evekhm/cms_iom_500 huggingface dataset:
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CloseLicense AgreementsPlease review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes.LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT")End User Point and Click Amendment:CPT codes, descriptions and other data only are copyright2023American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885.Applications are available at the AMA Web site,http://www.ama-assn.org/go/cpt.Applicable FARS\DFARS Restrictions Apply to Government Use.AMA Disclaimer of Warranties and Liabilities.
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Applicable FARS\DFARS Restrictions Apply to Government Use.AMA Disclaimer of Warranties and Liabilities.CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.CMS DisclaimerThe scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept".LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDTTM)End User License Agreement:
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Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept".LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDTTM)End User License Agreement:These materials contain Current Dental Terminology (CDTTM), copyright2023American Dental Association (ADA).  All rights reserved. CDT is a trademark of the ADA.The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen.If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting.Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site,http://www.ADA.org.Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use.U.S. Government Rights Provisions.Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.ADA DISCLAIMER OF WARRANTIES AND LIABILITIES.CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for software, including any CDT and other content contained therein, is with CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement.The ADA is a third party beneficiary to this Agreement.
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The ADA is a third party beneficiary to this Agreement.CMS DISCLAIMER.The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CDT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I Accept". If you do not agree to the terms and conditions, you may not access or use software. Instead you must click below on the button labeled "I Do Not Accept" and exit from this computer screen.LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)American Hospital Association DisclaimerThe American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.I AcceptI Do Not AcceptPage Help forMCD SearchCloseIntroductionThe MCD Search page is the starting point to search for Medicare Coverage documents. It allows users to identify and view both National and Local Coverage documents that reside within the database.National Coverage documents maintained in the MCD include:National Coverage Determinations (NCDs)National Coverage Analyses (NCAs)Coding Analyses for Labs (CALs)Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) meetingsTechnology Assessments (TA)Medicare Coverage Documents (MCDs)Local Coverage documents maintained in the MCD include:ArticlesLocal Coverage Determinations (LCDs)
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Local Coverage documents maintained in the MCD include:ArticlesLocal Coverage Determinations (LCDs)Learn more about the various document types found in the MCDEnter Search TermStart a search by entering your search term in the search box.Enter one of the following types of search terms:Keyword:For example, "Acupuncture".  This type of search will return all documents containing your search term.CPT/HCPCS procedure (billing) code:For example, "92250".  CPT/HCPCS codes are only included in Local Coverage Articles and certain Durable Medical Equipment (DME) LCDs, or possibly in retired versions of LCDs.  This type of search will return all documents containing the CPT/HCPCS code.ICD-10-CM code:For example, "E08.621".  ICD-10-CM codes are only included in Local Coverage Articles, or possibly in retired versions of LCDs. This type of search will return all documents containing the ICD-10-CM code.Document ID:For example, "A12345", "L12345", "CAG-00044N".  Please Note that MEDCAC Meetings, TAs, and MCDs do not have document IDs.  Entering a document ID will directly open the document.Contractor name:This will return all documents pertaining to the specified contractor. Accepted values are: CGS, First Coast, NGS, Noridian, Novitas, Palmetto, and WPS.Please note you can perform a search while leaving the search box empty.  This will return all documents in the MCD.Hint ListAs you enter your search term, a hint list will appear below the search box to help you with your search.  If you see what you need in the hint list, you can select it.  Otherwise, launch your search by pressing the <Enter> key or clicking on the green magnifying glass.AMA License AgreementIf you enter a CPT/HCPCS code, you may see a yellow bar.  Click on it to view and accept the AMA License Agreement.  This will allow you to see matching CPT/HCPCS codes in the hint list.
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Smart SearchesThe MCD offers some limited smart search capability.  The following are examples of some smart searches you can enter:"LCDs for cancer" will return LCDs that contain the word "cancer"."Acupuncture articles" will return Local Coverage Articles that contain the word "acupuncture"."Billing and coding articles for colonoscopy" will return Billing & Coding Articles that contain the word "colonoscopy".Narrowing Your Search by the StateYou can narrow your search to only those documents associated with a particular state by selecting the state where the service took place.Partial State SelectionsBoth California and New York support partial state selections.  The state selections for California include "California - Entire State", "California - Northern" and "California - Southern" and New York include "New York - Entire State", "New York - Downstate", "New York - Queens", "New York - Upstate".When searching documents for California and New York, your results may include documents that are not relevant for your location.  For example, if your location of service was in Southern California, your results may include documents that are associated only with "California - Northern", which may not be relevant.  When viewing Articles and LCDs for California and New York, please review the geographic information for that document and confirm that the document is relevant for your location of service.CMS RegionsWithin the state dropdown list, you can also select to narrow your search by CMS Region.  The CMS Regions are broken out by state as follows:CMS Region 1:CT, MA, ME, NH, RI, VTCMS Region 2:NJ, NY, Puerto Rico (PR), Virgin Islands (VI)CMS Region 3:DC, DE, MD, PA, VA, WVCMS Region 4:AL, FL, GA, KY, MS, NC, SC, TNCMS Region 5:IL, IN, MI, MN, OH, WICMS Region 6:AR, LA, NM, OK, TXCMS Region 7:IA, KS, MO, NECMS Region 8:CO, MT, ND, SD, UT, WYCMS Region 9:AZ, CA, HI, NV, American Samoa (AS), Guam (GU), Northern Mariana Islands (CNMI)CMS Region 10:AK, ID, OR, WA
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Submit Feedback/Ask a Questioncontainer-fluidGet email updatesSign up to get the latest information about your choice of CMS topics in your inbox. Also, you can decide how often you want to get updates.SIGN UPopens in new windowCMS & HHS WEBSITESMedicare.govopens in new windowMedicaid.govopens in new windowInsureKidsNow.govopens in new windowHealthCare.govopens in new windowHHS.govopens in new windowHELPFUL LINKSAcronymsArchiveContactsGlossaryPrivacy policyRSS FEEDSNewsroomBlogPodcastopens in new windowopens in new windowA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.7500 Security Boulevard, Baltimore, MD 21244opens in new windowopens in new windowopens in new windowTOOLSWeb policiesopens in new windowPlain languageopens in new windowNo Fear Actopens in new windowFreedom of Information Actopens in new windowInspector Generalopens in new windowFrequently Asked Questions (FAQs)Many questions can be answered on theHelp & Resources pagein the How To Library or by viewing the FAQs below. Please take a look and if you still have questions or would like to leave feedback,contact us!Are you a provider and have a question about billing or coding?Please contact your Medicare Administrative Contractor (MAC). MACs can be found in theMAC Contacts Report.Do you have questions related to the content of a specific Local Coverage Determination (LCD) or an Article?Please contact the Medicare Administrative Contractor (MAC) who owns the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details). MACs can also be can be found in theMAC Contacts Report.Are you a beneficiary and have questions about your coverage?Please call 1-800-Medicare or visitMedicare.govAre you looking for codes? (e.g., CPT/HCPCS, ICD-10)
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Are you a beneficiary and have questions about your coverage?Please call 1-800-Medicare or visitMedicare.govAre you looking for codes? (e.g., CPT/HCPCS, ICD-10)Local CoverageFor the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using theMCD Searchto find what you're looking for. Enter the code you're looking for in the "Enter keyword, code, or document ID" box.  The list of results will include documents which contain the code you entered.Please Note:For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.National CoverageNCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. As clinical or administrative codes change or system or policy requirements dictate, CR instructions are updated to ensure the systems are applying the most appropriate claims processing instructions applicable to the policy.How do I find out if a specific CPT code is covered in my state?
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How do I find out if a specific CPT code is covered in my state?Enter the CPT/HCPCS code in theMCD Searchand select your state from the drop down. (You may have to accept the AMA License Agreement.) Look for a Billing and Coding Article in the results and open it. (Or, for DME MACs only, look for an LCD.)  Review the article, in particular the Coding Information section.If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details).If you dont find the Article you are looking for,contact your MAC.Did you receive a Medicare coverage denial?Was your Medicare claim denied?  Here are some hints to help you find more information:1) Check out the Beneficiary card on theMCD Searchpage.2) Try using theMCD Searchand enter your information in the "Enter keyword, code, or document ID" box.  Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code.  Try entering any of this type of information provided in your denial letter.3) Contact yourMAC.4) VisitMedicare.govor call 1-800-Medicare.It is Thursday and the weekly MCD data isnt refreshed?Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. If that doesnt work please contacttechnical support.Are you having technical issues with the Medicare Coverage Database (MCD)?Technical issues include things such as a link is broken, a report fails to run, a page is not displaying correctly, a search is taking an unexpectedly long time to complete. If you are having an issue like this please contacttechnical support.Submit Feedback/Ask a QuestionCancelMCD Session Expiration WarningYour MCD session is currently set to expire in 5 minutes due to inactivity. If your session expires, you will lose all items in your basket and any active searches. If you would like to extend your session, you may select theContinueButton.ContinueCancelReset MCD Search Data
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ContinueCancelReset MCD Search DataIf you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues.OKCancelNoticeYou are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and ArticlesContinueCancelNoticeYou are leaving the CMS MCD and are being redirected toContinueCancelPopper is used with permission under the MIT license: https://github.com/popperjs/popper-core/blob/master/LICENSE.md
Article - Billing and Coding: Lab: Immunohistochemistry (IHC) Indications for Breast Pathology (A59292)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.Article TextBased on recommendations from the College of American Pathologists, the American Society of Clinical Oncologists (ASCO), and the National Comprehensive Cancer Network (NCCN), hormone receptor assays, estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu are the only current biomarkers that demonstrate standardized value in breast cancer pathology evaluation. Although other biomarkers, such as Ki-67, PI3K, and gene expression assays, have been studied, no proven standardized value has been established. Therefore, this A/B MAC will allow ER, PR, and Her2 testing by IHC for patients with primary invasive breast cancers and recurrent or metastatic cancers.To report an IHC service for an ER, PR, Her2, submit the following claim information:CPTCodeSpecimenUOS88342First single/multiplex stain188341Each additional2To report morphometric analysis,select oneof the following codes based on the type of morphometric analysis:CPTCodeService TypeUOS88360Manual388361Computer-assisted3Note: a unit of service applies to a single separately identifiable specimen.
Draft Article - Billing and Coding: Immunohistochemistry (IHC) Indications for Breast Pathology (DA59292)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.Article TextBased on recommendations from the College of American Pathologists, the American Society of Clinical Oncologists (ASCO), and the National Comprehensive Cancer Network (NCCN), hormone receptor assays, estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu are the only current biomarkers that demonstrate standardized value in breast cancer pathology evaluation. Although other biomarkers, such as Ki-67, PI3K, and gene expression assays, have been studied, no proven standardized value has been established. Therefore, this A/B MAC will allow ER, PR, and Her2 testing by IHC for patients with primary invasive breast cancers and recurrent or metastatic cancers.To report an IHC service for an ER, PR, Her2, submit the following claim information:CPTCodeSpecimenUOS88342First single/multiplex stain188341Each additional2To report morphometric analysis,select oneof the following codes based on the type of morphometric analysis:CPTCodeService TypeUOS88360Manual388361Computer-assisted3Note: a unit of service applies to a single separately identifiable specimen.
Draft Article - Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains (DA59295)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.2 Independent Laboratory Specimen Drawing, 60.2. Travel AllowanceCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lab: Special Histochemical Stains and Immunohistochemical Stains L35922.To report special histochemical stains and/or immunohistochemical stains services, please submit the following claim information:Select the appropriate CPTcodeEnter 1 unit of service (UOS)