medical billing and coding cover letter samples

Medical Coding Specialist Cover Letter Example

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Begin your Medical Coding Specialist cover letter with a professional greeting tailored to the hiring manager or the healthcare institution. Open with a strong introductory sentence that captures your enthusiasm for the role and briefly highlights your relevant qualifications. For example: "Dear [Hiring Manager's Name], As a dedicated Medical Coding Specialist with [number] years of experience in [specific types of coding, e.g., ICD-10, CPT], I am excited to apply for the position at [Healthcare Institution's Name]. My commitment to ensuring accurate and compliant medical coding has consistently contributed to the optimization of billing processes and the enhancement of revenue cycle management." This approach immediately informs the employer of your experience and shows that you have taken the time to personalize your application, which demonstrates genuine interest in the position.

The best way to end a cover letter for Medical Coding Specialists is with a professional closing that reiterates interest in the position and invites further discussion. For example: "Thank you for considering my application. I am enthusiastic about the opportunity to bring my expertise in ICD-10, CPT, and HCPCS coding to [Organization Name]. I am confident that my attention to detail and dedication to accuracy would make a valuable contribution to your team. I look forward to the possibility of discussing this exciting opportunity with you. Please feel free to contact me at your earliest convenience to arrange an interview. Warm regards, [Your Name]" This conclusion is effective because it reaffirms your suitability for the role, demonstrates eagerness to move forward in the hiring process, and maintains a tone of professionalism that is essential in the healthcare industry.

Medical Coding Specialists should craft a cover letter that highlights their expertise in medical coding, understanding of healthcare regulations, attention to detail, and any relevant certifications. Here's what they should include in their cover letter: 1. **Introduction**: Start with a strong opening that captures the employer's attention. Mention the position you're applying for and how you learned about it. 2. **Professional Background**: Summarize your professional history, focusing on your experience in medical coding. Highlight your knowledge of coding systems such as ICD-10, CPT, HCPCS, and any other relevant coding practices you are proficient in. 3. **Certifications and Education**: Mention any certifications you hold, such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or any other relevant credentials. Briefly note your educational background, especially if you have completed a specialized program in medical coding or health information management. 4. **Technical Skills**: Emphasize your familiarity with medical coding software, electronic health records (EHR), and any other technical tools you are proficient in. Employers value candidates who can seamlessly integrate into their systems. 5. **Attention to Detail**: Medical coding requires a high level of accuracy. Provide examples of how your attention to detail has positively impacted your previous roles, such as reducing coding errors or improving billing processes. 6. **Understanding of Compliance**: Demonstrate your knowledge of healthcare regulations, including HIPAA, and how you ensure compliance in your coding practices. Mention any experience you have with audits or quality control measures. 7. **Soft Skills**: Include key soft skills such as communication, problem-solving, and the ability to work under pressure. If you have experience working in a team or training other coders, mention this to show leadership and collaboration skills. 8. **Achievements**: Share any notable achievements or contributions you've made in your career, such as streamlining coding processes, contributing to revenue cycle improvements, or recognition you've received for your work. 9

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5 medical billing manager cover letters.

Approved by real hiring managers, these Medical Billing Manager cover letters have been proven to get people hired in 2024. A hiring manager explains why.

Table of contents

• Medical Billing Manager
• Senior Medical Billing Specialist
• Medical Billing Specialist
• Alternative introductions for your cover letter
• Medical Billing Manager resume examples

Medical Billing Manager Cover Letter Example

Why this cover letter works in 2024, highlighting achievements with numbers.

This sentence effectively quantifies the candidate's accomplishments in their previous role, showing their ability to manage tasks efficiently and accurately. This helps to demonstrate their expertise and potential value to the company.

Process Improvement and Innovation

By mentioning the implementation of a new billing software and its impact on productivity, the candidate shows their ability to drive improvements and adapt to new technologies, which is a desirable quality for any employer.

Emphasizing Relationship Building

This sentence highlights the candidate's success in building relationships with insurance providers, which is an important aspect of the medical billing process. This demonstrates that they understand the importance of collaboration and can contribute to the company's reputation for excellent customer service.

Personal Connection to Company Mission

Here's what I love: you're showing that you're not only familiar with UnitedHealth Group's mission, but you connect with it on a personal level because of your firsthand experience. This connection tells me you're likely to be more invested in your work and the company's success. Good stuff!

Quantifying Achievements

Wow, you've nailed it here! You're not just saying you improved the billing process, you're putting a number to that improvement. This shows that you understand the importance of measuring your achievements and it gives me a clear picture of the impact you had. Keep it up!

Transferrable Skills

You've nailed it! You've clearly listed the skills you've honed and how they align with the job requirements. This shows that you've understood the role and are ready to hit the ground running. This is exactly what we want in a candidate!

Aligned Career Goals

It's clear you've done your homework on UnitedHealth Group's culture and values, and you're showing us that they align with your own career aspirations. This indicates that you're a good cultural fit, which is a big tick in my book. Well done!

Showcase Project Impact

Highlighting a specific project where you made a substantial difference, like reducing billing errors, is a great move. This not only shows that you have hands-on experience, but also that you are capable of making meaningful improvements in your role.

Tech Savvy Demonstrated

By mentioning the integration of an AI-driven coding system, you're showing two things at once: your ability to lead a team effectively and your comfort with using technology to streamline processes. Both are highly valued in today's job market.

Align with Company Vision

What I really appreciate here is the way you've connected with UnitedHealth Group's use of data analytics. It shows that you've taken the time to understand the company's ethos and that you're as passionate about innovation as they are.

Express Eagerness and Skills

Straight up expressing your eagerness to bring your expertise to the company is a good move. You're not just saying you want the job, but also clearly outlining what you bring to the table in terms of skills and attitude.

Keep it Warm and Professional

The choice of "Warmest regards" for ending the letter strikes the perfect balance between friendly and professional. It leaves the reader with a positive impression of your communication style.

Senior Medical Billing Specialist Cover Letter Example

Aligning with company vision.

Right off the bat, you demonstrate that you're not just looking for any job - you're looking for this job at CVS Health because you resonate with our vision. This tells me you're likely to be a passionate and dedicated team member. Top marks for that!

Highlighting Tangible Results

You've done an excellent job here by showing specific, measurable outcomes you achieved in your previous role. This is a great way to highlight your capabilities and the potential value you could bring to us. Keep showing us the numbers!

Relevant Achievements

And here, you're not just listing your achievements, but you're tying them directly to the skills required for this role. This kind of relevance makes it easy for me to see your fit for the position. Great job!

Enthusiasm for Company Values

In this part, you're demonstrating that you understand and share our commitment to patient care. This kind of enthusiasm can be contagious in a team, and it shows me you're likely to be a motivated employee. Good on you!

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Medical Billing Specialist Cover Letter Example

Highlight system improvements.

The mention of overhauling the billing system and the impacts it had on accuracy and patient satisfaction gives a clear picture of your capabilities. It shows you're not just a doer, but a strategic thinker who can lead significant changes.

Spotlight on Efficiency

By indicating your knack for identifying inefficiencies, you position yourself as a problem-solver who can deliver practical solutions. It shows you are proactive and result-oriented, qualities highly valued in any professional environment.

Compliment the Company

Here, you're not just saying you like the company. You're specifically praising their use of technology in improving the billing process which aligns perfectly with your own experiences and aspirations. It shows you and CVS Health are a good fit for each other.

Offer Specific Skills

By stating that you bring a detailed understanding of medical billing processes, you're giving them a clear view of what you can contribute. It also shows that you're excited about the opportunity, which can make you more memorable.

End on a Positive Note

Your sign-off "Best regards" comes across as both friendly and professional. It’s a small detail, but it can leave a lasting positive impression.

Alternative Introductions

If you're struggling to start your cover letter, here are 6 different variations that have worked for others, along with why they worked. Use them as inspiration for your introductory paragraph.

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Thank you for the checklist! I realized I was making so many mistakes on my resume that I've now fixed. I'm much more confident in my resume now.

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Billing and Coding: Dental Services

Document note, note history, contractor information, article information, general information.

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(12) Dental Services Exclusion

Title XVIII of the Social Security Act, §1833(e) 

Title XVIII of the Social Security Act, §1862(a)(1)(A)

Title XVIII of the Social Security Act, §1862(a)(7)

CODE OF FEDERAL REGULATIONS- 42 CFR 411.15(a) and (i)

CODE OF FEDERAL REGULATIONS- 42 CFR 440.100

CODE OF FEDERAL REGULATIONS- 42 CFR 410.26

CMS Internet-Only Manual, Pub 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, §10.3 Certification for Hospital Admissions for Dental Services

CMS Internet-Only Manual, Pub 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, §70 Physician Defined and §70.2 Dentists

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 1, §30 Drugs and Biologicals and §70 Inpatient Services in Connection With Dental Services

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §120C Dentures and §150 Dental Services

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §60 - Services and Supplies Furnished Incident To a Physician’s/NPP’s Professional Service

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 16, §140 Dental Services Exclusion

CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, §260.6 Dental Examination Prior to Kidney Transplantation

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 3, §3.6.2.2

Article Guidance

Purpose:  The information in this article contains billing, coding or other guidelines that support the implementation of the CY 2023 Medicare Physician Fee Schedule Final Rule on Dental Services.

Title XVIII of the Social Security Act, §1862(a)(12) states no payment may be made for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made for inpatient hospital services because of underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR Part 411.15(i) states no payment may be made for dental services in connection with care, treatment filling, removal, or replacement of teeth, or structures directly supporting teeth, except for inpatient services in connection with dental procedures when hospitalization is required because of an underlying medical condition and clinical status or the severity of the dental procedures.

In addition, dental services that are inextricably linked to, and substantially related and integral to the clinical success of, a certain covered medical service are not excluded; payment may be made under Medicare Parts A and B for such services furnished in the inpatient or outpatient setting. Such services include, but are not limited to:

• Dental or oral examination performed as part of a comprehensive workup in either the inpatient or outpatient setting prior to Medicare-covered organ transplant, cardiac valve replacement, or valvuloplasty procedures; and medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, the organ transplant, cardiac valve replacement, or valvuloplasty procedure.
• The reconstruction of a dental ridge performed because of and at the same time as the surgical removal of a tumor.
• The stabilization or immobilization of teeth in connection with the reduction of a jaw fracture, and dental splints only when used in conjunction with covered treatment of a covered medical condition such as dislocated jaw joints.
• The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.

Ancillary services and supplies furnished incident to covered dental services are not excluded, and Medicare payment may be made under Part A or Part B, as applicable, whether the service is performed in the inpatient or outpatient setting, including, but not limited to the administration of anesthesia, diagnostic x-rays, use of operating room, and other related procedures.

Medicare payment may be made for services furnished incident to the professional medical or “inextricably linked” dental services by auxiliary personnel, such as a dental hygienist, dental therapist, or registered nurse who is under the direct supervision of the furnishing dentist or other physician or practitioner, if they meet the requirements for “incident to” services as described in § 410.26 of our regulations.

Definitions

Ancillary Services: For the purposes of payment under this Billing and Coding article, “ancillary services” are services that include, but are not limited to, x-rays, administration of anesthesia, and the use of the operating room, and other related procedures.

Dental Services: For the purposes of payment under this Billing and Coding article, “dental services” refer to dental and oral examinations and medically necessary diagnostic and treatment services, such as, but not limited to, the elimination of an oral or dental infection.

Dentist: For the purposes of payment under this Billing and Coding article, a “dentist” refers to a Doctor of Dental Medicine or Dental Surgery, who is legally authorized to practice dentistry in the state or territory within which they perform such function, and who is acting within the scope of their license.

Inextricable Linkage: For the purposes of payment under this Billing and Coding article, for a dental service to be considered “inextricably linked” to a covered primary medical procedure/service, evidence-based literature and/or clinical standard of care must be demonstrated such that the provision of these dental services PRIOR TO a primary covered medical procedure/service if not performed would result in a material difference in terms of clinical outcomes and success of the medical procedure/service.

Article Guidance: Claim Submission

Medicare payment for dental services is generally precluded by statute. Please refer to Title XVIII of the Social Security Act, §1862(a)(12) for non-covered services that are part of the dental exclusion. However, Medicare has paid for dental services in a limited number of circumstances, when that service is an integral part of a specific treatment of a beneficiary’s primary medical condition.

For dates of service January 1, 2023, and after, Medicare may pay for additional dental services that are “inextricably linked” to, and substantially related and integral to the clinical success of an otherwise covered medical service, such as dental exams and necessary treatments to eradicate dental infection prior to, or contemporaneously with, organ and hematopoietic stem cell transplants, cardiac valve replacements, and valvuloplasty procedures. If it is not clinically appropriate to eradicate an infection within one visit prior to the planned medical service, Medicare can make payment over multiple visits.

To be eligible to bill and receive direct payment for professional services under Medicare Part B, the medical professional and dentist would need to be enrolled in Medicare and meet all other requirements for billing under the Physician Fee Schedule. To learn how to enroll as a Medicare provider, visit the provider enrollment page for Part A or Part B.

Until such time that Noridian can accept the ADA Dental Claim form or the 837D electronically, please submit professional claims electronically on the X12 Health Care Claim: Professional (837P).

For efficient claims processing, the following information should be submitted:

• The name and NPI number of the medical physician treating the covered medical condition/planned procedure.
• The medical condition or surgical procedure linked to the dental services provided, and the estimated date of the planned procedure, if applicable.
• ICD-10 Diagnosis code(s) in the primary and secondary positions related to the dental service(s) provided.
• ICD-10 Diagnosis code(s) in the secondary positions related to the planned medical condition or surgical procedure that is considered “inextricably linked.”
• ICD-10 Diagnosis code Z01.818 should be included to notify us when the patient needs the dental service to eradicate dental infection prior to, or contemporaneously with, a covered cardiac valve surgical procedure.
• ICD-10 Diagnosis code Z76.82 should be included when the patient needs dental services to eradicate dental infection prior to, or contemporaneously with, organ or hematopoietic stem cell transplants.

When selecting the procedure or service that accurately identifies the service performed, dentists should use the most accurate code. If the CDT code more accurately identifies the service, this should be used rather than the CPT codes. In instances where there are overlapping CDT codes to describe durable medical equipment and supplies, we will make payment from the Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) fee schedule. If the item or supply is not on the list of codes payable by the Part B MAC, it would need to be billed to the DME MAC. To learn more about these DMEPOS coding policies please visit our website for Part A or Part B .

If a dentist wants to submit a claim to produce a denial so that Medicaid or another third-party payer can make primary payment, the dentist may submit a claim with the appropriate HCPCS modifier so that Medicare does not pay the claim. To learn more about the specific modifiers, visit our website for Part A or Part B .

Article Guidance: Documentation

Medicare payment may be made when a dentist provided dental services that are considered “inextricably linked” to and substantially related, and integral to the clinical success of an otherwise covered primary procedure or service provided by another physician or non-physician practitioner, treating the primary medical illness. If there is no exchange of information or integration between the medical professional regarding the primary medical service, and the dentist regarding the dental services, then there would not be an inextricable link between the dental and covered medical services within the CMS regulation 42 CFR Part 411.15(i)(3).

Without the integration between the medical and dental professionals, the dental services would not be covered under the Medicare Part B benefit as stated in Title XVIII of the Social Security Act, §1862(a)(12) since they would be in connection with care, treatment, filling, removal or replacement of teeth or structures directly supporting the teeth. Integration between the medical and dental professionals can occur when these professionals coordinate care. This level of coordination includes, but is not limited to, a referral or exchange of information between the medical professional and the dentist. The medical record should retain documentation that this integration has occurred. Examples of integration or coordination include, but are not limited to, a notation in the medical record that a conversation between the medical professional and dentist has occurred detailing the need for dental services prior to the planned medical procedure, a copy of a written consultation between the two providers, or a copy of written correspondence between the two providers.

While submission of a claim containing dental services is considered a certification by the provider of compliance with applicable payment policies and could be subject to normal post-pay review in accordance with Medicare policies, there may be instances when Noridian will request documentation from the dentists to demonstrate that dental services rendered were “inextricably linked” to a covered medical service before payment is made. That documentation might include:

• Dental records should be legible and signed with the appropriate name and title of the provider of the service:

Evaluations

Complete, periodic, or limited dental exam Consultation and coordination between the dentist and another medical professional treating the primary medical illness Evaluations at other locations than the service billed

Type of anesthesia Unusual events occurring during the anesthetic monitoring period Total time under anesthesia Medications provided to the patient including the dosage and time of administration Pain management prescribed post procedure

Radiographs

Type of x-ray or other imaging Results of x-ray or other imaging

Testing or diagnostic service

Documentation of tooth (teeth) treated

Use standard identification of teeth approved by the ADA and CMS – alpha designation for primary teeth, numeric for permanent teeth Tooth surface treated if appropriate Missing teeth documented in permanent record

Type of treatment

Treatment of caries Endodontic procedures Prosthetic services Preventive services Treatment of lesions and dental disease

2. Literature to support that the provision of certain dental services to treat a dental infection leads to improved healing, improved quality of surgery, or the reduced likelihood of readmission and/or surgical revisions. Examples of literature could include relevant peer-reviewed medical and/or dental literature and research studies, or evidence of clinical guidelines or generally accepted standards of care.

3. Clinical Evidence to support that certain dental services would result in significant improvements in clinical, quality and safety outcomes related to the covered medical condition/procedure.

If a dentist believes that Medicare will deny some or all the services or items because of medical necessity or an “inextricable link” may not be present, an Advance Beneficiary Notice of Noncoverage (ABN) should be issued in writing to the Medicare beneficiary. The ABN is optional when Medicare never covers a service, for example a benefit category denial, but should be used if Medicare does cover the service for some diagnoses, but the dentist believes it will not be covered for a particular situation. To learn more about the ABN process, visit our website for Part A or Part B .

This billing and coding article is not to be construed nor imply coverage of dental screening services, dental prophylaxis, treatment of simple dental caries, routine tooth extractions, dental prosthetics/splints/dentures/oral appliances, nor definitive reconstruction or restoration of dental structures because of the removal of identified infection and/or the source.

The expansion of potentially payable dental services does NOT apply to dental services performed AFTER the respective “inextricably linked” medical procedure/service. When an excluded service is the primary procedure involved, it is not covered regardless of its complexity or difficulty. The hospitalization or non-hospitalization of a patient has no direct bearing on the coverage or exclusion of a given dental procedure. Should the dental services provided fail to demonstrate inextricable linkage and thus fall under the Medicare Dental Exclusion, the claim may be denied as a benefit category denial subject to beneficiary liability.

Response To Comments

Coding information, bill type codes, revenue codes, cpt/hcpcs codes, cpt/hcpcs modifiers, icd-10-cm codes that support medical necessity, icd-10-cm codes that do not support medical necessity, icd-10-pcs codes, additional icd-10 information.

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Other Coding Information

Coding table information, revision history information, associated documents.

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LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)

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Page Help for Article - Billing and Coding: Dental Services (A59447)

Introduction.

This page displays your requested Article. The document is broken into multiple sections. You can use the Contents side panel to help navigate the various sections. Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).

Finding a specific code

Some articles contain a large number of codes. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Sometimes, a large group can make scrolling thru a document unwieldy. You can collapse such groups by clicking on the group header to make navigation easier. However, please note that once a group is collapsed, the browser Find function will not find codes in that group.

More information

• Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered.
• Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period.
• Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. The Medicare program provides limited benefits for outpatient prescription drugs. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug.
• Draft articles are articles written in support of a Proposed LCD. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD.

Articles are often related to an LCD, and the relationship can be seen in the “Associated Documents” section of the Article or the LCD. Article document IDs begin with the letter “A” (e.g., A12345). Draft articles have document IDs that begin with “DA” (e.g., DA12345).

Printing a Document to PDF

Frequently Asked Questions (FAQs)

Are you a provider and have a question about billing or coding.

Please contact your Medicare Administrative Contractor (MAC). MACs can be found in the MAC Contacts Report .

Do you have questions related to the content of a specific Local Coverage Determination (LCD) or an Article?

Are you a beneficiary and have questions about your coverage, are you looking for codes (e.g., cpt/hcpcs, icd-10), local coverage.

For the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using the MCD Search to 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 Coverage

NCDs 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?

Enter the CPT/HCPCS code in the MCD Search and 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 the Contractor Information section (expand the section to see the details).

If you don’t 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 the MCD Search page.

2) Try using the MCD Search and 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 your MAC .

4) Visit Medicare.gov or call 1-800-Medicare.

It is Thursday and the weekly MCD data isn’t refreshed?

Are you having technical issues with the medicare coverage database (mcd), mcd session expiration warning.

Your 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 the Continue Button.

Reset MCD Search Data

If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues.