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 Education Portal

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CGS offers many online education courses on popular topics. These presentations range from 15 to 45 minutes and provide a valuable overview of both policy-specific topics like ostomy supplies, and general topics like Advance Beneficiary Notice of Non-coverage. There’s also a complete series called “Welcome to Medicare” that takes you step-by-step through the Medicare process. These are great training tools for new staff as well as opportunities for veteran suppliers to brush up on their knowledge or learn about a new policy. Best of all, these online education courses are available whenever you find it most convenient; you can even pause the course and come back later. It’s another way we strive to provide information that will help your company thrive.

Login to our Online Education Portal to take any of the training sessions listed below.

ABN

Title: Advance Beneficiary Notice of Non-Coverage (ABN): Part 1

Length: 45:00

Course Summary:
Use of ABN, Triggering Events, General ABN Requirements, Retention and Period of Effectiveness, ABNs for Upgraded DMEPOS and Competitive Bidding, and Additional ABN Resources.

Completing ABN

Title: Advance Beneficiary Notice of Non-coverage (ABN) Part 2

Length: 45:00

Course Summary:
Completing the ABN, Other Considerations, Electronic Issuance of ABNs, and Additional ABN Resources

Commode Chairs

Title: Commode Chairs

Length: 20:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Commode Chairs to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

CERT

Title: Comprehensive Error Rate Testing Program

Length: 30:00

Course Summary:
This course will provide suppliers with an overview of the CERT process. Information such as how to identify a CERT documentation request and the proper way to respond will be addressed.

CPPA

Title: Condition of Payment Prior Authorization (PA) Program

Length: 30:00

Course Summary:
This course will provide an overview of the CPPA program, discuss affected codes, how to submit a Prior Authorization Request (PAR), documentation, timeframes, and more.

CPM

Title: Continuous Passive Motion (CPM) Devices

Length: 30:00

Course Summary:
This course will cover Medicare Coverage, Documentation Requirements, Coding and Billing and Claim Submission.

External Breast Prostheses

Title: External Breast Prostheses

Length: 30:00

Course Summary:
This course will define the Medicare coverage requirements for breast prostheses, list the documentation requirements for breast prostheses, and explain coding rules for breast prostheses, including replacement items.

Eye Prostheses

Title: Eye Prostheses

Length: 15:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Eye Prostheses to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

Facial Prostheses

Title: Facial Prostheses

Length: 20:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Facial Prostheses to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

HCPCS

Title: HCPCS Codes and Modifiers

Length: 45:00

Course Summary:
This course will give suppliers a clear understanding of the DME Fee Schedule category modifiers as well as provide information on the PDAC and how specific modifiers should be used when billing claim to Medicare.

HFCWOD

Title: High Frequency Chest Wall Oscillation Devices

Length: 20:00

Course Summary:
This course provides an overview of High Frequency Chest Wall Oscillation Devices, including an explanation of the coverage criteria, the covered HCPCS, documentation requirements and important billing reminders.

Medicare Fee Schedules

Title: Medicare Fee Schedules

Length: 20:00

Course Summary:
The course will review the Medicare fee schedule categories and explain Medicare claim payment methodologies.

NPWT

Title: Negative Pressure Wound Therapy

Length: 30:00

Course Summary:
This course will review coverage criteria, necessary modifiers, billing information, a look at documentation requirements specific to NPWT, and the top reasons for NPWT denials.

Orthopedic Footwear

Title: Orthopedic Footwear

Length: 30:00

Course Summary:
Suppliers taking this course will be provided with information on coverage criteria for Orthopedic Footwear, modifiers, and documentation requirements.

Osteogenesis Stimulators

Title: Osteogenesis Stimulators

Length: 30:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill Ostegenesis stimulators to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources will also be addressed.

Ostomy Supplies

Title: Ostomy Supplies

Length: 30:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Ostomy supplies to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

Pneumatic Compression Devices

Title: Pneumatic Compression Devices

Length: 30:00

Course Summary:
This course provides an overview of the coverage criteria for pneumatic compression devices (PCD). The definitions of the conditions for which the PCD may be used, as well as the documentation, reminders, and resources needed to submit compliant claims to Medicare, will be addressed.

Repairs, Maintenance, & Replacement

Title: Refractive Lenses

Length: 30:00

Course Summary:
This course will give suppliers an overview Coverage Criteria, Documentation Requirements, Billing Reminders and Resources.

Repairs, Maintenance, & Replacement

Title: Repairs, Maintenance, & Replacement

Length: 30:00

Course Summary:
This course will give suppliers an overview of the Medicare guidelines surrounding repair, maintenance and replacement of durable medical equipment. Including proper billing and modifier usage.

Seat Lift Mechanisms

Title: Seat Lift Mechanisms

Length: 20:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Seat Lift Mechanisms to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

Ventilators

Title: Ventilators

Length: 30:00

Course Summary:
Suppliers taking this course will be provided with information on coverage criteria, correct coding, documentation requirements, Comprehensive Error Rate (CERT), and resources.

Walkers

Title: Walkers

Length: 20:00

Course Summary:
Suppliers taking this course will be provided with information on how to properly code and bill claims for Walkers to Medicare. Medical necessity coverage criteria and additional CGS and CMS resources available to suppliers will also be addressed.

Welcome to Medicare: Segment 1

Title: Welcome to Medicare: Segment 1: Medicare Basics

Length: 30:00

Course Summary:
Medicare Basics will provide suppliers with an overview of the Medicare program as well as the role of the DME MAC in the Medicare process.

Welcome to Medicare: Segment 2

Title: Welcome to Medicare: Segment 2: Coverage and Medical Policy

Length: 30:00

Course Summary:
This segment will explain the role of the National and Local Coverage Determinations in the Medicare program as well as how to locate them on the CGS and CMS websites.

Welcome to Medicare: Segment 3

Title: Welcome to Medicare: Segment 3: Claim Submission

Length: 30:00

Course Summary:
This segment will review all that is needed for proper claim submission to Medicare, including Assignment Agreements, claim filing time limits, and much more.

Welcome to Medicare: Segment 4

Title: Welcome to Medicare: Segment 4: Place of Service / Consolidated Billing

Length: 30:00

Course Summary:
This segment will outline proper place of service codes for Medicare claims as well as review the consolidated billing process.

Welcome to Medicare: Segment 5

Title: Welcome to Medicare: Segment 5: Understanding Upgrades

Length: 30:00

Course Summary:
This segment will provide step by step instructions on how to properly bill an upgrade to Medicare. Including the correct modifiers to utilize to ensure that you claims are paid accurately.

Welcome to Medicare: Segment 6

Title: Welcome to Medicare: Segment 6: Medicare Secondary Payer

Length: 60:00

Course Summary:
This segment will provide suppliers with a detailed review of Medicare Secondary Payer guidelines and practices.

Welcome to Medicare: Segment 7

Title: Welcome to Medicare: Segment 7: Overpayment Recovery

Length: 30:00

Course Summary:
This segment details the Overpayment Recovery process as well as walks suppliers through the correct OPR forms to utilize when refunding Medicare.

Welcome to Medicare: Segment 8

Title: Welcome to Medicare: Segment 8: Telephone and Written Inquiries

Length: 20:00

Course Summary:
This segment examines the CGS Customer Service program and how to submit written inquiries to CGS.

Welcome to Medicare: Segment 9

Title: Welcome to Medicare: Segment 9: Reopenings

Length: 20:00

Course Summary:
This segment provides suppliers with a look at the Reopenings process, including how to properly file a Reopening Request and examples of the types of issues the Reopening Department can address.

Welcome to Medicare: Segment 10

Title: Welcome to Medicare: Segment 10: The Appeals Process

Length: 45:00

Course Summary:
This segment will review all of the different levels of the Medicare appeals process. Including how to submit proper appeal requests to each level.

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