CMS/Medicare Guidelines

Ever need a quick answer - for example: where do I find signature requirements from CMS? Where do I find Colonoscopy guidelines? 

This is not a comprehensive list, but it does address some of the immediate needs of the medical community.  If you have or know of others and would like to share, please email us; we'd love to include those links.

Contents on these pages can be viewed by hovering over the icon to the left of the links with your mouse. They can also be printed.

They can also be downloaded directly, by right-clicking on the link with your mouse and opening to a new window.

ABN forms, 2009

AWP - CMS -  Average Wholesale Price for Drugs - click on 2008 ASP drug pricing files on the left side of the page

CMS - 12/11/2009 - Hospital Anesthesia Services Interpretive Guidelines details from CMS - look for new anesthesia guidelines regarding physician supervision and definition re:"Immediately Available"; New MAC (monitored anesthesia care) guidelines; guidelines for CRNAs providing regional anesthesia for labor & delivery

CMS Internet Only Manuals 100-04 is the Medicare Claims Processing Manual but there are others here that are equally worthwhile.

CMS Medicare Physician Fee Schedule- January 2009 release. This file contains the revisions identified in the Physician Fee Schedule Final Regulation published November 2008.

CMS NCD/LCD Search Instructions from Trailblazerhealth.com

CMS NCDs for LABS

CMS "Principal Physician of Record" Transmittal 2010 Consultations Policy & Instructions re: Modifier AI for Hospitals or Nursing Facilities

"Coding What is Known at the time of billing" When the pathology report/note isn't available - how do we code? Malignany or benign tumor? See page 12, CMS Internet Only Manual, Pub 100-4, Chapter 23, Section 10.1.2(D).

Colonoscopy rules for ASC

Date and legible identity of the observer - 1995 and 1997 E/M Guidelines

ESRD (Hemodialysis)

Fee Schedule look-up (CPT, HCPCS, etc.) by CMS or by Region/Carrier  

Guide to Preventive Services - From CMS

Medical Record Cloning - From First Coast Service Options (FL Medicare), see page 4 - excellent definition!

Medicare Coverage Database (CMS) NCD, LCD for the states/regions

Medicare Part B Specialty Codes from Trailblazerhealth.com

Modifier Chart from CIGNA-Medicare 

POS codes 

POS Indicators   - then download addendum B.  The status indicators are in column D.  The inpatient only procedures have status indicators C

If you want to know what the rest of the status indicators are, go to and download addendum D1

POS & DOS Instructions from CMS for Professional & Technical Radiology Procedures Effective 10/02/2009

10.6.1 - Place of Service Instructions for the Interpretation of Diagnostic Tests 10.6.2 - Place of Service Instructions for the Technical Component (TC) and Professional Component (PC or Interpretation) of Diagnostic Tests Not Personally Performed Or Supervised By A Physician 10.6.3 - Date of Service (DOS) Instructions for the Interpretation and Technical Component of Diagnostic Tests

RAC Information page - Recovery Audit Contractors (RACs) Information & links from CMS

RACs Limits - Click here to see what CMS says about limits for RACs.

Requirements for Documentation of Physicians' Orders for Lab & Diagnostic Tests

and Signature RequirementsFrom CMS directly, effective 3/16/2010

and http://www.cms.hhs.gov/transmittals/downloads/R1787B3.pdf (this also addresses signature requirement: pg 2, 5a)

RVUs (CMS) from Medicare Physician's Fee Schedule, 2009 This is a direct download for the 2009 RVU

RVUs (CMS) from Medicare Physician's Fee Schedule for 2010 & prior years. This is a direct link to CMS. See also the upper right hand column for other pertinent information/links regarding the Fee Schedule.

RVU Indicator Meanings - 2009 Ever need to find what the Indicators mean? Here they are.

RVU 2010 with a twist - This contains only Globals & modifier use with Status Indicator Meanings. You can tell allowed bilateral procedures, co-surgeon-allowed procedures & Global days for procedures. Just a little tool that LJ created for when you don't need the entire RVU information.

Signature Requirements - Updated 3/17/2010 from Cigna Gov't Services; adding a signature later is not allowed. Read more here.

Signature Requirements

Signature Requirements for Diagnostic Test (Radiology) (this also addresses signature requirement: pg 2, 5a)http://www.cms.hhs.gov/Transmittals/Downloads/R80BP.pdf (2007-2008)

Signature Stamps & HHA 

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

"Two E/M services on the same DOS?" CMS Medlearn Articles