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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Current Frequently Asked Questions (FAQs)

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  1. How do I check the status of my claim?
  2. What if my claim status is not on file?

    • Ask the following questions:

      • Is the claim for DME? If it is not for DME, then it is possible that the provider needs to check a different part of Medicare, like Part B.
      • What jurisdiction should the claim be in?The beneficiary may receive DME in a state different from their address on file.
      • What jurisdiction is the beneficiary’s address in?The beneficiary address that is on file with Social Security will indicate which jurisdiction the supplier should bill, regardless of where the beneficiary received the DME.
      • Was the claim submitted on paper or electronically? If it is a paper claim, it could be rejected or not received.

      Published: 12.14.22
      Reviewed: 03.31.23

  3. How do I use myCGS?
  4. What are the top Targeted, Probe and Educate (TPE) reasons for denial?
  5. Where can I find phone numbers and addresses for CGS and other Medicare contractors?
  6. Where can I find guidance on filing a claim?

    • Information on filing claims is in the DME MAC Jurisdiction C Supplier Manual. Refer to Chapter 6PDF for help with paper claims and Chapter 8PDF for information on electronic claim submission.

      Additionally, our Provider Outreach and Education (POE) team offers a variety of educational materials on claim submission, which are available on our Claims Education page. Additional information about claim submission is available on our Claim Submission page.

      Published: 11.08.13
      Reviewed: 03.31.23

  7. How do I find information about Medicare statutes and regulations?

    • The DME MAC Jurisdiction C Supplier Manual provides an important overview of Medicare rules and regulations for DMEPOS suppliers. It is the first resource that you should use for Medicare billing questions. Also, subscribe to our electronic mailing list and monitor our news page for important updates regarding Medicare rules and regulations.

      Published: 03.23.16
      Reviewed: 03.31.23

  8. Where can I find information on overpayments and refunds? Where can I get information related to a specific offset?

    • Information regarding overpayments and refunds is in the DME MAC Jurisdiction C Supplier Manual, Chapter 12PDF.

      You can find information about specific offsets using either the myCGS web portal or the Jurisdiction B IVR.

      To find offset information in myCGS, log in to myCGS, go to the Finance tab, and select the Offsets secondary tab. After entering the financial control number (FCN) of the offset from your Remittance Advice, myCGS will provide you with the original overpayment date, current offset balance (if any), name and MBI of the beneficiary on the original overpayment, and the date of service that was overpaid.

      To obtain offset information from the IVR, press option 3 for Payment Information and 3 again for Offset Information. The IVR will ask you for your NPI, PTAN, last 5 digits of your tax identification number (TIN), and the FCN from your Remittance Advice. The IVR will provide you with the claim details of the original overpayment, as well as the overpayment letter date and current offset balance.

      For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.

      For more information about the IVR and its abilities, visit the IVR System Script and User GuidePDF.

      Published: 11.08.13
      Reviewed: 03.31.23

  9. 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?

    • Information on same or similar equipment regarding capped rental items and Inexpensive or Routinely Purchased (IRP) items is available through the myCGS web portal or the Jurisdiction C IVR at 1.866.238.9650.

      To access same or similar equipment information in myCGS, log in to myCGS, go to the Claim Preparation tab, and submit a Certificate of Medical Necessity (CMN) Status Request.

      To submit a CMN Status Request, you will need to enter the following beneficiary information:

      • MBI
      • Beneficiary Last Name
      • Beneficiary First Name
      • Beneficiary Date of Birth
      • HCPCS Code

      Note that in myCGS, you can search for more than one HCPCS code at a time by using an asterisk (*) as a qualifier. For instance, if you enter E* in the HCPCS field, myCGS will return CMN results for any HCPCS code that begins with an E.

      Additionally, myCGS offers the ability to search for claim history of a specific HCPCS code or codes. (Enter only the first letter of a code to search for all codes beginning with that letter.) To access Claim History, go to the Claim Preparation tab, and then select the Claim History secondary tab.

      For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to get started, visit our myCGS page.

      To access same or similar information on the IVR, choose option 1 for "Beneficiary Information" and then either option 2 for CMN Status, option 3 for Oxygen CMN Status, or option 4 for Diabetic Supplies or Shoes. You will need the following information to utilize the IVR:

      Provider Information

      • NPI
      • PTAN
      • Last five digits of your Tax Identification Number (TIN)

      Beneficiary Information

      • MBI
      • First initial of the beneficiary's name (including prefixes)
      • First six letters of the beneficiary's last name (including suffixes and hyphenated last names)
      • Date of birth
      • HCPCS code of the item you are inquiring about

      The IVR will report the following information if there is same or similar equipment on file:

      • Whether or not a CMN/DME information form (DIF) is on file, including the HCPCS code
      • CMN/DIF initial date, revised date, and/or recertification date
      • Length of need
      • Number of months paid (if rented)
      • Last paid date (if rented)
      • Phone number of previous supplier (if rented)

      Note: Customer service representatives (CSRs) are unable to release any extra information outside of what the IVR can provide.

      For more information about the IVR and its abilities, please refer to the IVR System Script and User GuidePDF.

      You are required to utilize myCGS or the IVR for same or similar inquires for all HCPCS that require the DME MAC to set up a CMN/DIF. For items which do not require a CMN/DIF (for example, CPAP supplies, as well as other items that are not capped rental or IRP items), contact Customer Support at 1.866.270.4909. EXCEPTION: Note that same or similar information for orthotics/prosthetics (L codes) is only available through myCGS (using Claim History) or by written inquiry. CSRs are not able to provide claim history for orthotics/prosthetics.

      Published: 11.08.13
      Reviewed: 03.31.23

  10. How can I determine if a beneficiary is enrolled in a Medicare Advantage Plan (MAP)?

    • You can obtain Medicare Advantage Plan (MAP) information through the myCGS web portal or through the Jurisdiction C IVR by calling 1.866.238.9650.

      To access MAP information in myCGS, log in to myCGS, and go to the Beneficiary Eligibility tab.

      To access the MAP information on the IVR, press option 1 (Beneficiary Information) from the main menu, then option 1 (Beneficiary Eligibility). After following the prompts, the IVR will report the effective dates of the MAP enrollment, the name of the MAP (if available), and the contract ID (usually one letter and four numbers). A list of names, addresses, and phone numbers for MAP contractors is on the CMS websiteExternal Website.

      For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.

      For more information about the IVR and its abilities, please refer to the IVR System Script and User GuidePDF.

      Published: 11.08.13
      Reviewed: 03.31.23

  11. How can I check the status of my Redetermination request?

    • You can check the status of a Redetermination by using the myCGS web portal or the Jurisdiction C IVR.

      In myCGS, go to the Reprocessing tab. You can search for a Redetermination by either the document control number (DCN) of the case or the claim control number (CCN) of the claim. myCGS will then provide you with the date in which we received your request and the current status of the case, including whether it is pending, reversed, upheld, or dismissed.

      To find Redetermination status on the IVR, select option 2 (claim information), followed by option 3 (Redetermination information), and then option 2 (Redetermination status).

      To verify Redetermination status, you must provide your NPI, PTAN, last five digits of your tax identification number (TIN), the beneficiary's Medicare number, beneficiary's name, and the claim number (CCN, ICN) of the claim that is being appealed. The IVR will provide the status of your Redetermination request, including whether it is pending, reversed, upheld, or dismissed.

      For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.

      For more information about the IVR and its abilities, please refer to IVR System Script and User GuidePDF.

      Published:11.08.13
      Reviewed: 03.31.23

  12. How do I use this website?

    • Watch a video tour to learn how to use the cgsmedicare.com website.

      Published: 12.14.22
      Reviewed: 03.31.23

  13. What if I receive a same/similar denial?

    • Check out the following resources:

      Published: 12.30.22
      Reviewed: 03.31.23

  14. I received a medical necessity denial. What should I do next?

Provider Outreach and Education (POE) Question & Answers (Q&As):

Selected Q&As based on topic or policy, compiled through our interactions with our Jurisdiction B and Jurisdiction C supplier community:

These Q&As are reviewed annually.

Medical Review Q&As

Selected MR Q&As:

These Q&As are reviewed annually.

Revised: 02.17.23

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