Skip to Main Content
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.


Impact

Print | Bookmark | Email | Font Size: + |

Revised: 07.21.14

201 Report

With the exception of the remittance advice, the 201 Report is the most important claims related ‘report’ generated by the FISS system. This report has three main sections. Two are informational in nature, while the 'Returned to Provider' section is extremely important because it identifies the claims that have not passed our edits and must be addressed by the provider before processing can resume. Currently the Medicare 201 Report is only available through the Direct Data Entry (DDE) system for CGS J15 providers. The Medicare 201 Report can be accessed daily through DDE.

The 201 Report provides information on pending, processed, and returned claims; however, information regarding pending, or suspended claims, claims that are processing through the Common Working File (CWF), RTPd claims, and claims that are in the payment floor (PB9996), are all displayed on the Claim Count Summary Screen (Option 56) under Inquiries (01 – Main Menu) in DDE.

Pending Claims

The "Pending" section of the 201 Report lists all the claims that are pending within FISS as of the point in time the 201 Report is generated. The claims will be listed in alphabetical order based on the patient's last name. The report is also segmented to list claims of similar bill types together, such as inpatient, outpatient, etc. On DDE versions, the data reflects the status as of the conclusion of the previous work day. The following provides a definition of each heading within the report.

201 Report-Pending Claims Definitions

Title

Definition

NAME

Beneficiary name, alphabetized by last name

MED REC NUMBER

Medical Record number listed by provider on the claim.

HIC NUMBER

Beneficiary's Health Insurance Claim (Medicare) number

RECD DATE

Date claim received by CGS

ADMIT DATE

Date of admission

FROM/THRU DATE

Dates of service

ADJ IND

Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".

LAST TRAN

Last Transaction Date, or the last date that CGS took action on this claim.

SUB IND

Submission Indicator, P= paper claim, A= electronic claim

SUSP TYPE

Suspense Type, identifies the location within the FISS system:

MED

Medical Review

MSP

Medicare Secondary Payer

CWFR

Common Working File Regular

CWFD

Common Working File Delayed

SUSP

Suspense, any other category not described above

TOTAL CHARGES

Total charges for the claim

ADS

Additional Development System. If no other information has been requested, this field will be blank. If additional information has been requested (i.e. medical records), this field will contain a " Y ".

ADS REASON CODES

Codes that identify the requested the information for the claim, if any.

Back to the top of the page Top

Processed Claims

The "Processed" section lists all claims that have been processed since the last generation of the 201 Report. On the DDE version, the data reflects the status as of the conclusion of the previous work day. A claim will appear on this section only once for each time it is submitted.

201 Report-Processed Claims Definitions

Word

Definition

NAME

Beneficiary name, alphabetized by last name

MED REC NUMBER

Medical Record number listed by provider on the claim.

HIC NUMBER

Beneficiary's Health Insurance Claim (Medicare) number

RECD DATE

Date claim received by CGS

ADMIT DATE

Date of admission

FROM/THRU DATE

Dates of service

ADJ IND

Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".

PAID DATE

The date claim will be paid or rejected.

CLEAN IND

Clean Claim Indicator

A

PIP Other

B

PIP Clean

C

NON-PIP Other

D

NON-PIP Clean

E

Additional info was requested (NON-PIP)

F

Additional info was requested (PIP)

G

Date of death overlaps claim, as result claim was developed (NON- PIP)

H

Date of death overlaps claim, as result claim was developed (PIP)

I

Non-definitive response from CWF requiring development (NON-PIP)

J

Non-definitive response from CWF requiring development (PIP)

K

Definitive response not received from CWF within 7 days (NON-PIP)

L

Definitive response not received from CWF within 7 days (PIP)

M

Claim manually set to "Other" (NON-PIP)

N

Claim manually set to "Other" (PIP)

O

Sequential claim in which the prior claim was pending & determined to be "Other", NON-PIP

P

Sequential claim in which the prior claim was pending & determined to be "Other" ( PIP)

REJECT CODE

The 5 digit code that identifies the reason for a reject.

Back to the top of the page Top

Returned Claims

The "Returned" section of the 201 Report lists all the claims that have failed the billing edits since the creation of the last report. A claim will appear on this section of the 201 Report only once for each time it is submitted. It is crucial that this section of the 201 Report be monitored and worked on an on-going basis. The claims will be listed in alphabetical order based on the patient's last name. The report is also segmented to list claims of similar bills types together, such as inpatient, outpatient, etc. On DDE versions, the data reflects the status as of the conclusion of the previous work day.

201 Report-Returned Claims Definitions

Word

Definition

NAME

Beneficiary name, alphabetized by last name

MED REC NUMBER

Medical Record number listed by provider on the claim.

HIC NUMBER

Beneficiary's Health Insurance Claim (Medicare) number

RECD DATE

Date claim received by CGS

ADMIT DATE

Date of admission

FROM/THRU DATE

Dates of service

ADJ IND

Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".

RTP DATE

Returned to Provider Date. The date it was determined that an error appeared on the claim.

Back to the top of the page Top

 

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © 2025 CGS Administrators, LLC. All Rights Reserved