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CGS Associates, LLC

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Online Tools

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist Medicare (Providers or Suppliers) with submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although every reasonable effort has been made to provide effective resources to assure correct claim submission, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information provided by these tools. CGS is not responsible for any human or mechanical errors or omissions.

Self-Service Guide – NEW!

A convenient source for information about all of our self-service tools and calculators, this booklet may be downloaded for easy reference.

ABN
Advance Beneficiary Notice of Noncoverage (ABN) Form Instructions Tool

The Advance Beneficiary Notice of Noncoverage (ABN) Form Instructions Tool provides DME Suppliers an easy way to view instructions for each item on the ABN form form.

ADR
ADR Tool

This tool lets you enter the Additional Documentation Request (ADR) number provided on your letter so you can see who requested the information and what documentation you need to provide for payment consideration. The tool also provides links to information and education based on the specific documentation requested.

ADR Timeliness Calculator

The ADR timeliness calculator will assist you in determining the date ADR documentation must be received in order to meet the time frame for submission.

New! Overpayment Interest Calculator

Enter the Date on the Demand Letter, the Date the check is being mailed, the Overpayment Amount and the Interest Rate and find the Total Amount Due.

Appeals
Appeals Decision Tree

Do you need to submit a request for redetermination or request a reopening? Use the Appeals Decision Tree for guidance on the correct action to take.

Appeals Time Limit Calculator Español

I would like to submit my Redetermination Request today. Will it meet the 120 day timeliness requirement?

ALJ Appeals Status RequestExternal Website

The Office of Medicare Hearings and Appeals (OMHA) has made a link available so you can check the status of your appeal hearing before the Administrative Law Judge (ALJ). Scroll to the bottom of the page and click on "PROCEED TO AASIS." You will be directed to the ALJ Appeal Status Information System Inquiry page. Enter the ALJ Appeal Number (e.g. 1-############), referenced on the Acknowledgement Letter or Notice of Hearing from the Office of Medicare Hearings and Appeals in the appropriate cell. Next, answer the security/validation question then click "Submit Inquiry." The resulting page will give you the status of the appeal in question. Please note, the system will allow you to enter up to ten (10) appeal numbers - follow the instructions on the page.

Calculators
Enteral Nutrition Calculator

The Enteral Nutrition Calculator assists suppliers in determining the proper units of service required to submit a claim for Medicare payment consideration.

CPM Device Date Span Calculator

This calculator determines the date span for DME MAC coverage of CPM devices based on the dates of surgery, onset, and discharge.

End Stage Renal Disease 30 Month Coordination Period Calculator

This tool calculates the 30 month coordination period prior to Medicare becoming the primary insurance for ESRD beneficiaries.

KX Table Español

The information listed in this chart may not include all of the coverage criteria for a given product/service. You may refer to the corresponding LCD for further coverage requirement information.

Nebulizer Medication Calculator

The Nebulizer Calculator gives DME suppliers the ability to input the strength of the ordered drug, the size of the vial dispensed (if applicable) and the frequency the medication is taken daily. The calculator will display the maximum number of units that can be billed in a 30 or 90 day period.

Parenteral Nutrition Solution Lipids (B4185) Calculator

This calculator is designed to assist suppliers in billing the correct units of service for HCPCS code B4185. For lipids, one unit of service of code B4185 is billed for each 10 grams of lipids provided. 500 ml of 10% lipids contains 50 grams of lipids (5 units of service); 500 ml of 20% lipids contains 100 grams (10 units of service); 500 ml of 30% lipids contains 150 grams (15 units of service).

CERT
CERT Claim Identifier Tool

This CERT Claim Identifier Tool has been designed to aid Medicare suppliers obtain the results of their CERT review. You may search this database by CID.

CGS Medicare Mobile App
CGS Medicare Mobile App

The CGS Medicare mobile app offers several features, including LCDs, Physician Letters, CGS Wizard, and more!

Charts
Orthotics Chart

This Orthotics Chart is designed to show the differences between off-the-shelf, custom-fit, and custom-fabricated orthoses. Suppliers will be able to see the requirements for each type compared side by side. Links to the Policy Articles and the DMEPOS Quality Standards are included in the event that more information is needed.

Claim Submissions and Denials
CGS Wizard

CGS Wizard contains detailed processed claim information for all claims submitted to Jurisdiction C including ADR status, medical review decisions, education and resources! All you need to use the tool is a 14-digit Claim Control Number (CCN).

Claim Denial Resolution Tool Español

This tool has been developed to provide the supplier community guidance on how to address claim denials in the most efficient manner. Enter the Reason Code and Remark Code (if applicable) from your Remittance Advice into the search fields. The tool will provide the remittance message for the denial and the possible causes and resolution. Please Note: This tool is available for claim denial assistance with the common denials and may not address every scenario.

Claims Timely Filing Calculator

This tool will assist in determining the claim timely filing limit for the billed service(s).

CMS 1500 Claim Form Instructions Tool

The CMS 1500 Claim Form Instructions Tool provides DME Suppliers an easy way to view instructions for each item on the claim form. Simply hover your cursor over a specific field, and instructions will pop up.

Divider Sheets

The Divider Sheets standardize the process so you no longer need to create your own cover sheets for your documentation.

Consolidated Billing/Part A
Consolidated Billing Tool

This tool was developed to assist suppliers with determining if a specific DMEPOS item is payable for beneficiaries in a Skilled Nursing Facility, during a Home Health Episode, or while enrolled in Hospice.

HCPCS
HCPCS Lookup

The HCPCS Lookup Tool allows you to view the description of individual HCPCS codes.

Listserv
Join/Update Listserv

By joining the CGS electronic mailing list, you can get immediate updates on all Medicare information, including: Medicare publications, important updates, workshops, and medical review information.

MBI
Medicare Beneficiary Identifier (MBI) and Beneficiary Name to Number Converter

CGS offers two converter tools in one! Convert the 11 digit alpha/numeric Medicare Beneficiary Identifier (MBI) to receive the characters necessary to enter using your telephone keypad when accessing information via the Interactive Voice Response (IVR) system.

You can also convert the beneficiary's name to a number to assist with the IVR. This tool converts the beneficiary's first initial of their first name and first six letters of their last name for the IVR beneficiary name validation process.

Medicare Secondary Payer (MSP)
MSP Line Level Calculator

The MSP Calculator will assist you in determining the line by line claim payment for covered services when Medicare is the secondary payer.

MSP Lookup

Unsure if Medicare should pay as the primary or secondary insurer for your patient? By answering a few simple questions this tool will help you determine if Medicare is the primary or secondary insurer.

Modifiers
Advanced Modifier Engine (AME) - New!

The Advanced Modifier Engine was designed by CGS to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations. The tool includes Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) commonly billed HCPCS with billing scenarios. Based on the specific HCPCS entered and the billing scenario, the tool recommends modifiers for claim submission.

KE & KY Modifier Tool

The KE/KY Modifier Tool will help Suppliers determine the appropriate use of the KE and/or KY modifiers. The KE and KY modifiers are used to indicate options/accessories used with a non-competitive bid base.

Modifier Finder Tool

This Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information.

Repair Modifiers Tool

This self-service tool should only be utilized to determine the modifiers for use when billing a replacement for wheelchair accessories incident to a repair.

Order/Referring Job Aid
Ordering/Referring Provider Denial Job Aid

If you have received a claim rejection/denial due to a missing/incomplete/invalid ordering provider name and/or NPI, you must correct and resubmit your claim in order for payment to be considered. Use the following chart for guidance on correcting your claim.

PECOS
Provider Enrollment, Chain, and Ownership System (PECOS)External Website

This link will connect you with the enrollment tool for the Medicare Provider Enrollment, Chain and Ownership System (PECOS).

Positive Airway Pressure (PAP)
Positive Airway Pressure (PAP) Tool

This tool was created for suppliers who provide or bill PAP devices and accessories for Medicare beneficiaries with obstructive sleep apnea. Type in a HCPCS code from the Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCD (L33718) and get all related information about that particular HCPCS code (description, billing frequency, etc.).

Power Mobility Devices (PMD)
Power Mobility Devices Denial Help Aid

View categories of denials associated with claims for power mobility devices. Select the denial reason(s) listed in your claim denial letter to find additional explanations and key references from Medicare policies.

Prior Auth
Condition of Payment Prior Authorization Look-Up

This tool was created to look up codes subject to Condition of Payment Prior Authorization.

Power Mobility Devices Weight Requirements Tool

This tool provides weight requirements and coding options for a variety of power mobility base HCPCS codes.

Site Map
Site Map

Need help finding your way around our site? This resource will help.

Therapeutic Shoes for Persons with Diabetes Activity Timeline
New! Therapeutic Shoes for Persons with Diabetes Activity TimelinePDF

This TSD activity timeline is designed to assist suppliers in obtaining proper documentation from the Certifying Physician & Ordering Physician Practitioner within the required timeline. It also assists the supplier to meet the supplier activity timelines and requirements outline in the Local Coverage Determination (LCD) and Policy Article (PA).

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