How to use touch tone on Medicare IVR

DME MAC A IVR User Guide - Using Touch-Tone Options

The IVR is programmed to allow for the entry of all data using touch-tone in the event the user is unable to
successfully speak to the IVR. These instructions detail how to use touch-tone to enter various types of
information requested by the IVR.

Note: Providers can switch between voice and touch-tone throughout the call (e.g., voice for Medicare number and touch-tone for beneficiary name); however, you cannot combine speech and touch-tone when providing a single element (e.g., voice for the numbers in a Medicare number and then touch-tone for suffix).


Using Touch-Tone for Alpha-Numeric Elements

When a single touch-tone entry contains alpha and numeric information (e.g., Medicare number) utilize the
following instructions.

Each button on the telephone keypad has a corresponding set of letters. Each letter is identified as a 1, 2, or 3 to indicate its position on that key.

Three keys are required to enter a letter.
Examples:
Medicare number 155-55-5555W
Press:
The first nine digits of the Medicare number:

* (star key) to indicate that you are about to enter a letter
The key containing the letter W
The position of the letter on that key (1st position)
Note: For the letters Q and Z, assume they appear on the 1 key as shown.



Common Letter Navigation
Letter     Touch-Tone Entry
A                     *21
B                     *22
C                     *23
D                     *31
M                    *61
T                     *81
W                   *91
S                     *73
Q                    *11
Z                     *12


Using Touch-Tone for Beneficiary Names

The format for entering the beneficiary’s name is LAST NAME, FIRST INITIAL. Select the number key
that represents the letter you wish to enter. For example, to enter the name John Doe, press 3-6-3-5 (entered
as DOEJ). To enter the letters Q or Z, use the 1 key.

CPT code G8642, G8643 - E-prescription update

2011 Electronic Prescribing (eRx) Incentive Program Update

In November, the Centers for Medicare & Medicaid Services announced that beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

The payment adjustment in 2012, with regard to all of the eligible professionals’ Part B-covered professional services, will result in the eligible professional or group practice receiving 99% of the Physician Fee Schedule (PFS) amount that would otherwise apply to such services. In 2013, the eligible professional will receive 98.5% of their covered Part B-eligible charges if they aren’t a successful electronic prescriber. In 2014, the penalty for not being a successful electronic prescriber is 2% resulting in eligible professionals receiving 98% of their covered Part B charges.

For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011- June 30, 2011 to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011. Group practices reporting as a GPRO I or GPRO II in 2011must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012.

If an eligible professional or selected group practice wishes to request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims should one of the following situations apply:

• G8642 - The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.



• G8643 - The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act



Additionally, there will be a G8644 code which can be used by eligible professionals to indicate that they do not have prescribing privileges. Reporting this G8644 code prior to June 30, 2011 will prevent the eligible professional from being subjected to a payment adjustment in 2012.

Medicare ABN guide - How to complete

COMPLETING THE ABN

The revised ABN can be found at:

http://www.cms.gov/BNI/02_ABN.asp

The ABN is composed of five sections and 10 blanks, which must appear in the following order from top to bottom on the notice:

Notifier (A)

      Provider must place his name, address and telephone number at the top of the notice.

      If the billing and notifying entities are not the same, the name of more than one entity may be given in the notifier area.

Patient Name (B)

      Provider must enter first and last name of the beneficiary receiving the notice. The middle initial should also be used if there is one on the beneficiary’s Medicare card.

Identification Number (C)

      Medicare numbers or Social Security numbers must not appear on the notice.

Body (D)

      Providers must list the specific items or services believed to be non-covered in the blank of the note as well as in the first block of the table.

      In the case of partial denials, providers must list in the blank the excess component(s) of the item or service for which denial is expected.

Table (D, E, F)

      First Block (D).

                o Providers must list the specific items or services believed to be non-covered.

                 

      Reason Medicare May Not Pay (E).

                o Providers must explain in beneficiary-friendly language why they believe the items or services may not be covered by Medicare. Commonly used reasons for non-coverage are:

      “Medicare does not pay for this test for your condition.”

      “Medicare does not pay for this test as often as this (denied as to frequency).”

      “Medicare does not pay for experimental or research use tests.”

                 

Note: To be a valid ABN, there must be at least one reason applicable to each item or service listed. The same reason for non-coverage may be applied to multiple items.

                

Estimated Cost (F).

                o Provider must complete the Estimated Cost blank to ensure the beneficiary has all available information to make an informed decision about whether to obtain potentially non-covered services.

o Providers must make a good faith effort to insert a reasonable estimate for all the items or services listed. In general, we would expect the estimate be within $100 or 25 percent of the actual costs, whichever is greater. Examples of acceptable estimates would include, but not be limited to the following:

      For a service that costs $250:

                o “Between $150–$300.”

     o  “No more than $500.”

                

Multiple items or services that are routinely grouped can be bundled into a single-cost estimate.

Options 1, 2 or 3

The beneficiary or his representative must choose only one of the three options listed.

Option 1:

                o This allows the beneficiary to receive the item or services at issue and requires the provider to submit a claim to Medicare. This will result in a payment decision that can be appealed.

Option 2:

                o This option allows the beneficiary to receive the non-covered items or services and pay for them out-of-pocket. No claim will be filed and Medicare will not be billed. Therefore, there are no appeal rights associated with this option.

o Providers will not violate mandatory claims submission rules under 1848 of the Social Security Act when a claim is not submitted to Medicare at the beneficiary’s written request when selecting this option.

                 

Option 3:

                o This option means the beneficiary does not want the care in question. By checking this box, the beneficiary understands that no additional care will be provided and, thus, there are no appeal rights.

Additional Information (H)

Providers may use this space to provide additional clarification they believe will be of use to beneficiaries. For example:

                 

      A statement advising the beneficiary to notify his provider about certain tests that were ordered but not received.

      An additional dated witness signature.

      Other necessary annotations:

                o Annotations will be assumed to have been made on the same date as that appearing with the beneficiary’s signature.

Signature Box (I, J)

Once the beneficiary reviews and understands the information contained in the ABN, the Signature Box is to be completed by the beneficiary or representative.

                 

Signature:

                o The beneficiary or representative must sign the notice to indicate that he received the notice and understands its contents. If a representative signs, he should indicate “representative” after his signature.

                 

Date:

                o The beneficiary or representative must write the date he signed the ABN. If the beneficiary has physical difficultly writing and requests assistance in completing this blank, the date may be inserted by the provider. 

HOW THE ABN PROTECTS THE PROVIDER

WHAT IS AN ABN? 

An ABN is a written notice that a provider/supplier gives to a Medicare patient before items or services are rendered when the provider/supplier believes Medicare probably/certainly will not pay for some or all of the items or services.

ABNs should only be provided to Medicare beneficiaries. The ABN allows the beneficiary to make an informed decision about whether to receive services that he may be financially responsible for paying. The ABN serves as proof the patient had knowledge prior to receiving the service that Medicare might not pay. If a provider does not deliver a proper ABN to the patient, the patient cannot be billed for the service.

Note: Providers may not issue ABNs to shift financial liability to a beneficiary when full payment is made through bundled payments (e.g., National Correct Coding Initiative). ABNs cannot be used when the beneficiary would otherwise not be financially liable for payments for the service because Medicare made full payment.

Note: The newly revised ABN replaces the following notices: 

 ABN-G (CMS-R-131-G).

 ABN-L (CMS-R-131-L).

 Notice of Excluded Medicare Benefits (NEMB) (CMS-20007).

HOW THE ABN PROTECTS THE PROVIDER

      When a valid ABN has been given, the provider is free to bill the patient for the denied services.

      If an ABN is not valid, the provider may not bill the patient for the services. 

      ABNs may not be used to bill patients for services that are denied as bundled into other payments.

Payment Adjustment Information - E-prescription

Electronic Prescribing (eRx) Payment Adjustment Information

Beginning 2012, Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (P.L.110-275) (MIPPA) requires CMS to subject eligible professionals who are not successful electronic prescribers under the eRx Incentive Program to a payment adjustment. This payment adjustment applies to all of the eligible professional's Part B-covered professional services under the Medicare Physician Fee Schedule (MPFS). From 2012 through 2014, the payment adjustment will increase with each new reporting period. Accordingly, for 2012, eligible professionals receiving a payment adjustment will be paid 1.0% less than the MPFS amount for that service. In 2013 and 2014, the payment adjustment increases to 1.5% and 2.0% respectively.

Significant Hardship Exception: Eligible professionals may be exempt from the application of the payment adjustment if CMS determines that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship. This hardship exception is subject to annual renewal.

How to appeal on Medicare IVR

DME MAC A IVR User Guide - Appeals Options

Appeals - Option 4 

When the appeals option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• CCN

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Document Control Number (DCN)
• All associated CCNs
• Appeal status
• Received date
• Dates of service
• Appeal decision


For appeals navigation options, please refer to the following:

                                      Appeals Navigation
Voice                                                  Touch-Tone Entry
Repeat That                                                    1
Next CCN                                                      2
Previous CCN                                                3
Change CCN                                                  4
Change Medicare Number                              5
Change PTAN                                                6
Main Menu                                                     7

CPT CODES - Cardiology codes

DESCRIPTION CODE Cardiovascular Stress Test ? Using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress with physician supervision, interpretation and report 93015 Physician supervision only, without interpretation and report 93016 Tracing only, without interpretation and report 93017 Interpretation and report only 93018 Microvolt T-wave Alternans Testing ? Microvolt T-wave alternans for assessment of ventricular arrhythmias 93025 Holter Testing ? Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation 93224 Recording (includes hook-up, recording and disconnection) 93225 Scanning analysis with report 93226 Physician review and interpretation 93227 Holter Testing ? Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning, utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation 93230 Recording (includes hook-up, recording and disconnection) 93231 Microprocessor-based analysis with report 93232 Physician review and interpretation 93233 ECG ? At least 12 leads, with interpretation and report 93000 Tracing only, without interpretation and report 93005 Interpretation and report only 93010 Rhythm ECG ? One to three leads, with interpretation and report 93040 Tracing only, without interpretation and report 93041 Interpretation and report only 93042 Spirometry ? Including graphic report, total and timed forced vital capacity (FVC) 94010 Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator (aerosol or parenteral) or exercise 94060 Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after test dose of bronchodilator (aerosol only) antigen, exercise, cold air, methocholine or other chemical agent, with spirometry as in 94010 94070 Vital Capacity, total (separate procedure) 94150 Maximum breathing capacity, maximal voluntary ventilation (MVV) 94200 Respiratory flow volume loop 94375 Aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes 94664 Pulse Oximetry ? Multiple determinations (e.g., during exercise) 94761 Noninvasive ear or pulse oximetry for oxygen saturation by continuous overnight monitoring 94762 ABP Monitoring ? Utilizing a system such as magnetic tape and/or computer disk for 24 hours or longer; including recording, scanning analysis, interpretation and report 93784 Recording only 93786 Scanning analysis with report 93788 Physician review with interpretation and report 93790

Courtesy, Quality America, Inc. 2006

TYPICAL PROCEDURE REIMBURSEMENT RANGE Exercise Stress $100-$275 Microvolt T-wave Alternans $192-$375 Holter $143-$325 Electrocardiography $25-$60 Spirometry $35-$75 Pulse Oximetry $17-$40 A B P Monitoring $75-$225

Codes for billing Evaluation and Management procedures 99201 - 99205

The Physicians’ Current Procedural Terminology – 4th Edition (CPT-4) book includes codes for billing Evaluation and Management (E&M) procedures. It is important that providers use the current version of the CPT-4 and report E&M code definitions carefully.


General Information: The following paragraphs include general information about E&M procedures.

Levels of Care : Within each category and subcategory of E&M service, there are three to five levels of care available for billing purposes. These levels of care are not interchangeable among the different categories and subcategories of service. The components used to describe and define the various levels of care are listed in the “Evaluation and Management” section of the CPT-4 book.

Modifiers: Modifiers used to describe circumstances that modify a listed E&M code are listed with their descriptors in the Modifiers: Approved List and Modifiers Used With Procedure Codes sections of the appropriate Part 2 manual.


New Patient : A new patient is one who has not received any professional services. Reimbursement from the provider within the past three years. If a new patient visit has been paid, any subsequent claim for a new patient service by the same provider, for the same recipient received within three years will be paid at the level of the comparable established patient procedure.


RAD Reductions : The payment resulting from this change in the level of care will be made with a Remittance Advice Details (RAD) message defining the reduction as being in accordance with the service limit set for the procedure. These codes are listed in the Remittance Advice Details (RAD) Codes and Messages: 001 – 9999 sections in the Part 1 manual. Providers who consider the service appropriate and the reduction inappropriate should submit a Claims Inquiry Form (CIF).

Established Patient Reimbursement : An established patient is one who has received professional services from the provider within the past three years.

E&M Services Separately Reimbursable : The following CPT-4 codes for E&M services are separately reimbursable if billed by the same provider, for the same recipient and same date of service, and if the required documentation is included in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or on an attachment included with the claim.

New patient, office or other outpatient visit (99201 – 99205) and established patient, office or other outpatient visit (99211 – 99215)

Claims for codes 99211 – 99215 must document the following: The patient was seen on two separate occasions on the same date of service (the patient left the provider’s office and returned for a second visit); and Medical necessity.

New patient, office or other outpatient visit (99201 – 99205) and new or established patient, office or other outpatient consultation (99241 – 99245). Claims for codes 99241 – 99245 must document the following: Another provider requested the patient consultation; Consultation was regarding a separate problem than that of the earlier initial patient visit; and Medical necessity.

Established patient, office or other outpatient visit (99211 – 99215) and another established patient, office or other outpatient visit (99211 – 99215) may be reimbursed when:

The patient was seen on two separate occasions on the same date of service (the patient left the provider’s office and returned for a second visit). Documentation must be submitted with the claim to medically justify two services on the same day.

The same doctor, or two doctors with the same group number, sees the recipient twice on the same day. Documentation must be submitted with the claim to medically justify a second visit on the same date of service by the same or a different doctor.


New or established patient, subsequent hospital care (99231 – 99233) and subacute subsequent care (HCPCS codes X9928 – X9932)

Restricted to any combination of two services by the same provider, for the same recipient and same date of service. Providers may be reimbursed for more than two services if there is documentation that either the patient’s status deteriorated or there was a significant change which necessitated more than two physician visits to the bedside on the same day.

New or established patient, subsequent hospital care (99231 – 99233) and new or established patient, initial inpatient consultation (99251 – 99255)

Code combinations 99231 – 99233 and 99251 – 99255 may be reimbursed when: Two different physicians provide inpatient services to the same recipient on the same date with the same group provider number. Documentation must be submitted with the claim to medically justify two services on the same day.

One physician provides inpatient services to a recipient twice on the same date of service. Documentation must be submitted with the claim to medically justify two services on the same day.

New or established patient, initial hospital care (99221 – 99223) and new or established patient, subsequent hospital care (99231 – 99233) Code combination 99221 – 99223 and 99231 – 99233 may be reimbursed when: Two different physicians provide inpatient services to the same recipient on the same date with the same group provider number. Documentation must be submitted with the claim to medically justify two services on the same day.

One physician provides inpatient services to a recipient twice on the same date of service. Documentation must be submitted with the claim to medically justify two services on the same day.

2011 eRx Incentive Program rules and Regulations

Electronic Prescribing (eRx) Incentive Program Statutory Authority - Statute/Regulations

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate program for eligible professionals who are successful electronic prescribers for 2009 through 2013, as detailed in MIPPA. A link to the MIPPA legislation can be found in the "Related Links Outside CMS" section below. For 2009 and 2010, the Secretary is authorized to provide successful electronic prescribers an incentive payment equal to 2.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period (January 1, 2009 – December 31, 2009). For 2011 and 2012, eligible professionals who are successful electronic prescribers may qualify to earn an incentive payment equal to 1.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period. For 2013, the incentive payment amount is reduced to 0.5%. Beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment, or penalty. Specifically, for 2012 through 2014, if an eligible professional is not a successful electronic prescriber for the reporting period for the year, the PFS amount for covered professional services furnished by such professional during the year shall be less than the PFS amount that would otherwise apply by 1.0% for 2012, 1.5% for 2013, and 2.0% for 2014.

More detailed information regarding eligible professionals may be found by clicking on the "Eligible Professionals" section page to the left.

2011 eRx Proposed Rule

The Centers for Medicare & Medicaid Services released a proposed rule for changes to the Medicare Electronic Prescribing (eRx) Incentive Program. The proposed rule has been published in the Federal Register on June 1, 2011. The Federal Register published version has now been posted. To view the proposed rule, see link titled "2011 PFS Proposed Rule -- CMS-3248-P" in the "Related Links Outside CMS" section below. The deadline for submitting comments to the proposed rule is July 25, 2011.

2011 eRx Incentive Program Regulations

CMS' proposals for the 2011 eRx incentive as well as our proposals for implementing the eRx payment adjustment that begins in 2012 can be found in the 2011 Medicare Physician Fee Schedule (PFS) proposed rule. The 2011 PFS proposed rule was published in the Federal Register on July 13, 2010. The deadline for submitting comments to the proposed rule is August 24, 2010. To view the entire 2011 PFS proposed rule, including instructions for submitting comments, click on the "2011 PFS Proposed Rule -- CMS-1503-P" in  below.

The 2011 eRx Incentive Program, including the requirements related to the eRx payment adjustment that begins in 2012, was finalized in the 2011 PFS final rule with comment period. The final regulation is on display at the Federal Register. To view the entire 2011 PFS final rule with comment period, see "2011 PFS Final Rule -- CMS-1503-FC" in below.

2010 eRx Incentive Program Regulations

CMS' proposals for the 2010 eRx Incentive Program, including the proposed criteria that CMS will use to determine what eligible professionals the eRx incentive applies to and how "successful electronic prescriber" will be defined for 2010, can be found in section G5 of the 2010 PFS proposed rule (74 FR 33593 through 33600). The 2010 PFS proposed rule was published in the Federal Register on July 13, 2009.
The 2010 eRx Incentive Program was finalized in the 2010 PFS final rule with comment period (74 FR 61849 through 61861). The final regulation was published in the Federal Register on November 25, 2009.

2009 E-Prescribing Incentive Program Regulations

Detailed information about the criteria that CMS will use to determine what eligible professionals the eRx incentive applies to and how "successful electronic prescriber" is defined for 2009 are described in section O2 of the final 2009 Physician Fee Schedule (PFS) rule (73 FR 69847 through 69852) that was published in the Federal Register on November 19, 2008.

Emergency CPT code billing with E & M code

E&M service with Emergency

Emergency Department Services : Claims for emergency department E&M services must be accompanied by an appropriate diagnosis code reflecting the need for the level of E&M services rendered. Inappropriate upcoding is subject to audit.

No distinction is made between new and established patients in the emergency department. Providers must use CPT-4 codes 99281 – 99285 when billing for emergency department services, whether the patient is new or established. If a recipient visits the emergency department more than once on the same date of service, the provider should use the recipient’s records from the first visit instead of completing a new evaluation. Claims for E&M services rendered more than once in the emergency department by the same provider, for the same recipient and date of service are reimbursable only if they contain medical justification or an indication from the provider that the recipient came to the emergency department more than once in the same day.

Note: Evaluation and Management (E&M) CPT-4 codes 99281 – 99285 are physician service codes and under most circumstances, only physicians may submit claims for these codes. The treating physician and the emergency department services may not submit separate claims using these codes for the same recipient and date of service.

E&M codes 99284 and 99285 are not reimbursable together or more than once to the same provider, for the same recipient and date of service. Instead, providers should use code 99283 to bill for second and subsequent recipient visits on the same date of service.


E&M: Place of Service/Facility Type Codes : The CPT-4 and HCPCS codes listed below are restricted to the following facility type/Place of Service codes:

CPT-4 Code Description- Facility TypeUB-04 -Place of Service Code CMS-1500

99201 – 99215 Office Services 13, 71, 72, 73, 74, 75, 76, 79, 83 11, 22, 24, 25, 53, 65, 71, 72

99221 – 99233, 99238, 99239 Hospital Services 11, 12 21, 25

99241 – 99245 Office Consultation 13, 14, 24, 33, 34, 44, 54, 64, 71, 72, 73, 74, 75, 76, 79, 83, 89 11, 12, 22, 23, 24, 25, 53, 55, 62, 65, 71, 81, 99

99251 – 99255 Initial Inpatient Consultation 11, 12, 25, 26, 27, 65, 71, 73, 74, 75, 76, 86 21, 31, 32, 53, 54, 99


The CPT-4 and HCPCS codes listed below are restricted to the following facility type/Place of Service codes (continued):

CPT-4 Code Description                Facility Type UB-04                     Place of Service Code CMS-1500

99281 – 99285                                 Emergency Department Services            14* 23

99291 – 99292                                 Critical Care Services                           11, 12, 13, 14* 21, 22, 23

99341 – 99350                                 Home Services                         14, 24, 33, 34, 44, 54, 64 12, 55, 99

99460, 99462                                    Newborn Care                              11, 12 21

99477                                                Neonate Intensive E&M              13, 14, 24, 34, 44, 54 or 64 21



HCPCS Code Description Facility Type UB-04 Place of Service Code CMS-1500

X9922 – X9970 Adult Subacute Care 27** 99**

X9922 – X9970 Pediatric Subacute Care 27** 99**

* Facility type “14” must be billed in conjunction with admit type “1.”

** Facility type “27” or Place of Service code “99” must be billed in conjunction with modifier HB to denote adult or HA to denote child.



Refer to the CMS-1500 Completion or UB-04 Claim Form

Completion – Outpatient section of the appropriate Part 2 manual for facility type/Place of Service codes and descriptions. Refer to the end of these sections to see the correspondence between local and national codes.

Claims for services rendered in an inappropriate facility type/Place of Service will be denied with RAD code 062, “The facility type/Place of Service is not acceptable for this procedure.”

Note: The codes listed on the previous page cannot be billed with facility type code “89” on the UB-04 or Place of Service code “81” on the CMS-1500 (independent laboratories). Claims for these codes billed with facility type code “89” or Place of Service code “81” will be denied.

CMN Status Options of Medicare IVR

DME MAC A IVR User Guide - CMN Status Options

CMN Status - Option 3

When CMN status is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• HCPCS code

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Initial certification date
• Recertification date
• Revised date
• Length of need

At any time during CMN status playback the caller can give the next Medicare number if multiple CMN
status requests are needed.

At the end of CMN status playback the caller has the option of saying; “change HCPCS” to obtain
information on another HCPCS code for the same beneficiary.

CPT code 99357

CPT 99357 with E&M Services

CPT-4 Code 99357 To report prolonged inpatient E&M services, CPT-4 codes 99357 (each additional 30 minutes) must be billed in conjunction with code 99356.

Billing Calculations CPT-4 codes 99356 and 99357 are subject to the least restrictive frequency limitation as the required companion code. To calculate the amount of time that is payable for prolonged inpatient services, take the total unit/floor time and subtract the time of the primary E&M service. The following table may be used to calculate billing for prolonged inpatient E&M services.



Time of E&M visit code not included                  First hour               Each additional 30 minutes

Less than 30 minutes                                       Not reported               Not reported

30 – 74 minutes                                               99356                        Not reported

75 – 104 minutes                                             99356                        99357

105 – 134 minutes                                           99356                       99357 (quantity of 2)

135 – 164 minutes                                           99356                       99357 (quantity of 3)

165 – 194 minutes                                          99356                        99357 (quantity of 4)

Patient payment posting process

Here is the list of possibilities in patient payment posting process and what is the correct method to post.

1. Payment is equal to Balance.
Post the entire payment according to balance.

2. Payment is lesser than balance.
a) Check any notes in the statement as which DOS to post.
b) If no notes in the statement, see the statement history if payment match with statement then post as per statement.
c) or else post from oldest DOS.

3. Payment greater than balance.

a) Check whether its a duplicate payment.
b) Post the balance and keep remaining in open credit.

Patient payment at time of visit.

1) Generally patient pays copay for current DOS hence if there is no notes in the payment then post into the current DOS.
2. If patient pays more than copay, it may be some for today visit and remaining for old visit. Hence post accordingly.

Vaccine CPT code updates on category I and III

AMA Releases Updates to Category I, III CPT Codes

 The American Medical Association has released updates to several Category I vaccine CPT codes.

The FDA pending indicator has been removed from CPT 90670, and CPT 90644 was approved after the AMA's October editorial meeting, according to the update.

The following Category I codes were revised in the update:

• CPT 90663 (Influenza virus vaccine, pandemic formulation, H1N1)
• CPT 90650 (Human Papilloma virus vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use)
• CPT 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use)

The following Category I codes are new codes, according to the update:

• CPT 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed)
• CPT 90664 (Influenza virus vaccine, pandemic formulation, live, for intranasal use)
• CPT 90666 (Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use)
• CPT 90667 (Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use)
• CPT 90668 (Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use)