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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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.

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.
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.
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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October 4, 2024

Provider Alert: Part A Medical Review Additional Documentation Request (MR ADR) Update

Please ensure your facility has processes in place to monitor for MR ADRs and respond timely to these requests. If CGS does not receive the medical record documentation within the required timeframe (45 calendar days), the claim will deny with reason code 56900.

Sign Up for myCGS Today to Submit Medical Records!

myCGS is the recommended route for submitting your MR ADRs. You can also submit missing records requested by our medical review department, complete 56900 denial reopenings and submit your redeterminations thru myCGS. This is a secure, free web-based application that allows you to submit your ADR's directly to CGS, ensuring a timely response in submitting your medical records for review as well as providing a confirmation of the receipt of your records. myCGS eliminates the issues that may be encountered when faxing and prevents the delays and cost associated with mailing your documentation for review. This electronic process is convenient and an immediate way to meet the 120-day time limit for submitting an appeal or reopening as well. Refer to the myCGS User Manual Web page for more details to get registered today.

Faxing MR ADRs

When submitting medical records via fax for a MR ADR, a copy of the ADR letter must be page 1 of your faxed submission. Please DO NOT use your facility's cover letter as page 1. The bar code found on the MR ADR is essential to ensure the records submitted are routed to the correct location for review. When the facility's cover letter is submitted as page 1 of the fax, the critical bar code located on the ADR letter isn't scanned to properly route the documentation to the correct location. This may cause unnecessary denials for no documentation received within the allowed time frame for submission because the documentation was attached to another claim in error. This could result in delays in the review process or receipt of payment for your facility. CGS encourages providers to utilize myCGS to eliminate faxing issues encountered with the MR ADR submission process.

IMPORTANT NOTE: Please allow three to five (3 – 5) minutes in between each of your faxes if faxing records for multiple claims. This will help to ensure 'each set' of documents is attached to the correct claim DCN and not attached to another record in error.

If you are faxing a large number of pages, PLEASE, split the large document into smaller groups of documents (50-60 pages); PLEASE use the same cover sheet on each group and include the following information on each faxed group of documents:

Documents 1 of 5

Documents 2 of 5

Documents 3 of 5, etc.

Submitting Multiple MR ADRs

If you are responding to multiple MR ADR requests, clearly separate the documentation for each claim with a copy of the ADR letter as page 1 and/or send each ADR separately. Faxed, myCGS and esMD submissions can only contain one beneficiary per claim and date of service. Multiple responses sent together, but not separated, may result in the documentation being imaged as one claim and could cause unnecessary denials for missing documentation if it was attached to another claim in error.

Provide a Designated Provider Contact with Each ADR submitted

CGS recommends that you include a completed TPE or Probe and Educate ADR Documentation Cover Sheet after a copy of the ADR letter with each claim submitted for medical review. Ensure the provider contact name and phone number (you may provide more than 1 provider contact and include an email address for correspondence) are completed on this form. This will improve the accuracy and timeliness of both the submission and the review process. The medical review department may provide a courtesy call to the provider contact listed to request additional documentation for an easily curable error identified during the review process to prevent a full or partial claim denial or Health Insurance Prospective Payment System (HIPPS) code change due to missing documentation. If you are contacted by our medical review department, please respond promptly. These contact attempts to request missing documentation and the receipt of the records are time sensitive.

Follow These Steps Before Submitting an MR ADR

	Was My MR ADR submitted properly?
	Did I include a copy of the Additional Documentation Request (ADR) letter as page 1 of my submission in place of my facility's cover letter?
	Did I include a TPE or Probe & Educate ADR Documentation Cover Sheet (with a designated provider contact) after a copy of the ADR letter?
	If multiple MR ADR requests are being submitted: Each request was clearly separated with a copy of the ADR letter as page 1, followed by the TPE ADR Documentation Cover Sheet (with a designated provider contact) or the ADR will be sent separately for each submission. myCGS is the recommended route for submission.
	If the first 3 steps are completed, you are ready to send your documentation for review!

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