CMS Data Disclaimer

Adjuvex incorporates publicly available data published by the Centers for Medicare & Medicaid Services (CMS) to support claims processing, denial management, and revenue cycle analytics. This data includes, but is not limited to:

• Medicare Physician Fee Schedule (MPFS): Relative value units (RVUs), conversion factors, and geographic practice cost indices (GPCIs) published annually by CMS.
• National Coverage Determinations (NCDs): CMS coverage policies applicable to all Medicare contractors.
• Local Coverage Determinations (LCDs): Coverage policies issued by Medicare Administrative Contractors (MACs) for their respective jurisdictions.
• CARC/RARC Codes: Claim Adjustment Reason Codes and Remittance Advice Remark Codes maintained by the Washington Publishing Company (WPC) under contract with CMS.
• ICD-10-CM/PCS Codes: Diagnosis and procedure codes maintained by CMS and the National Center for Health Statistics (NCHS).
• HCPCS Level II Codes: The Healthcare Common Procedure Coding System code set maintained by CMS.
• MA RADV Audit Guidelines: Risk Adjustment Data Validation audit procedures published by CMS for Medicare Advantage organizations.

CMS updates its published data on various schedules, including quarterly (HCPCS), annually (MPFS, ICD-10), and as needed (NCDs, LCDs). Adjuvex makes commercially reasonable efforts to maintain current data within the platform; however:

• There may be a lag between CMS publication and incorporation into the Adjuvex platform.
• CMS may issue corrections, transmittals, or interim final rules that supersede previously published data.
• Reimbursement calculations derived from CMS fee schedule data are estimates only and may differ from actual payer adjudications.

Users should always verify reimbursement calculations, coverage determinations, and coding guidance against the official CMS website at cms.gov before making billing or coding decisions.

Adjuvex, Inc. is a private company. This product is not manufactured, endorsed, distributed, or supported by the Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services, or any other government agency. References to CMS, Medicare, Medicaid, and related programs are for descriptive purposes only.

For customers using Adjuvex for Medicare Advantage Risk Adjustment Data Validation (RADV) audit support:

• RADV audit findings generated by Adjuvex are preliminary and require review by qualified clinical and coding staff before submission to CMS or your delegated entity.
• Adjuvex does not constitute legal or regulatory advice regarding RADV audit obligations, extrapolation methodology, or repayment calculations.
• MA organizations are solely responsible for their compliance with 42 C.F.R. § 422.310 and CMS RADV audit procedures.
• Risk adjustment factor (RAF) calculations are based on CMS-HCC model data and are estimates only. Official RAF values are determined by CMS during the annual reconciliation process.

Adjuvex supports HL7 FHIR R4 compliant data exchange in accordance with the CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and the ONC 21st Century Cures Act Final Rule. Customers using FHIR integrations acknowledge:

• FHIR data ingested by Adjuvex may contain PHI subject to HIPAA protections as outlined in our Business Associate Agreement.
• Adjuvex processes FHIR data only for the purposes authorized under the customer's subscription agreement and BAA.
• Compliance with applicable information blocking provisions under 45 C.F.R. Part 171 is the responsibility of the Covered Entity or API developer, not Adjuvex.

CMS data incorporated into the Adjuvex platform is provided "as is" and "as available." Adjuvex disclaims all warranties, express or implied, regarding the accuracy, completeness, timeliness, or fitness for a particular purpose of CMS-derived data. In no event shall Adjuvex be liable for any damages arising from reliance on CMS data accessed through the platform, including but not limited to claim underpayments, overpayments, audit findings, or regulatory enforcement actions.

For authoritative, up-to-date information, please refer to the following official sources:

• CMS Physician Fee Schedule
• CMS Medicare Coverage Database (NCDs and LCDs)
• CMS RADV Audit Information
• CMS ICD-10-CM/PCS Code Sets
• CMS HCPCS Code Set

If you have questions about how Adjuvex uses CMS data or need clarification on any aspect of this disclaimer, please contact:

• Email: compliance@adjuvex.com
• Adjuvex, Inc. · 100 Innovation Drive · Suite 200 · Wilmington, DE 19801