Medical Coding Resources

CMS Coding Resources

Access official CMS coding and billing resources, including ICD-10, HCPCS, NCCI, Medicare coding policies, and related updates.

Link: CMS Coding & Billing Resources

ICD-10-CM Guidelines

Review official ICD-10-CM coding guidelines, code files, updates, and reporting requirements for diagnosis coding. CMS currently provides FY 2026 ICD-10-CM files and official coding guidelines through its ICD-10 resource center. (Centers for Medicare & Medicaid Services)

Link: CMS ICD-10 Resources

CPT® Coding Resources – American Medical Association

Access CPT coding resources directly from the American Medical Association, which develops and maintains the CPT code set. Resources include coding updates, E/M guidance, CPT Assistant information, and other official CPT educational materials. (American Medical Association)

Link: AMA CPT Coding Resources

HCPCS Coding Resources – CMS

Review HCPCS Level II coding information for supplies, medications, DME, services, and procedures. CMS publishes quarterly HCPCS updates and searchable code files. (Centers for Medicare & Medicaid Services)

Link: CMS HCPCS Resources

National Correct Coding Initiative (NCCI)

Access CMS NCCI policies and edits designed to promote correct coding and prevent improper Medicare payments. Resources include Procedure-to-Procedure edits, Medically Unlikely Edits, manuals, and related coding guidance. (Centers for Medicare & Medicaid Services)

Link: CMS NCCI Resources

Modifier Guidance

Review CMS coding and billing resources when determining appropriate modifier use, including circumstances involving distinct services, repeat procedures, professional and technical components, and other claim-reporting situations.

Link: CMS Medicare Coding & Billing

Documentation & Medical Necessity Resources

Use CMS coverage policies and Medicare coverage resources to evaluate documentation requirements, medical necessity, covered indications, and billing requirements.

Link: Medicare Coverage Database

Medicare & CMS Resources

Medicare Learning Network®

The Medicare Learning Network provides education for healthcare professionals, coders, billers, suppliers, and organizations regarding Medicare policies, billing requirements, compliance, and program updates. (Centers for Medicare & Medicaid Services)

Link: Medicare Learning Network

MLN Connects®

Stay informed about Medicare Fee-for-Service news, claim updates, coding information, policy changes, educational resources, and CMS announcements through the weekly MLN Connects newsletter. (Centers for Medicare & Medicaid Services)

Link: MLN Connects Newsletter

Medicare Physician Fee Schedule

Review Medicare physician payment information, RVUs, payment policies, and fee schedule data for professional services.

Link: Medicare Physician Fee Schedule

Medicare Coverage Database

Search Medicare National Coverage Determinations, Local Coverage Determinations, coverage articles, and related policy information.

Link: Medicare Coverage Database

National Coverage Determinations

Review national Medicare coverage requirements that apply across Medicare jurisdictions.

Link: CMS National Coverage Determinations

Medicare Administrative Contractors

Find the Medicare Administrative Contractor responsible for processing Medicare claims and issuing local billing and coverage guidance for your jurisdiction.

Link: CMS Medicare Administrative Contractors

Coverage & Medical Necessity Resources

Local Coverage Determinations

Review Medicare contractor-specific LCDs that describe when particular services are considered reasonable and medically necessary.

Link: Search Medicare Coverage Policies

National Coverage Determinations

Review nationwide Medicare coverage requirements and conditions for specific services, procedures, devices, and treatments.

Link: Medicare NCD Search

Medicare Coverage Articles

Access Medicare billing and coding articles that may include documentation requirements, diagnosis-code guidance, utilization parameters, and claim-reporting instructions.

Link: Medicare Coverage Database

Medical Necessity & Documentation

Use CMS coverage policies and payer guidance to help determine whether documentation supports billed services and applicable medical-necessity requirements.

Link: CMS Medicare Coverage Resources

Compliance & Regulatory Resources

HHS Office of Inspector General

Access federal healthcare compliance resources addressing fraud, waste, abuse, billing compliance, enforcement, exclusions, and healthcare program integrity.

Link: HHS OIG Compliance Resources

OIG General Compliance Program Guidance

Review the OIG's general framework for healthcare compliance programs, including risk assessment, education, auditing, monitoring, reporting, and corrective action.

Link: OIG General Compliance Program Guidance

OIG Industry Compliance Guidance

Access compliance resources applicable to physicians, hospitals, billing companies, and other healthcare organizations.

Link: OIG Compliance Guidance Library

HIPAA for Healthcare Professionals

Review HHS guidance regarding HIPAA privacy, security, electronic transactions, and protection of individually identifiable health information. (HHS.gov)

Link: HHS HIPAA for Professionals

OIG Exclusion Search

Healthcare organizations may use the OIG exclusion database to determine whether individuals or entities are excluded from participation in federal healthcare programs.

Link: OIG Exclusions Search

Credentialing & Provider Enrollment Resources

PECOS – Medicare Provider Enrollment

PECOS allows physicians, practitioners, providers, and suppliers to electronically enroll in Medicare, update enrollment information, manage reassignment information, and complete certain revalidation activities. (Pecos)

Link: PECOS Medicare Enrollment

NPPES – National Provider Identifier

Use the National Plan and Provider Enumeration System to apply for or update a National Provider Identifier.

Link: NPPES

NPI Registry

Search publicly available National Provider Identifier information for healthcare providers and organizations.

Link: NPI Registry

CAQH Provider Data Portal

Healthcare professionals may use the CAQH Provider Data Portal to maintain credentialing and demographic information used by participating health plans and healthcare organizations.

Link: CAQH Provider Data Portal

Medicare Provider Enrollment Resources

Access CMS enrollment resources, checklists, revalidation information, and guidance for physicians, non-physician practitioners, and other providers.

Link: CMS Provider Enrollment Resources

Revenue Cycle & Reimbursement Resources

Claims & Billing Guidance

Review CMS requirements related to Medicare claims submission, coding, billing policies, claim processing, and reimbursement.

Link: CMS Medicare Claims & Billing

Denial Prevention & Compliance

Use Medicare education and compliance resources to identify common billing errors, improve documentation, and reduce avoidable claim denials.

Link: Medicare Learning Network Compliance Resources

Correct Coding & Claim Edits

Review NCCI edits and coding policies before submitting claims to identify potentially inappropriate code combinations or unit reporting.

Link: CMS NCCI Edits

Medicare Reimbursement Resources

Access CMS payment systems, fee schedules, reimbursement policy information, and program-specific payment guidance.

Link: CMS Medicare Payment Resources

Medicare Appeals

Review information regarding Medicare claim appeals and the levels of the Medicare Fee-for-Service appeals process.

Link: CMS Medicare Appeals

Need Help Applying the Guidance?

Healthcare coding, billing, reimbursement, credentialing, and compliance requirements can vary based on specialty, payer, documentation, contracts, and the services provided.

Prolific Medical Billing Services LLC can help your organization interpret requirements, identify revenue cycle opportunities, strengthen coding and billing processes, and address operational challenges specific to your practice.

Resource Disclaimer: External resources are provided for informational convenience. Prolific Medical Billing Services LLC does not control third-party websites and does not guarantee that external content is complete or current. Healthcare professionals and organizations should verify applicable coding, payer, regulatory, and reimbursement requirements before making billing or compliance decisions.