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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COVID-19

The Centers for Medicare & Medicaid Services (CMS) is committed to protecting American patients and residents by ensuring health care facilities have up-to-date information to adequately respond to Coronavirus (COVID-19) concerns. Refer to the CMS Current EmergenciesExternal Website web page to access waiver and flexibility informationExternal Website as well as various updates and guidance during this public health emergency.

Refer to the CMS Podcast and TranscriptsExternal Website web page to access Coronavirus COVID-19 Stakeholder Calls. To receive information about these calls, and to receive email updates directly from CMS, go to the CMS websiteExternal Website, scroll to the bottom of the page and to the "Receive Email Updates" icon and enter your email address and submit (select Open Door Forums).

CGS has provided CMS COVID-19 related resources (not all inclusive) below. Please share with your appropriate staff. Click on the resource below to view.

Section 1135 and Section 1812(f) Waivers

The Secretary of the Department of Health & Human Services declared a public health emergency (PHE) in the entire United States on January 31, 2020. On March 13, 2020 Secretary Azar authorized waivers and modifications under Section 1135 of the Social Security Act (the Act), retroactive to March 1, 2020. Refer to the MLN Matters Special Edition article, SE20011 – Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)External PDF for additional information.

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Accelerated/Advance Payment

CMS has expanded the current Accelerated and Advance Payment Program during the COVID-19 public health emergency to extend financial hardship relief to impacted Medicare Part A Providers, and Part B Providers/Suppliers.

Note: Please refer to the April 27, 2020, Special Edition MLN Connects "COVID-19: CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment ProgramExternal PDF" for additional information.

Providers/suppliers experiencing cash flow problems shall submit the COVID-19 Accelerated/Advance Payment FormPDF, signed by the provider's/supplier's authorization official that is legally able to make financial obligations on behalf of the providers/supplier (digital – signature and a facsimile (fax) request is acceptable). Instructions can be found on the form. Providers/suppliers that are part of a group practice may attach a list of PTANs/NPIs to the form.

The request may be submitted to CGS via email CGS.ERS.CORR@cgsadmin.com, fax 1.615.664.5949, or mail to:

CGS Administrators, LLC
ATTN: CFO Accelerated Payments
PO Box 20018
Nashville, TN 37202

COVID-19 Provider Enrollment and Accelerated Payment Telephone Hotline: The telephone hotline 1.855.769.9920 has been created for providers and suppliers to initiate provisional temporary Medicare billing privileges and address questions regarding provider enrollment flexibilities and accelerated payments, afforded by the COVID-19 waiver. The hotline is available Monday–Friday 7:00 am–4:00 p.m. Central Time (CT).

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All Providers

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COVID-19 Public Health Emergency (PHE) Tip Sheets

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End Stage Renal Disease (ESRD) Facilities

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Frequently Asked Questions (FAQs)

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Home Health Providers

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Hospice Providers

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Hospital

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Laboratories

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Opioid Treatment Program (OPT) Providers

CMS revised regulation text to allow audio-only telephone calls for the therapy and counseling portions of the weekly bundles and the add-on code for additional counseling or therapy (HCPCS code G2080) for beneficiaries with opioid use disorders, provided all other requirements are met. Providers may conduct the periodic patient assessments (HCPCS code G2077) via two-way interactive audio-video communication technology or by telephone only in cases where the beneficiary does not have access to two-way interactive technology. For more details, refer to the Opioid Billing & Payment information on the CMS website.

Provider Enrollment

Provider Enrollment Telephone Hotline: The telephone hotline 1.855.769.9920 (Monday–Friday, 7:00 am–4:00 pm Central Time (CT)) has been created for physicians and non-physician practitioners to initiate provisional temporary Medicare billing privileges via telephone and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver.

CMS has provided instructions for CGS to process abbreviated information over the telephone, collecting minimal information to establish a Provider Enrollment Chain and Ownership System (PECOS) enrollment record. CMS is waiving the following screening requirements:

  • Criminal background checks associated with the FCBC – 42 C.F.R. 424.518
  • Site-visits – 42 C.F.R. 424.518
  • In state licensure requirements – as long as the provider is licensed to render equivalent services in another state and are not affirmatively excluded from practice in that state or in any other state (based on the MAC verified state licensing board and/or the Office of Inspector General (OIG)), they can be enrolled for reimbursement in subsequent states.

Refer to the Part B Provider Enrollment web page for additional information.

In addition, this is available for Part A certified provider and suppliers who are establishing isolation facilities for COVID-19 positive patients and want to enroll and bill for their services. Refer to the Part A Provider Enrollment web page for additional information.

Enrollment of Ambulatory Surgical Centers (ASCs) as Hospitals

ASCs can use the provider enrollment hotline to establish temporary billing privileges as a 'Hospital.' For additional information, ASCs should refer to the Guidance for Processing Attestation Statements from Ambulatory Surgical Centers (ASC) Temporarily Enrolling as Hospitals during the COVID-19 Public Health EmergencyExternal PDF. CGS will:

  • Collect minimal information in order to identify the ASC's current enrollment record in the Provider Enrollment Chain and Ownership System (PECOS) (i.e. Legal Business Name (LBN), National Provider Identifier (NPI), Tax Identification Number (TIN)).
  • Verify that the ASC is in an approved status in PECOS. If the ASC is not in an approved status, the ASC's request for temporary enrollment privileges will be rejected. If the ASC is in an approved status, the ASC will be notified over-the-phone that the temporary billing privileges process is being initiated and they should expect an approval of temporary billing privileges within 3 business days.
  • Attestation process will be initiated by obtaining the contact person email address and sending the contact person an email including the attached attestation form. A signed and dated attestation form will be obtained via email or fax, which will be included when informing the CMS Location Office. Digital signatures are acceptable. ASC providers are required to attest to all applicable hospital federal participation requirements as outlined in the attestation form.
  • Information from the ASC PECOS enrollment record will be used to create the Hospital enrollment record in PECOS.
  • CGS will inform the appropriate CMS Location Office that an ASC has applied for temporary billing privileges through the hotline as a Hospital in order to initiate the survey and certification process.
  • Upon receipt of the tie-in information, CGS shall finalize the enrollment record in PECOS and issue the attached temporary billing privileges approval letter via email.
  • The ASC's billing privileges will be deactivated once the approval for the hospital enrollment has been established. The effective date of the deactivation should be the date prior to the effective date for the hospital.

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Skilled Nursing Facility (SNF)

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Telehealth

Refer to the List of Telehealth ServicesExternal Website for the Covered Telehealth Services for PHE and the COVID-19 pandemic, effective March 1, 2020Zip File. An updated Telehealth Services MLN BookletExternal PDF is available on the CMS website. Also available is the General Provider Telehealth and Telemedicine Tool KitExternal PDF.

Video now available on Medicare Coverage and Payment of Virtual ServicesExternal Website, providing answers to common questions about the Medicare telehealth services benefit.

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MLN Connects Special Editions

Subscribe to the weekly email newsletterExternal PDF for health care professionals.

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MLN Matters® Articles

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Press Releases

Review all CMS Coronavirus disease 2019 (COVID-19) press releasesExternal Website.

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Recorded CGS COVID-19 Webinars/Teleconferences

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Sequestration

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, section 3709, temporarily suspends the 2 percent payment adjustment pertaining to all Medicare payments. The suspension of this adjustment is effective with claims with a Through date of May 1, 2020 through December 31, 2020.

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