2025 portable X-ray response to comments
Thank you for taking the time to provide your comments on portable x-ray services. First Coast appreciates your feedback and...
Clinicians: Are you ordering urological supplies for your patients?
Urological supplies are covered as part of the Prosthetic Device benefit as outlined in the Social Security Act § 1861(s)(8)...
What modifiers are applicable to ambulatory surgical centers (ASCs)?
Payment for ASCs are made under a separate payment system. As such, certain modifiers are specific to ASCs. View the following article to learn more: Modifiers applicable to ASCs.
What modifiers do I use to indicate the status of an ABN?
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary by viewing the following article: How to use modifiers to indicate the status of an ABN.
Which modifiers may not be corrected through the reopening process?
View the following list of codes that may not be corrected using the reopening process in SPOT.
How should MDPP suppliers submit claims for MDPP sessions delivered via distance learning to patients located in other states?
MDPP suppliers submit all claims for MDPP services to their MAC, regardless of where the patient is located.
The claims submission process will be the same for MDPP sessions delivered via distance learning as for MDPP sessions delivered in-person.
MDPP suppliers will use “Other” (99) as their place of service (POS) code for sessions delivered via distance learning and HCPCS code G9887.
For MDPP billing, claims may list the currently enrolled practice location (not the coach’s home address) as the POS.
Can MDPP suppliers offer distance learning MDPP sessions to FFS patients living in other states?
Yes.
Please note, suppliers must ensure all patients are eligible for MDPP under FFS Medicare and follow all Centers for Disease Control and Prevention (CDC) Diabetes Prevention Recognition Program (DPRP) standards for distance learning delivery. All MDPP suppliers must maintain the capacity to offer MDPP services in person, even if they are currently delivering most or all MDPP sessions via distance learning.
Can an FFS Medicare patient enroll with any MDPP supplier offering distance learning MDPP sessions, even if the supplier is in a different state?
Yes. Eligible FFS Medicare patients can enroll with any MDPP supplier offering MDPP sessions via distance learning, regardless of where the patient and supplier are located.
What if a beneficiary moves to a location where there is no MDPP supplier after he or she has started receiving the set of MDPP services?
If there is no MDPP supplier in the new location, the beneficiary can attend virtual sessions through distance learning (e.g., a live virtual classroom), if offered. The beneficiary may also identify other MDPP suppliers that offer distance learning delivery of MDPP services.
Where within the claim form should an MDPP supplier include the Demonstration Code "82"?
MDPP suppliers should report Demonstration Code "82" in Item 19 on the CMS-1500 claim form or in the EDI equivalent 2300 REF01 P4 and 2300 REF02 82.