Browse by Topic
Advance Beneficiary Notice of Noncoverage (ABN) - View an ABN overview, medical necessity, triggering events, tips, key points and resources
Appeals - If dissatisfied with an initial claim determination, you have the right to request an appeal. There are many appeal levels and each level must be processed before proceeding to the next. View details
Claims - Access the CMS-1500 instructions and tutorial and view other claim submission related information
Clinical Trials - View information on the different clinical research studies, Medicare coverage for those types, as well as billing guidance and scenarios and solutions
Compliance Program - View overview of Medicare compliance program requirements
Documentation Requirements - View checklists to help providers submit appropriate documentation to Medicare
Drugs, Biologicals and Injections - View guidance on drugs, biologicals and injections
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) - Access the Noridian DME Homepages, Latest Updates, contact information, Local Coverage Determinations (LCDs) and articles and Jurisdiction Lists
Electronic Data Interchange (EDI) - Connect with EDI regarding electronic claim submissions
Emergencies and Disasters - In the event of a national or regional catastrophe or disaster, view resources
Fraud & Abuse - View information regarding fraud, abuse, and the related process to report potential concerns
Incentive Programs - View variety of CMS programs with financial incentives for providers
Incident To - View criteria, terminology, direct supervision, direct personal supervision, employment and billing information
Medicare Beneficiary Identifier (MBI) - Congress requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A randomly generated MBI will replace SSN-based Health Insurance Claim Number on new Medicare cards. View details
Medicare Secondary Payer (MSP) - View general MSP related information, informaiton on Benefits Coordination & Recovery Center (BCRC), billing electronically, payment examples and access the payment calculator
Modifiers - Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators. View details
Non-Covered Services - View the differences between not medically necessary services/items and those statutorily excluded.
Noridian Medicare Portal (NMP) - Access General, Registration, End User, and Administrator function related guides and details
Observation - Observation vs inpatient. View decision making scenerios and related reference guides
Overpayment and Recoupment - Overpayment: Repayment, interest rates, and types. Recoument: Request an immediate recoupment, repond to demand letter and submit a voluntary refund. View details
Preventive Services - Medicare pays for many preventive services to keep beneficiaries healthy. View details
Remittance Advice (RA) - View/ access RA related information. Qualified Medicare Beneficiary (QMB) Program, Reason Code guidance, WPC reason and remark codes
Telehealth - Beneficiaries are eligible for telehealth services only if they are treated at an originating site located either in a rural health professional shortage areas (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). View details
Last Updated May 16, 2018
CPT, ADA, and AHA End User License Agreement for Providers
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.
CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
Copyright © 2018, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816
Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.