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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Tools & Calculators

Select a tool category from the list below, or browse the full list in the left navigation menu.

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

On the ABN Form Instructions Tool, suppliers can hover over fields on the ABN form and read descriptions and instructions, making it easy to understand.

Additional Documentation Request (ADR)
ADR Tool

Enter the ADR number on your letter to view who requested the information and what documentation you need to provide for payment consideration. This tool also links to helpful information and education based on your results.

ADR Timeliness Calculator

The ADR timeliness calculator helps you determine the date that the ADR documentation must be received in order to meet the submission timeframe.

Overpayment Interest Calculator

Calculate the total overpayment amount due by entering the date on the demand letter, the date the check is being mailed, the overpayment amount, and the interest rate.

Appeals
Appeals Decision Tree

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

Appeals Time Limit Calculator Español

Use this calculator to determine whether your redetermination or reconsideration request will meet the 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 ALJ. Enter the ALJ Appeal Number (1-############), referenced on the Acknowledgement Letter or Notice of Hearing from the OMHA. Next, answer the security/validation question and click "Submit Inquiry to view the status of the appeal in question." The system will allow you to enter up to 10 appeal numbers.

Calculators
Capped Rental Items Monthly Payment Calculator

This page contains two calculators: The Capped Rental Items Monthly Payment Calculator and the Standard Power Wheelchairs and Complex Rehabilitative Power Wheelchairs and Wheelchair Options/Accessories Monthly Payment Calculator. Each calculator will estimate monthly payments for HCPCS codes based on the Fee Schedule amount entered. The amounts estimated by the calculators are not guaranteed amounts and are based solely on the amounts that are entered into the calculators. Amounts may change based on other factors.

Continuous Passive Motion (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 (ESRD) 30-Month Coordination Period Calculator

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

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.

New! K0553 Billing Calculator

Use the K0553 Billing Calculator to determine the next date of service that can be billed for K0553 (supply allowance for therapeutic continuous glucose monitors, or CGMs).

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 daily frequency of the medication. The calculator will display the maximum number of units that can be billed in a 30- or 90-day period.

Overpayment Interest Calculator

Enter the date on the demand letter, the date the check is being mailed, the overpayment amount, and the interest rate to find the total amount due.

Parenteral Nutrition Solution Lipids (B4185) Calculator

This calculator assists suppliers in billing the correct units of service for HCPCS code B4185.

Total Parenteral Nutrition DME Information Form (DIF) Expiration Date Calculator

The Total Parenteral Nutrition DME Information Form (DIF) Expiration Date Calculator calculates the end date of the DIF based on the initial date and length of need.

Comprehensive Error Rate Testing (CERT)
CERT Claim Identifier Tool

This CERT Claim Identifier Tool helps suppliers obtain CERT review results. Search this database by CID.

CGS Medicare Mobile App
CGS Medicare Mobile App

The CGS Medicare mobile app offers several features, including local coverage determinations (LCDs), physician letters, the CGS Wizard, and more!

Claim Submissions and Denials
5010 277CA Reject Code Lookup Tool

The Reject Code Lookup Tool provides explanations for the edit codes returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement for an electronically submitted claim.

Advanced Modifier Engine (AME)

The AME helps suppliers bill proper HCPCS codes and modifier combinations. Select a DMEPOS category, HCPCS code, scenario, and sub-scenario, and the AME will recommend suggested modifiers for claim submission.

CGS Wizard

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

Claim Denial Resolution Tool Español

This tool provides the remittance message for the claim denial and lists possible causes and resolutions. Please note that this tool is available for claim denial assistance with the common denials and may not address every scenario.

Claim Documentation Divider Sheets

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

Claims Timely Filing Calculator

This tool helps determine the claim timely filing limit for billed service(s).

CMS 1500 Claim Form Instructions Tool

The CMS 1500 Claim Form Instructions Tool gives 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.

Consolidated Billing Tool

This tool helps suppliers determine if a specific DMEPOS item is payable for beneficiaries in a skilled nursing facility (SNF), during a home health episode, or while enrolled in hospice.

HCPCS Lookup

The HCPCS Lookup Tool shows the description of individual HCPCS codes.

KE & KY Modifier Tool

This tool helps suppliers correctly use of the KE and/or KY modifiers, which indicate options/accessories used with a non-competitive bid base.

Medicare Secondary Payer Lookup

Unsure if Medicare should pay as the primary or secondary insurer for your patient? Answer a few simple questions and find our suggestion.

Modifier Finder Tool

This tools helps suppliers use modifiers correctly. Search the database by modifier or keyword, and review the corresponding records. You can also view the entire list of modifiers, definitions, and additional billing information.

Remittance Advice Instructions Tool

On the Remittance Advice Instructions Tool, suppliers can hover over fields on the form and read descriptions and instructions, making it easy to understand. Many of the descriptions will also apply to the Electronic Remittance Advice, though they may not appear in the same order.

Same/Similar Tool

The Same/Similar Tool helps suppliers determine if an item may be considered the same as, or similar to, equipment already in possession of the beneficiary when billing base items. Just enter the HCPCS code in the search field to view the results!

Disclaimer: This tool is a guide only. Lower Limb Prosthetics HCPCS codes, some HCPCS codes that are not part of an LCD policy, and HCPCS codes associated with accessories and supplies have been excluded from this tool. Although every reasonable effort has been made to ensure the accuracy of this tool, there may be situations in the claim history that will still cause a claim to allow or deny in a same/similar situation. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. The tool is not claim or beneficiary specific. Please utilize the myCGS web portal for beneficiary specific utilization information.

Consolidated Billing/Part A
Consolidated Billing Tool

This tool helps suppliers determine if a specific DMEPOS item is payable for beneficiaries in a skilled nursing facility (SNF), during a home health episode, or while enrolled in hospice.

HCPCS
HCPCS Lookup

The HCPCS Lookup Tool shows the description of individual HCPCS codes.

Same/Similar Tool

The Same/Similar Tool helps suppliers determine if an item may be considered the same as, or similar to, equipment already in possession of the beneficiary when billing base items. Just enter the HCPCS code in the search field to view the results!

Disclaimer: This tool is a guide only. Lower Limb Prosthetics HCPCS codes, some HCPCS codes that are not part of an LCD policy, and HCPCS codes associated with accessories and supplies have been excluded from this tool. Although every reasonable effort has been made to ensure the accuracy of this tool, there may be situations in the claim history that will still cause a claim to allow or deny in a same/similar situation. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. The tool is not claim or beneficiary specific. Please utilize the myCGS web portal for beneficiary specific utilization information.

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

CGS offers two converter tools to help suppliers correctly enter a beneficiary’s 11-digit alphanumeric MBI and name into the IVR.

Medicare Secondary Payer (MSP)
MSP Line Level Calculator

The MSP Calculator helps determine the line-by-line claim payment for covered services when Medicare is the secondary payer.

MSP Lookup

Are you unsure if Medicare should pay as the primary or secondary insurer for your patient? Answer a few simple questions to receive guidance.

Modifiers
Advanced Modifier Engine (AME)

The AME helps suppliers bill proper HCPCS codes and modifier combinations. Select a DMEPOS category, HCPCS code, scenario, and sub-scenario, and the AME will recommend suggested modifiers for claim submission.

KE & KY Modifier Tool

This tool helps suppliers correctly use of the KE and/or KY modifiers, which indicate options/accessories used with a non-competitive bid base.

Modifier Finder Tool

This tools helps suppliers use modifiers correctly. Search the database by modifier or keyword, and review the corresponding records. You can also view the entire list of modifiers, definitions, and additional billing information.

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

This link connects you to the PECOS enrollment tool.

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

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

Power Mobility Devices (PMD)
Power Mobility Devices Weight Requirements Tool

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

Prior Authorization
Prior Authorization Look-Up

This tool shows whether or not a particular HCPCS code is subject to Prior Authorization.

Site Map
Site Map

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

Disclaimer: CGS’s online tools and calculators are informational and educational tools only, designed to assist Medicare suppliers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement. 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.

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