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.
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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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Medicare Secondary Payer (MSP) Overview

Medicare Secondary Payer Manual (CMS Pub. 100-05)

Medicare is a secondary payer when the beneficiary is covered by group insurance, Workers' Compensation, or if other third-party liability (no-fault, liability, Federal Black Lung Program) applies. For detailed information on CMS's Medicare Secondary Payer, refer to the CGS web page, CMS Guidelines and Resources for Medicare Secondary Payer (MSP), for links to the various CMS MSP regulations.

IDENTIFYING MSP RECORDS: Check the beneficiary's eligibility using ELGA, the CGS IVR, or myCGS, to determine if a beneficiary has an MSP record. When your claim has dates of services that fall within the Effective and Termination dates of an MSP record, the claim must acknowledge the MSP record by reporting appropriate MSP coding on your claim. Refer to the Checking Beneficiary Eligibility (Chapter 2) of the Direct Data Entry (DDE) Manual for information on using ELGA to identify MSP records that may impact your Medicare billing.

SUBMITTING MSP CLAIMS TO MEDICARE: Claims that include MSP information must be submitted either electronically (ANSI ASC X12N 837 format) or by entering the MSP claim directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE). For more information, refer to the Submitting Medicare Secondary Payer (MSP) Claims and Adjustments web page. Effective January 1, 2016, paper UB-04 claims can only be submitted if your agency meets the small provider exception, (CMS Pub. 100-04, Ch. 24 §90), or if the services are related to Black Lung.

MSP BILLING RESOURCES: Specific data elements are required on an MSP claim to ensure correct processing and payment. Some of these data elements include occurrence codes, value codes, payer codes, and insurer information. CGS offers the following tools to assist providers with billing appropriate MSP claims.

Medicare Secondary Payer (MSP) Billing & Adjustments quick resource tool – This tool is a flow chart that guides you to appropriate data elements that are required on your claim based on the type of MSP record.
The Medicare Secondary Payer (MSP) Billing & Adjustments Online Tool – This is an online decision tree based on the quick resource tool. Simply answer the questions and you will be directed to complete billing information specific to the type of MSP record.
Billing MSP Claims With Value Code 44 web page explains when it is appropriate to submit Value Code 44 on MSP claims. Value Code 44 should not be billed on conditional claims (Payer Code C). Value code 44 is defined as the amount a provider agreed to accept from a primary insurer as payment in full.
CGS Federal Black Lung (BL) Program web page provides information about billing Medicare secondary for beneficiaries who are covered by the Federal BL Program.
Medicare Payment for MSP Claims web page explains the four calculations used to determine reimbursement when Medicare is the secondary payer.
Medicare Secondary Payer FAQs web page includes answers to the most common MSP questions. MSP is one of the most common reasons why providers call the CGS Provider Contact Center. Therefore, CGS encourages providers to review these FAQs, as well as the Medicare Secondary Payer (MSP) Billing & Adjustments quick resource tool

SUSPENDED MSP CLAIMS: Claims/adjustments with MSP information may require Medicare staff intervention and suspend for more than 60 days. Providers may call the Provider Contact Center if their MSP claim has been in the same "S MXXXX" status/location for longer than 60 days.

MSP Resources from the Centers for Medicare & Medicaid Services (CMS)

Medicare Secondary Payer Web page
Medicare Secondary Payer Fact Sheet
Other Insurer Intake Tool
CMS Guidelines and Resources for Medicare Secondary Payer
Claims Processing Medicare Secondary Payer (MSP) Policy and Procedures Regarding Ongoing Responsibility for Medicals (ORM) (MM8984)
Instructions on utilizing 837 Institutional CAS segments for Medicare Secondary Payer (MSP) Part A Claim
Clarification of Conditional Payment Policy for Liability, No-Fault and Workers' Compensation (MLN Matters article 7355)
MLN7748519 – Medicare Secondary Payer: Don't Deny Services & Bill Correctly
Contact the Benefits Coordination & Recovery Center (BCRC)
MSP provisions (including information about situations in which Medicare pays as secondary): CMS Medicare Secondary Payer Manual (Pub. 100-05), chapter 2
MSP billing/claim submission requirements: CMS Medicare Secondary Payer Manual (Pub. 100-05), chapter 3
Processing MSP Claims Related or Unrelated to an Accident or Injury for Non-GHP Claims with ICD-9-CM Diagnosis Codes 500-508 and 800-999 or Related ICD-10-CM Diagnosis Codes – Medicare Secondary Payer (MSP) Manual (Pub 100-05, Ch. 6, Section 40.10
Coordination of benefits: CMS Benefits Coordination & Recovery Center (BCRC) web page
Medicare Secondary Payer (MSP) Status/Location R B75XX

Reviewed: 12.20.23