Medicare/Medicaid Vision Benefits

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Cataract surgery. Medicare covers many of the costs associated with cataract surgery, including the cost of a standard intraocular lens (IOL) used to replace your eye’s natural crystalline lens that has become clouded by a cataract.   If you choose a premium intraocular lens, such as a multifocal IOL to correct your eyesight at all distances and thereby reduce your need for reading glasses after surgery, you must pay the added cost for this IOL (above the cost of a standard IOL) out-of-pocket.
Source: allaboutvision.com

Medicare.gov: the official U.S. government site for Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

How Can I Get Vision and Dental Coverage Under Medicare?

Medicare Advantage (Medicare Part C) plans are offered by private companies and include the same coverage as Original Medicare Parts A and B, plus a number of additional benefits that Original Medicare does not offer. Dental and vision care are often included in Medicare Advantage plans, and most plans also include prescription drug coverage. Some plans charge a premium, in addition to the Part B premium you pay to Medicare. Because Medicare Advantage plans are run privately, not all plans are available in all regions. You can find out what plans are available near you by using Medicare’s  plan finder, an online tool at Medicare.gov.
Source: medicaremadeclear.com

Anthem Blue Cross Medicare Advantage Plans

Posted by:  :  Category: Medicare

*All information submitted is private and not shared with third parties. We have a no spam or solicitation policy. All data is used expressly by medicareadvantagecalifornia.com and qualified associated medicare brokers to provide consumers with requested California Medicare Advantage information and assistance. By clicking on ‘Submit’, you consent to receiving a phone call and/or email from a licensed insurance representative representing a top health insurance company such as Aetna, Anthem, Blue Cross Blue Shield, Humana, United Healthcare and WellPoint regarding Medicare Advantage, Medicare Supplement and / or Medicare Drug Plans. When calling our toll free number you will be connected to a qualified associated medicare broker to assist you.
Source: medicareadvantagecalifornia.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Advantage Plans 2016

Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans, and Medicare Medical Savings Account Plans. For people enrolled in a Medicare Advantage Plan their Medicare services are covered through the plan and are not paid for under Original Medicare. For the most part,  Advantage Plans offer prescription drug coverage. Medicare Advantage Plans cover all Medicare services and may also offer extra coverage.
Source: medicarehealthinsurancefacts.com

Anthem HealthKeepers Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The following Anthem HealthKeepers plans offer Medicare Advantage and Part D coverage to Virginia residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Source: usnews.com

Ohio Anthem Senior Advantage HMO Plans – Basic, Plus

This is not a complete listing of plans available in your service area. For additional plan options contact us. This website may display a subset of available plans based on your preferences and the plans we are contracted with. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.
Source: medicareoptions4u.com

CMS 1500 Claim Form, Codes & Information

Posted by:  :  Category: Medicare

The 1500 Health Insurance Claim Form answers the needs of many health payers. It is the basic paper claim form prescribed by many health plans for claims submitted by physicians and suppliers, and in some cases, for ambulance services. In the 1960s there were a number of different claim forms and coding systems required by third-party payers to communicate information regarding procedures and services to agencies concerned with insurance claims. However, there was no standardized form for physicians and other health care providers to report health care services. Therefore, the American Medical Association (AMA) embraced an assignment in the 1980s to work with the Centers for Medicare & Medicaid Services (CMS; formerly known as HCFA), and many other payer organizations through a group called the Uniform Claim Form Task Force to standardize and promote the use of a universal health claim form. Although many providers now submit electronic claims, many of their software/hardware systems depend on the existing 1500 Claim Form in its current image. Minor changes have been made to the form in order to accommodate the National Provider Identifier (NPI) as well as other identifiers.
Source: findacode.com

Institutional paper claim form (CMS

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of institutional charges to most Medicaid State Agencies. Please contact your Medicaid State Agency for more details on their requirements for this paper form. The National Uniform Billing Committee (NUBC) is responsible for the design of the form, and award of the contract for printing of the form. CMS does not supply the form to providers for claim submission. Blank copies of the form may also be available through office supply stores in your geographic area. Although a copy of that form can be downloaded, copies of the form should not be downloaded for submission of claims, since your copy may not accurately replicate colors included in the form. These colors are needed to enable automated reading of information on the form. You can find Medicare CMS-1450 UB-04 completion and coding instructions in Chapter 25 of the Medicare Claims Processing Manual (Pub.100-04). Further information on the UB-04 is available through the NUBC web site. A link is provided below. The UB-04 will retain the CMS-1450 designation.
Source: cms.gov

CMS 1500 Claim Forms and HCFA 1500 Claim Forms

Claim Forms Plus provides online ordering of CMS (HCFA) 1500 08/05 Claim Forms. This is the 08/05 version and it is approved OMB-0938-0999 FORM CMS-1500. If you have any questions or concerns about our company or products, please feel free to contact us by phone or email.
Source: claimformsplus.com

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Medicare Part B Medical Insurance: Coverage, Premiums, Coinsurance & Deductibles

The Medicare Part B premium ($104.90 in 2015) is automatically deducted from your Social Security check every month. If you don’t receive Social Security benefits, you will be billed for Part B. People with higher incomes (individuals with annual incomes over $85,000 and couples with incomes over $170,000) will pay higher Part B premiums. See table below.
Source: cahealthadvocates.org

Find and Compare Best Medicare Plans Online

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B. Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage. When choosing a plan it is important to determine what is expected from the insurance coverage. It would be advantageous for beneficiaries to compare and select coverage based on the plan that will best meet their individual needs.
Source: online-health-insurance.com

Compare $0 Premium Medicare Advantage Plans PPO or HMO

Medicare Advantage Plans offer all of the benefits covered under Original Medicare and more. Also, most plans include Medicare Part D prescription drug coverage. To enroll in a plan, you must be eligible for Medicare Part A and B. You usually pay one monthly premium to the Medicare Advantage plan, if any, and continue to pay your Medicare Part B premium, unless otherwise paid for under Medicaid or by another third party. Medicare Advantage enrollment periods
Source: medicareoptions4u.com

What’s Medicare Supplement Insurance (Medigap)?

Posted by:  :  Category: Medicare

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Medicare Supplement (Medigap) Insurance Plans

MedSupp plans can help pay Original Medicare’s copayments and deductibles. Each type of plan offers a different level of coverage, and is named with a different letter (such as Plan A). The plans are standardized, so that all plans of the same letter offer the same benefits. In other words, the benefits for a Medicare Supplement Plan D enrollee in Rhode Island are the same for a Medicare Supplement Plan D enrollee in Tennessee. However, the premiums can differ among these private insurance companies.
Source: planprescriber.com

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplement Insurance and Plans

Medicare is the federal program the vast majority of Americans 65 and older depend on for their healthcare. People under 65 with disabilities and individuals with end-stage renal disease can also qualify. Medicare is commonly divided into four parts. Original Medicare Part A and Part B help pay costs for hospital care and medical expenses, respectively. Specifically, Part A pays for medically-necessary inpatient hospital services, skilled nursing facility care after a hospital stay, certain home healthcare, and hospice care. Part A does not pay for private hospital rooms, surgery that is not deemed medically-necessary, most care received outside the United States, unskilled personal care, and a variety of other services. Part B, meanwhile, pays only 80% of most Medicare-covered medical costs. Deductible, copayment, and coinsurance costs associated with Original Medicare add up quickly for many people.
Source: medicaremall.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Hawaii Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The plans below offer Medicare Advantage and Part D coverage to Hawaii residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Source: usnews.com

Tennessee Medicare Assistance

Posted by:  :  Category: Medicare

Both programs work hand in hand to assist all Tennesseans with their questions and concerns about Medicare issues. Working through federally funded grants from Centers for Medicare and Medicaid Services and Administration on Aging, SHIP and SMP is administered throughout the nine Area Agencies on Aging and Disability.
Source: tnmedicarehelp.com

Medicare Coverage in Tennessee

Outside of the IEP and GEP, you can’t enroll in Part A and/or Part B unless you’re eligible for a Special Enrollment Period (SEP). If you didn’t sign up for Part B when you were first eligible because you were working or had other health coverage (for example, through an employer group plan), you can enroll in Part B when your coverage or employment ends. To qualify for an SEP, the health coverage must be based on current employment (either your own or your spouse’s). You won’t have to pay a late enrollment penalty if you sign up during an SEP.
Source: planprescriber.com

Medicare/Medicaid Crossover Claims

A copy of the Medicare EOB (and TPL EOB if applicable) is required. Claims received without a Medicare EOB will not be processed and returned to the provider. UB-04 NOTICE: The submitter of this form understands that misrepresentation of falsification of essential information as requested by this form may serve as the basis for civil monetary penalties and assessments and may upon conviction include fines and/or imprisonment under Federal and/or State Laws. Refer to CMS Manual System, Transmittal 1104 , dated November 3, 2006 for the UB-04 Printing Standards. Compliance with these standards is required to facilitate the use of image processing technology. Claims will be returned to the submitter if they do not meet these standards and/or are not printed on an original UB-04 NUBC approved claim form.
Source: tn.gov

Medicare.gov: the official U.S. government site for Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

2015 Tennessee Medicare Part D Prescription Drug Plan Highlights www.Q1Medicare.com

Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3720 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2015, ALL formulary generics will have at least a 35% discount and ALL brand drugs will have at least a 55% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
Source: q1medicare.com

Medicare claim submission address

Posted by:  :  Category: Medicare

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

Medicare/Medicaid Crossover Claims

A copy of the Medicare EOB (and TPL EOB if applicable) is required. Claims received without a Medicare EOB will not be processed and returned to the provider. UB-04 NOTICE: The submitter of this form understands that misrepresentation of falsification of essential information as requested by this form may serve as the basis for civil monetary penalties and assessments and may upon conviction include fines and/or imprisonment under Federal and/or State Laws. Refer to CMS Manual System, Transmittal 1104 , dated November 3, 2006 for the UB-04 Printing Standards. Compliance with these standards is required to facilitate the use of image processing technology. Claims will be returned to the submitter if they do not meet these standards and/or are not printed on an original UB-04 NUBC approved claim form.
Source: tn.gov

Electronic Billing & EDI Transactions

The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

Medicare Billing: Wheelchairs, Scooters, Lift Chairs

We understand that the process of submitting claims to Medicare can be difficult and time consuming. To help make the process easier, SpinLife offers what is known as “courtesy billing”. This means that after you purchase an eligible product from SpinLife and request at checkout that we courtesy bill Medicare, we send you all of the documentation required by Medicare for you to complete with your physician. Once medically qualifying documentation is submitted into SpinLife, we can submit a claim to Medicare on your behalf. If your claim is approved by Medicare, they will reimburse you directly for their portion of your claim via mail.
Source: spinlife.com

DMEPOS Competitive Bidding

Posted by:  :  Category: Medicare

Under the program, a competition among suppliers who operate in a particular competitive bidding area is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
Source: cms.gov

Competitive Bidding Program

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it pays for those equipment and supplies under the Competitive Bidding Program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers.
Source: medicare.gov

DME Competitive Bidding Program

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it will pay for those equipment and supplies under the competitive bidding program. Qualified, accredited suppliers with winning bids are chosen as Medicare-contract suppliers.
Source: medicare.gov

Medicare National Competitive Bidding Program

CCS Medical is one of only 18 suppliers awarded CMS contracts to provide mail order diabetic testing supplies at competitively bid prices nationwide and in the four U.S. territories (American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands). As announced previously by CCS Medical, one of the brands that CCS Medical will be carrying is LifeScan’s OneTouch® Ultra® test strips, the No. 1 brand recommended by endocrinologists and diabetes educators.
Source: ccsmed.com

Despite Billions Of Dollars Saved, Congress Tries To Thwart Medicare’s Competitive Bidding

Once again people are only given half the story. Everybody in the DME industry agrees with the fact that you can buy items from Amazon cheaper, but let’s compare apples to apples here. Amazon does not require a face to face visit to the doctor who then has to PROPERLY note the visit in his/her chart, then send the patient to a therapist to have a full evaluation which must include quantifying measurements of the person’s physical limitations, which then gets sent to the DME, who then sends a prescription back to the doctor for signature. At this point Amazon also does not have to pay for a surety bond to be able to provide to a Medicare patient. Amazon also does not have to spend $20,000 to be accredited to sell to a Medicare patient. Amazon also gets paid all the money in one lump sum, not paid over 13 months like Medicare pays. Amazon also does not receive complex medical reviews which requests all the afore mentioned documentation to Medicare before ever receiving payment at which time Medicare scrutinizes all “i’s that are not dotted a “t’s” that are not crossed. Amazon also does not have to employee a respiratory therapist or an Assistive Technology Practitioner to sell their items. Amazon also does not have to deliver, instruct and be on call 24 hours a day if the power goes out or if Mrs. Jane Doe can’t figure out how to change her oxygen tubing. In addition to all of this we are required to provide oxygen service for 5 years but only get paid for the first 3 years. The last 2 years are completely FREE! Come on Amazon, match that! If Medicare would like to give me a credit card for my services, I would be glad to sell the items for the same price as Amazon. Before an article is written and before you make comments, make sure you have the facts. FYI this is not a democratic or republican issue, it’s simple math. The acquisition costs of the equipment is the smallest part of our cost. The Government (democrats & republicans) can’t seem to get their head around the fact that a lot goes into providing this equipment. Billing Medicare, with their pages and pages and pages of rules and regulations makes it very costly. Let’s look at the logic of this. Let’s go after the smallest percentage of the Medicare budget to look for savings instead of the waste that’s happening in the operations of the program. How much has it cost the tax payers to create this ridiculous program. I have asked this question to several law makers who has NO idea. What?! Wouldn’t you think that someone would have an idea how much this program has cost us? If it cost us 120 million to save 100 million, that math doesn’t work either.
Source: forbes.com

DMEPOS Competitive Bidding

Today President Obama signed into law H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015″ (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading
Source: healthindustrywashingtonwatch.com

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Coding Rules for SLP Services

Untimed CPT codes represent “typical” visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. For significantly atypical procedures, a “-22″modifier can be used to indicate that the work is substantially greater than typically required and a “-52″modifier for an abbreviated procedure. Modifier “-22″ should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. For claims with the “-22″ modifier a description of the need for extended services should accompany the claim. Modifier “-59″ is used to establish one procedure as distinct from another procedure billed on the same day. Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT code. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively. For therapy services that exceed the annual therapy cap, a -KX modifier is required, indicating services are medically necessary and the documentation is available for review.
Source: asha.org

Colorectal cancer screenings

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
Source: medicare.gov

Medicare Eligibility Guidelines

The patient has either of the following: a) Current pressure ulcer or past history of a pressure ulcer on the area of contact with the seating surface; or b) Absent or impaired sensation in the area of contact with the seating surface or inability to carry out a functional weight shift due to one of the following diagnoses: spinal cord injury resulting in quadriplegia or paraplegia (344.00-344.1), other spinal cord disease (336.0-336.3), multiple sclerosis (340), other demyelinating disease (341.0-341.9), cerebral palsy (343.0-343.9), anterior horn cell diseases including amyotrophic lateral sclerosis (335.0-335.21, 335.23-335.9), post polio paralysis (138), traumatic brain injury resulting in quadriplegia (344.09), spina bifida (741.00-741.93), childhood cerebral degeneration (330.0-330.9), Alzheimer’s disease (331.0), Parkinson’s disease (332.0).
Source: mobilitycare.com

Medicare Policies and Guidelines

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Source: findacode.com