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CMS/Medicare Guidelines

This page reviewed and updated 11/8/2015.

ABN form - From CMS, the most up-to-date version is from 2011 and can be downloaded directly from CMS.

Ambulatory Surgical Center (ASC) - Medicare approved HCPCS/CPT codes and payment rates, 2013, 2014 and 2015. Addendum AA, BB, DD1, DD2 and EE

Drug Prices - Average Sale Price (ASP) for Drugs - click on the link on the right hand side for the year that's needed to find the Pricing Files.

CMS Physician Fee Schedule (PFS) Look-up ToolWhen pricing a procedure, finding RVU information on a particular CPT code this is a fast and easy lookup tool.

CMS Lab Fee Schedule for dates of service 2009 to current year.

CMS MLN Matters Articles - All of them from 2004 to current year.

CMS MLN Matters Q&A regarding the use of -AI modifier to indicate "Principal Physician of Record"

CMS Transmittals - Did you miss the latest CMS Transmittal? Go here and see what the latest information is from CMS.

Internet Only Manuals (IOMs) from CMS; 100-04 is the Medicare Claims Processing Manual but there are many here that are equally worthwhile.

CMS National Correct Coding Initiative (NCCI) - Bundling Edits and Medically Unlikely Edits table in .xls format for physician coding and hospital/facility coding for the current year

Electronic Health Records Fact Sheet - from CMS, an excellent definition of "cloning" and altering entry dates. Providers should read this.

HCPCS codes Table of Drugs and the Alpha-Numeric HPCS codes from CMS with descriptions. The years included here are from 2014-2016.

Medicare Coverage Database Good search tool to find an NCD or LCD for all the states/regions.

Modifier 59 Replacement Modifiers CMS Transmittal 1422 regarding the "new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

NCCI Policy Manual - for Medicare Services - Effective January 1, 2015. This is a zipped file that has PDF documents that address NCCI bundling logic and information for each chapter of the CPT book. This is the Medicare "Bible" for bundling edits - a must have/read and referral source for coding.

Nurse Practitioners and Clinical Nurse Specialists - What they can do. CMS Transmittal 75: Nurse Practitioner (NP) Services and Clinical Nurse Specialist (CNS) Services

PFS Relative Velue Files - from CMS. This link goes back to 2003 RVU files to current year.

Place of Service Codes (POS) - CMS has updated the POS codes to include 2016 new POS codes.

Place of Service(POS) Instructions for the Professional Component (PC or Interpretation) and the Technical Component (TC) of Diagnostic Tests. See pg 13-ish

Principal Physician of Record - 2010 Transmittal introducing the use of -A1 modifier to indicate "Principal Physician of Record"

Recovery Auditor Contractors (RACs) - Recent updates on what CMS states that a RAC can and cannot do. Good reading.

Status Indicators - for the PFS Fee Schedule Relative Value Files.

Signature Requirements - Original guidance Transmittal 94 from CMS within IOM 100-02

Signature Requirements for Diagnostic Test - CMS MLN Matters with links to original transmittals and guidance.

MLN re: Signature Stamps - "With few exceptions, stamped signatures are not acceptable" from CMS, with links to original guidance.