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.
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.
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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Frequently Asked Questions (FAQs)

Current FAQs from Customer Support
Top Claim Denials
Medical Review and Provider Education
myCGS Web Portal Q&As

Click on a question to expand or Show All / Close All

Current FAQs from Customer Support

What information do I need to enter so the customer service agent can answer my questions?
- To protect the privacy of Medicare beneficiaries and providers, we must authenticate certain elements before releasing beneficiary-specific information. If you select options 1, 2, or 3 when you call our Customer Support number, you will need to enter the following elements using your telephone keypad:
  - Provider National Provider Identifier (NPI)
  - Provider Transaction Access Number (PTAN)
  - The last five digits of the provider Tax Identification Number (TIN)
  - Medicare Beneficiary Identifier (MBI)
  - Beneficiary's first initial
  - Beneficiary's last name – Enter up to six letters followed “#” sign (ignore any spaces)
  - The beneficiary's date of birth.
  We created a tool to help you convert letters to numbers on your telephone keypad. Use the Medicare Beneficiary Identifier (MBI) and Name to Number Converter before you call us. Just enter the MBI or patient's name in the tool and it will show you the correct combination of numbers to enter on your telephone.
  
  We do not require authentication for general questions.
  
  Published: 09.25.2024
  Revised: 06.19.2025
How do we get information on a patient’s eligibility such as Medicare effective date and other insurance coverage?
- CMS requires suppliers and providers use self-service technology to access beneficiary information. Using self-service technology will save you time and eliminate the need to call and speak to Customer Support.
  
  You must check beneficiary eligibility using:
  - myCGS DME Web Portal (secure online web portal)
  - Billing agencies, clearinghouses, software vendors
  - HIPAA Eligibility Transaction System (HETS)
  Published: 09.25.2024
  Revised: 06.19.2025
Where can I find information on how often or how frequent an item can be supplied?
- There are several ways to look for this information. Keep in mind that not all items have a frequency listed.
  - Review the appropriate Local Coverage Determination (LCD) and Policy Article
  - See the Supplier Manual, Chapter 5 for replacement information.
  - See the DME Supplier Services MUE table: Medicare National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE).
  - Use the Same/Similar Code Lookup to look up which HCPCS codes are considered same or similar.
  Published: 09.25.2024
  Reviewed: 06.19.2025
I need to find out if a beneficiary has had a specific item in the past (same or similar inquiry). What's the best way to find this information?
- - See the same/similar screen in the myCGS DME Web Portal. This is the best way to find this information.
  - Call the Jurisdiction C Interactive Voice Response (IVR) line for same or similar information for some products.
  Note: Customer service representatives (CSRs) are unable to release any extra information outside of what the IVR can provide.
  
  Same or similar information for orthotics/prosthetics (L codes) is only available through myCGS or by written inquiry. CSRs are not able to give claim history for orthotics/prosthetics.
  
  Published: 11.08.2013
  Revised: 06.19.2025
How do I know which modifier to use?
- 1. Review the appropriate Local Coverage Determination (LCD) and Policy Article.
  2. See our Advanced Modifier Engine (AME). Enter a specific HCPCS code and the billing scenario, and the tool will recommend modifiers for claim submission.
  Published: 12.17.2024
  Reviewed: 06.19.2025
Where can we find Medicare documentation requirements for an item or service?
- - Review the appropriate Local Coverage Determination (LCD) and policy article. Keep in mind that not all items have an LCD and policy article.
  - Review our Medical Review Resources including Documentation Checklists, policy specific resources, and more
  Published: 03.19.2025
  Reviewed: 06.19.2025
Where can I find guidance on filing a claim?
- Chapters 6 and 8 of the DME MAC Supplier Manual includes rules for mandatory claim submission, assignment, time limit, place of service, claim completion instructions, and much more.
  
  Our Provider Outreach and Education (POE) team offers education on claim submission and other important topics. The POE calendar of events, online education courses, videos and other information is available on the Education and Outreach page.
  
  Published: 11.08.2013
  Reviewed: 06.19.2025
How do I check the status of my claim?
- CMS requires the use self-service technology to obtain claim status and beneficiary eligibility information. Customer Service Representatives are not able to provide it.
  
  CGS offers two self-service methods to check the status of a claim:
  - myCGS DME Web Portal is the easiest way to obtain claim status information, and much more
  - JC Interactive Voice Response (IVR) line
  Suppliers may also use claim status inquiry (CSI) through a gateway connection with a network service vendor.
  
  Published: 12.14.2022
  Revised: 06.19.2025
What if my claim status is not on file?
- Only claims processed by DME MAC Jurisdictions B or C are available on the myCGS DME Web Portal. Only claims processed by DME MAC Jurisdiction C are available on the JC Interactive Voice Response (IVR) line. Consider the following questions:
  - Is the claim for durable medical equipment, prosthetics, orthotics, or supplies? If it is not for DMEPOS items, then it is possible the provider needs to check a different part of Medicare, like Part B. Supplier Manual Chapter 1 – Introduction explains the different parts of Medicare.
  - What jurisdiction is the beneficiary's address in? The beneficiary's address on file with the Social Security Administration decides the claim jurisdiction. Send DMEPOS claims to the DME MAC jurisdiction for the state in which the beneficiary lives. Supplier Manual Chapter 15 – Resources lists four DME MAC jurisdictions with states and territories.
  - What jurisdiction should the claim be in? The beneficiary may receive DME in a state different from their address on file.
  - Was the claim sent on paper or electronically? If it is a paper claim, we may not have received it or we may have rejected it. We publish claim submission guidelines in the Supplier Manual Chapter 6 – Claim Submission and Supplier Manual Chapter 8 – EDI.
  If you filed the claim electronically, check with your software vendor, billing service or clearinghouse, if applicable. The CEDI (Common Electronic Data Interchange) contractor publishes information on the CEDI Contractor website about electronic claim front end edits and reports.
  
  Published: 12.14.2022
  Reviewed: 06.19.2025
My claim denied. How can I find out my next steps?
- These CGS tools can assist you with claim denials. You don't need a user ID or password to use these tools:
  - Claim Denial Resolution Tool – Enter the American National Standards Institute (ANSI) Reason Code from your Remittance Advice (RA). The tool will give you detailed information for the claim denial and possible causes and resolutions.
  - CGS Wizard – Enter the 14-digit Claim Control Number (CCN) to easily view claim denial information and helpful education on specific claims.
  Published: 03.19.2025
  Reviewed: 06.19.2025
Where can I get information related to a specific offset of an overpayment?
- CGS offers 2 self-service methods to check offset information:
  - See the Finance tab in the myCGS DME MAC Web Portal.
  - Call the Jurisdiction C Interactive Voice Response System (IVR) line.
  If the overpayment was from a PTAN associated with the same Tax ID, starting April 1, 2024, the Remittance Advice includes the PTAN of the location that caused the withheld amount. See Provider Level Adjustment Codes on Remittance Advice for details.
  
  Published: 11.08.2013
  Revised: 06.19.2025
How was the allowed amount calculated on my claim?
- - The item paid at the greatest amount allowed for the HCPCS code you billed. For more information about pricing, see the Supplier Manual Chapter 10 – Pricing. If you disagree with the decision, request a redetermination.
  - See Fee Schedules for more information and resources about fee schedules and single payment amounts (SPAs).
  Published: 06.14.2024
  Revised: 06.19.2025
What if I receive a same/similar denial?
- Check out the following resources:
  - Same/Similar Code Lookup Tool – enter a HCPCS code in the search field to view a list of other HCPCS codes that may be the same as or similar to the base item entered.
  - If the item denied with ANSI Reason Code M3 – Supplier Manual Chapter 3, Section 13 explains how liability is assessed on same or similar denials.
  - Repairs, maintenance, replacements, and reasonable useful lifetime (RUL) – Supplier Manual Chapter 3, Section 11 and Chapter 5, Section 9
  Published: 12.30.2022
  Revised: 06.19.2025
I received a medical necessity denial. What should I do next?
- Refer to the appropriate Local Coverage Determination (LCD) and Policy Article. You can also consider these questions:
  - Does the item require a modifier?
  - Does the item require a specific diagnosis?
  - Did you receive an Additional Documentation Request (ADR) letter?
  If you disagree with the decision, consider submitting a redetermination request.
  
  Published: 12.30.2022
  Revised: 06.19.2025
How can I check the status of my Redetermination request?
- CGS offers 2 self-service methods to check the status of your Redetermination request.
  - See the Reprocessing tab in the myCGS DME Web Portal to check your Redetermination request status.
  - Call the Jurisdiction C Interactive Voice Response System (IVR) line to check your Redetermination request status.
  Published: 11.08.2013
  Revised: 06.19.2025
What is the status of my prior authorization request?
- myCGS DME MAC web portal is the quickest method to find the status of your prior authorization request. You can also view and print the decision letter in myCGS. CGS will also send the decision letter to you in the mail.
  
  Published: 06.14.2024
  Revised: 06.19.2025
Where can I find phone numbers and addresses for CGS and other Medicare contractors?
- We list addresses and phone numbers for CGS and other Medicare contractors here: Contact Information.
  
  You can also find contact information for other DME MACs, and other Jurisdiction C resources, by referring to the DME MAC Supplier Manual, Chapter 15.
  
  CMS publishes current maps and lists of Medicare Administrative Contractors here: Who are the MACs.
  
  Published: 11.06.2023
  Reviewed: 06.19.2025
How do I know when there are system issues with the myCGS DME Web Portal?
- Look for the button at the top right-hand corner of the CGS website, below the "Join Electronic Mailing List" link and just above the search bar. It is present on every CGS webpage.
  
  The button's color shows the myCGS status:
  - Green – myCGS is functioning normally.
  - Yellow – there is an issue with one of the myCGS features.
  - Red – myCGS is currently down.
  If you click on the myCGS Status button, you'll go to the myCGS Alerts page, which lists the myCGS Status button key and current and past myCGS issues and their statuses.
  
  Published: 06.14.2024
  Reviewed: 06.19.2025
How do I prevent being locked out of myCGS DME MAC Web Portal?
- Enter the correct password when logging into myCGS. If you enter the password incorrectly 3 consecutive times in a row within a 120- minute period, your account will lock.
  - We recommend that if you have 2 consecutive unsuccessful login attempts that you do one of the following to prevent being locked out.
    - Wait 120 minutes and then try to log in again or
    - Use the "Forgot Password" link on the login screen to generate a temporary password. You can find instructions for “Forgot Password” under Chapter 11- My Account in the myCGS User Manual.
  - Set a calendar reminder to log into myCGS every 28 days. If you are inactive for 30 days, your account will lock.
  - Set a calendar reminder to change your log in every 58 days. You must change your password every 60 days, or your account will lock.
  Published: 03.19.2025
  Reviewed: 06.19.2025
Who do I contact for help with enrolling in the Medicare program as a DMEPOS supplier?
- Contact the appropriate National Provider Enrollment contractor:
  - National Provider Enrollment (NPE) East (Novitas Solutions): Alabama, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin, District of Columbia, Puerto Rico, US Virgin Islands
  - National Provider Enrollment (NPE) West (Palmetto GBA): Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands
  Published: 06.19.2025

Top Claim Denials

How do we correct claims that denied with Remittance Advice Remark Codes CO-4 N519 (non-covered charge, statutorily excluded services)?
- - Check to see if the item is mentioned in a Local Coverage Determination (LCD) and Policy Article. If so, review the applicable policies for coverage criteria and modifier requirements.
  - Make sure the item falls under the Medicare DMEPOS benefit category by reviewing the Supplier Manual, Chapter 9.
  - If you disagree with this decision, submit a redetermination request.
  Published: 06.19.2025
How do we correct claims that denied with Remittance Advice Remark Code CO-PR B7 N570 (missing/incomplete/invalid credentialing data)?
- Our records show that your PTAN was not effective for the date of service billed.
  - Check to make sure you billed using the correct NPI. If the NPI was incorrect, resubmit the claim with the correct NPI.
  - If the NPI billed was correct, contact the National Provider Enrollment (NPE) contractor to determine why your PTAN is not effective. Resubmit the claim after the NPE has corrected and updated the record.
  - If you disagree with the claim decision, submit a redetermination request.
  Published: 06.19.2025
Why did my claim deny with Remittance Advice Code CO-16 N382 (claim/service lacks information or has billing errors which is needed for adjudication)?
- We received the claim after the New Medicare Card transition period and the claim was billed with the wrong Medicare number.
  - Ask the beneficiary for their most current Medicare Card to confirm their Medicare beneficiary identifier (MBI).
  - Resubmit the claim with a valid Medicare beneficiary identifier (MBI).
  Published: 06.19.2025
How do we correct claims that denied CO-97, M2 (the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated, not paid separately when the patient is an inpatient)?
- Our records show that the beneficiary was in a hospital or skilled nursing facility (SNF) on this date of service.
  - See the Supplier Manual, Chapter 6 for information about billing when the beneficiary is in an inpatient stay.
  - See the Beneficiary Information tab in myCGS for information about the patient’s hospital and SNF. The myCGS User Manual explains how to use this feature.
  - If you billed the incorrect date of service, correct and resubmit the claim.
  - If you disagree with this decision, submit a redetermination request.
  Published: 06.19.2025
How do we correct claims that denied with Remittance Advice Remark Codes CO-4 N519 (procedure code is inconsistent with the modifier used, or a required modifier is missing)?
- - Review the appropriate Local Coverage Determination (LCD) and Policy Article.
  - Use our Advanced Modifier Engine (AME). Enter a specific HCPCS code and the billing scenario. The tool will recommend modifiers for claim submission.
  - Once you correct the modifiers, resubmit the claim.
  Published: 03.19.2025
  Reviewed: 06.19.2025

Medical Review and Provider Education:

Click on the link to view questions related to the topic:

myCGS Web Portal Q&As

Answers to questions about all aspects of registration, recertification, passwords, and using myCGS.

Updated: 06.19.2025