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HCPCS Definitions

Using the HCPCS Code Sets

CMN Certificate of medical necessity (CMN) a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician.
CCI Correct coding initiative (CCI) - The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.
DME Durable medical equipment (DME) - reusable medical equipment such as walkers, wheelchairs, or hospital beds.
DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DMERCS Durable Medical Equipment Regional Carriers (DMERCS) Durable Medical Equipment Regional Carriers. Private company that has a contract with Medicare to pay for DME to regional carriers (Part B)
LCD Local Coverage Determination (LCD) - a determination as to whether the service is reasonable and necessary
MUE Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report for a single beneficiary on a single DOS.
MCM Medically Unnecessary Edits (MUE) - is a unit of service (UOS) edit for a HCPCS/CPT code for the same provider, same beneficiary, and same date of service.
NCD a determination as to whether the service is reasonable and necessary which sites statutory requirements
Overcoding/upcoding Overcoding/upcoding – Assigning a code specifically for the purpose of obtaining a higher level of payment
Undercoding Failure to assign codes to based on the care that was provided
ABN Advance Beneficiary Notice is a notice that a doctor or supplier should give a Medicare beneficiary to sign when the doctor or supplier believes that Medicare will not pay for a particular service.
Carrier private company that has a contract with Medicare to pay your physician and most other Medicare Part B bills (third party administrator)
Created by: 1770799046