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CGS-MolDx

General

ICD-10

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.

Helpful Resources Regarding ICD-10

CMS ICD-10-CM/PCS Resources

ICD-10-CM/PCS Resources Offered By Other Organizations

  • AAPCExternal Website (American Academy of Professional Coders)
  • AHIMAExternal Website (American Health Information Management Association)
  • WEDIExternal Website (Workgroup for Electronic Data Interchange)
  • WHOExternal Website(World Health Organization)

Incentive Programs

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:

Reimbursement

Coverage and Claim Submission

Articles

Medicare Diabetes Prevention Program (MDPP)

MSP

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. Refer to the following resources for additional information.

For more information about Medicare Secondary Payer (MSP) provisions and billing requirements, refer to the following CMS and CGS resources:

CMS Resources

Opioid Treatment Program Services

Section 2005 of the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act established a Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs).

REMINDER: OTPs should not bill more than once in a 7-day period, except in limited situations, such as a beneficiary starting treatment at the OTP in the middle of the OTP's standard weekly billing cycle. Please reference the resources below for additional information.

CMS Resources

Outpatient Therapy

Patient Driven Payment Model (PDPM)

Preventive Services

Medicare pays for many preventive services that can help prevent illness from occurring or determine if a person is at risk for certain conditions so he or she can take steps to prevent them.

Use the resources below to find more information about the preventive services that Medicare covers and offer them to your patients.

CMS Resources

CGS Resources

Sleep Studies

Updated: 05.07.2026

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