Web Portal: Click here to get started on claim correction or reopening form submission.

Reopenings Phone: 866.813.7878

Underpayment Fax: 615.782.4649
Overpayment Fax: 615.782.4477

Mailing Address:
CGS – Jurisdiction C Written Reopenings
PO Box 20010
Nashville, TN 37202

Refer to Reopenings for detailed instructions on requesting reopenings for minor errors and omissions.

Reopening Request Form Completion GuidePDF
Reopening Request FormPDF

Other Contacts

People with Medicare (Beneficiary Customer Service)

Phone: 1.800.MEDICARE (800.633.4227)
Hearing Impaired/TTY: 1.877.486.2048

www.medicare.govExternal website

CEDI (Electronic Data Interchange)

CEDI Helpdesk Phone: 866.311.9184

Email: ngs.cedihelpdesk@anthem.com

www.ngscedi.comExternal website

Contact CEDI regarding: Electronic Claim Submission, Electronic Remittance Notices, and 276/277 transactions

CGS Headquarters

Address:
CGS Headquarters
26 Century Blvd., Ste ST610
Nashville, TN 37214-3685

Competitive Bidding Implementation Contractor (CBIC)

Beneficiaries should call 1.800.MEDICARE (1.800.633.4227) for assistance with questions about the competitive bidding program or claims.

Suppliers or referral agents who have questions about the competitive bidding program should contact the CBIC:

Competitive Bidding Implementation Contractor (CBIC) websiteExternal Website

Comprehensive Error Rate Testing (CERT)

Mailing Address:
CERT Documentation Center
1510 East Parham Road
Henrico, VA 23228

Fax: 804.261.8100

Customer Service Phone: 443.663.2699

Toll Free Phone: 888.779.7477

Email: certprovider@nciinc.com

CERT C3HUB web siteExternal Website

Freedom of Information Act (FOIA)

Mailing Address:
Attn: DME MAC Freedom of Information Coordinator
Suite ST610
26 Century Blvd
Nashville, TN 37214

Refer to Supplier Manual: Chapter 1 - Introduction (DME MAC Jurisdiction C)PDF for additional information and examples.

All FOIA requests are subject to fees for search, review, and copy/duplication. Before submitting your request, you may want to see if the information can be obtained from our website.

Office of Inspector General (OIG) to
report fraud and abuse

File a Complaint OnlineExternal website

Phone: 1.800.HHS.TIPS (1.800.447.8477)

TTY Phone: 1.800.377.4950

Mailing Address:
U.S. Department of Health and Human Services
Office of Inspector General
ATTN: OIG HOTLINE OPERATIONS
PO Box 23489
Washington, DC 20026

OIG HotlineExternal website


Pricing, Data Analysis, and Coding (PDAC)

Contact Center Phone: 877.735.1326

Medicare Pricing, Data Analysis and Coding (PDAC)External Website

Reconsiderations (Appeals)

Durable Medical Equipment (DME) Qualified Independent Contractor (QIC) for second level independent external reviews of Medicare Fee-for-Service healthcare denials.

Mailing Address:
Maximus Federal Services, Inc.
Medicare DME
3750 Monroe Avenue
Suite 777
Pittsford, NY 14534

Phone: 585.348.3200

Email: DMEInfo@MAXIMUS.com

MAXIMUS Federal ServicesExternal Website

Recovery Auditor (RAC)

Phone: 866.201.0580

Performant Recovery, Inc.External Website

Supplemental Medical Review Contractor (SMRC)

Phone: 1.833.860.4133

Email: SMRCMail@Noridian.com

Supplemental Medical Review Contractor (SMRC)-Noridian Healthcare Solutions, LLC (NHS)External Website

Supplier Enrollment
National Supplier Clearing House (NSC)

Phone: 866.238.9652

Email National Supplier Clearinghouse

Mailing Address:
National Supplier Clearinghouse
Palmetto GBA, AG-495
PO Box 100142
Columbia, SC 29202-3142

National Supplier Clearinghouse (NSC)External Website

The Centers for Medicare & Medicaid Services (CMS)

Toll-Free Phone: 877.267.2323

Local Phone: 410-786.3000

TTY Toll-Free Phone: 866.226.1819

TTY Local Phone: 410-786-0727

CMS Website

 

Other Helpful Links

CMS

DME MACs

  • Jurisdiction A – Noridian Healthcare SolutionsExternal website – Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont
  • Jurisdiction B – CGS – Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin
  • Jurisdiction C – CGS – Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia
  • Jurisdiction D – Noridian Healthcare SolutionsExternal website – Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming

Remittance Advice Reason Codes

Unified Program Integrity Contractors (UPIC)

CoventBridge Group – UPIC Midwestern (Unified Program Integrity Contractor) for IA, IL, IN, KS, KY, MI, MN, MO, NE, OH, & WIExternal Website

Qlarant – UPIC Southwest (Unified Program Integrity Contractor) for AR, CO, LA, MS, NM, OK, & TXExternal Website

Safeguard Services, LLC – UPIC Southeast Unified Program Integrity Contractor) for AL, FL, GA, NC, PR, SC, TN, VA, VI, & WVExternal Website

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved