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For dates of service on or after October 1, 2015, Medicare providers are required to report ICD-10 codes on their claims. The ICD-10 codes sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures. The Centers for Medicare & Medicaid Services (CMS) website provides a dedicated ICD-10 web page offering a variety of resources to assist providers with the ICD-10 implementation.
If you will not be able to complete the necessary system changes to submit claims with ICD-10 codes by October 1, 2015, or find that you are unable to submit claims on or after October 1, 2015, due to issues with your billing software, vendor or clearinghouse, ICD-10 claims submission alternatives are available.
Helpful resources regarding ICD-10:
CMS ICD-10-CM/PCS Resources
Medicare Learning Network (MLN) Matters Articles
ICD-10-CM/PCS Resources Offered By Other Organizations
- AAPC(American Academy of Professional Coders)
- AHIMA(American Health Information Management Association)
- HIMSS(Health Information and Management Systems Society)
- WEDI(Workgroup for Electronic Data Interchange)
- WHO(World Health Organization)
Find helpful information on incentive programs using these resources on the CMS website:
Injections & Drugs
Access guidance regarding injections & drugs (including biologicals) through the following links:
Coverage and claim submission:
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Frequently Asked Questions (FAQs)
MolDX Local Coverage Determinations (LCDs)
The determination as to whether Medicare pays as primary or secondary is based on various laws. For more information about Medicare Secondary Payer (MSP) provisions and billing requirements, refer to the following CMS resources:
- Appeals, Adjustments and the D9 Claim Change Reason (Condition) Code
- Billing MSP Claims With Value Code 44
- Changes in Submitting Medicare Secondary Payer (MSP) Claims and Adjustments
- Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation (WC) Medicare Secondary Payer (MSP) Claims
- CMS Instructions to Contractors Regarding MSP Pub. 100-05
- Common Working File (CWF) Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record was Subsequently Deleted or Terminated
- Coordination of Benefits Information
- Medicare Secondary Payer (MSP) and the Coordination of Benefits Contractor (COBC) Reminder
- Medicare Secondary Payer (MSP): Condition, Occurrence, Value, and Patient Relationship, and Remarks Field Codes
- Medicare Secondary Payment Adjustment Information
- MSP Reason Code 30928
- Termination of the Common Working File ELGA, ELGH, HIQA, HIQH, and HUQA Part A Provider Queries
- Updating Beneficiary Information with the Benefits Coordination & Recovery Center (BCRC) (formerly known as the Coordination of Benefits Contractor) - MLN Matters PDF Document SE1416
- What Should Providers Know about MSP?
Access guidance regarding outpatient therapy services submitted to Medicare Part A on a UB-04 form (including “Part B of A” therapy services) through these CMS resources:
Find more information regarding preventive services through these CMS resources: