As CMS methodologically applied the above criteria to develop the CY 2025 list of E/M CPT/HCPCS codes subject to the comparative payment rate analysis (henceforth called "CY 2025 E/M Code …
1 The codes on this list reflect services delivered primarily by physicians and non-physician practitioners (NPPs) in an office-based setting for primary care, obstetrics and gynecological, and outpatient …
CCBHC Billing Codes | Medicaid
CMS CCBHC Demonstration Billing Codes On November 17, 2016, CMS published the 2017 Alpha Numeric Healthcare Common Procedure Coding System (HCPCS) File & Code Sets which contain …
CMS Technical Instructions: Reporting Race and Ethnicity in the T-MSIS ...
Jun 29, 2021 · CMS Technical Instruction Use of “Other”, “Unknown” and “Unspecified” T-MSIS Race and Ethnicity Codes For the RACE (ELG213) and ETHNICITY-CODE (ELG204) data elements, …
CMS Technical Instructions: Diagnosis, Procedure Codes
Jul 17, 2019 · CMS expects to find diagnosis codes and procedure codes populated for most claims and encounter records in inpatient (IP), long-term care (LT) and other (OT) files. However, not all claims …
CMS Guidance: Reporting Expectations for Dual-Eligible Beneficiaries ...
Oct 6, 2016 · Dual-eligible beneficiaries are individuals who receive both Medicare and Medicaid benefits. The two programs cover many of the same services, but Medicare pays first for the …
Billing and Coding Guidance | Medicaid
Medicare Monoclonal Antibody COVID-19 Infusion Program InstructionFact sheet for State and Local Governments About CMS Programs and Payment for Hospital Alternate Care SitesFrequently Asked …
CMS Guidance: Reporting Denied Claims and Encounter Records to T …
Mar 13, 2020 · Reason Why CMS Wants States to Submit Denied Claims and Encounters CMS needs denied claims and encounter records to support CMS’ efforts to combat Medicaid provider fraud, …
Medicaid Drug Rebate Program Dispute Resolution
Aug 20, 2025 · What is Medicaid Drug Rebate Dispute Resolution? The Medicaid Drug Rebate Dispute Resolution Program (DRP) is for states and/or manufacturers that are unable to mutually resolve …
Long-Term Services and Supports (LTSS) Quality Measures
CMS is the measure steward for 15 nationally standardized LTSS quality measures including managed care and fee-for service (FFS) quality measures delivered by states through their Medicaid …