Coding and coverage

Free Medicare coding, billing, and coverage tools built from public CMS files, updated automatically every quarter (coverage policies weekly). One set of codes carries from tool to tool.

• Medicare coverage checker

  Enter HCPCS or CPT codes and ICD-10-CM diagnoses. See the NCDs, LCDs, and billing and coding articles that apply in your state, whether each diagnosis is on the covered list, documentation requirements, and frequency limits.

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• NCCI edits, MUEs, and fee schedule

  Check whether codes can be billed together on the same day, the modifier indicator, MUE units per day with the adjudication indicator, and Medicare Physician Fee Schedule payment with RVUs, global days, and GPCIs for your locality.

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• ICD-10-CM code lookup

  Search by code or words. Billable status, Excludes1 and Excludes2, code first and use additional code notes, 7th character values, and the CMS-HCC V28 mapping.

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• Prior authorization letters

  Letters of medical necessity and appeal letters, prefilled from the coverage checker with your codes and the policies that apply.

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• HCC risk score estimator

  Paste ICD-10-CM codes and demographics to estimate a CMS-HCC V28 risk score, with every hierarchy and coefficient shown.

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• NPI lookup

  Search the NPPES registry for a rendering, referring, or ordering provider's NPI, taxonomy, and practice address.

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Sources: CMS Medicare Coverage Database and Coverage API, CMS NCCI PTP and MUE files, Medicare Physician Fee Schedule relative value files, HCPCS Level II quarterly files, and the ICD-10-CM code files from CMS and the CDC. CPT codes are shown by number only. Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.