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CGS Medicare Review

A long-time Medicare administrative contractor for CMS

By Deb Gordon
Updated June 06, 2023
Fact checked by
Michael Logan
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Fact checked by Michael Logan
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CGS

 CGS 
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Our Take

CGS Administrators is an Administrative Contractor for Medicare. It processes and pays claims for Medicare Parts A and B, as well as durable medical equipment and home health and hospice services in different parts of the country. Depending on where you live, CGS may be processing the claims your healthcare providers submit for your care and deciding whether to approve or deny those claims.

  • Pros & Cons
  • Key Takeaways
  • Company Overview
Pros & Cons
Pros

  • Extensive geography and services

  • High level of compliance with Medicare standards

  • No reported customer complaints

Cons

  • Does not offer Medicare insurance plans

Key Takeaways
  • CGS Administrators processes claims for Medicare Parts A and B, home health and hospice, and durable medical equipment.
  • CGS Administrators covers 38 states and U.S. territories.
  • It operates in jurisdictions with at least 94% compliance scores.
Company Overview

CGS Administrators is a subsidiary of Celerian Group. It's a Medicare Administrative Contractor (MAC) for the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare.

CGS Medicare is headquartered in Nashville, Tennessee. It serves 24 million beneficiaries and nearly 150,000 healthcare professionals. CGS processes claims and payments for healthcare providers and suppliers who participate in the Medicare program. It operates as a Part A, Part B, home health and hospice, and durable medical equipment (DME) MAC.

CGS does not provide any direct service to Medicare enrollees.

Geographical Restrictions

CGS operates in 38 states and three territories. Its footprint for some services overlaps. It's the DME MAC in Jurisdiction B, Jurisdiction C, Puerto Rico, and the Virgin Islands. Jurisdiction B includes seven states and Jurisdiction C covers 15 states.

CGS also serves as the home health and hospice MAC in 15 states and the District of Columbia and as a Part A and B service provider in Ohio and Kentucky.

  • Parent Company Celerian Group
  • Customer Service Telephone, online, myCGS portal, and CGS Medicare app
  • Phone Number 866-590-6727
  • Official Website www.cgsmedicare.com
CGS

 CGS 
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Pros Explained

  • Extensive geography and services: CGS operates in 38 states. It holds multiple Medicare Administrative Contracts (MAC).
  • High level of compliance with Medicare standards: CMS’s 2021 evaluation of its administrative contracts in jurisdictions where CGS operates were 94% and 96% in jurisdictions B and C, respectively.  
  • No reported customer complaints: A search of the Consumer Financial Protection Bureau site turns up zero complaints against CGS.

Cons Explained

  • Does not offer Medicare insurance plans: CGS is an administrative contractor that provides claims processing and service on behalf of CMS. But it's not an option for people who are looking for Medicare insurance. It doesn't directly serve consumers. It directs people to contact Medicare with any issues or complaints.

Available Plans

CGS doesn’t offer Medicare insurance plans or services to consumers. It provides support for providers who serve Medicare beneficiaries. CGS processes claims so it decides whether to approve or deny claims according to Medicare rules and guidelines. There are up to five levels of appeal depending on the service.

What You Need to Know

CGS doesn’t sell Medicare insurance. It provides administrative services on behalf of CMS.

Durable Medical Equipment (DME) MAC

CGS processes claims for DME, orthotics, and prosthetics, and it provides service to the suppliers of those products. Suppliers submit claims to the MAC covering the geographic territory where the Medicare beneficiary lives.

Medicare Parts A and B MAC

CGS provides customer service. It processes claims for Medicare Parts A and B covered services. Providers submit Part A and Part B claims to the MAC covering the geography where the provider is physically located. 

Home Health and Hospice MAC

CGS processes home health and hospice claims. Providers submit these claims to the MAC covering the geographical area where the provider is physically located.

Customer Service

Each CGS contract area has its own customer service phone number and online access.

DME MAC Jurisdiction B

  • Customer Service: 866-590-6727, 8 a.m. to 5 p.m. EST, Monday through Friday
  • Interactive voice response (IVR): 877-299-7900 

DME MAC Jurisdiction C

  • Customer Service: 866-270-4909, 8 a.m. to 6 p.m. EST, Monday through Friday
  • IVR: 866-238-9650

Part A Support (Ohio/Kentucky) 

  • Customer Service: 866-590-6703, 8 a.m. to 5 p.m. EST, Monday through Friday
  • IVR: 866-289-6501

Part B Support (Ohio/Kentucky) 

  • Customer Service: 866-276-9558, 8 a.m. to 5 p.m. EST, Monday through Friday
  • IVR: 866-290-4036

Home Health and Hospice 

  • Customer Service: 877-299-4500, 9 a.m. to 5:30 p.m. EST, Monday through Friday
  • IVR: 877-220-6289

Customer Satisfaction 

CMS assesses each MAC based on factors such as customer satisfaction with the MAC website, provider enrollment, financial management, claims processing, appeals, and beneficiary customer service. CMS publishes overall average results by year, but it doesn't publish individual contractor performance.

Important

CGS doesn't directly offer customer service for Medicare enrollees, but it works directly with providers and suppliers who service people on Medicare.

Third-Party Ratings

CMS evaluates MACs on dozens of compliance measures and publishes those results in overall reports by jurisdiction. Average compliance in fiscal year 2021 was 96%. Compliance in the jurisdictions CGS operates in was above 94% or above.

These CMS assessments provide oversight and accountability to the MACs.

Cost

CGS processes claims according to Medicare fee schedules for the relevant services.

Competition: CGS vs. Humana

CGS isn't an option if you’re looking for Medicare coverage. It doesn't offer health plans that you can choose from. You might consider Humana if you're looking for a plan. It's one of the largest Medicare Advantage plans with availability in 84% of U.S. counties.

Humana offers many types of Medicare coverage. It provides Medicare plans in every state. It offers extra benefits on many plans, including dental, vision, and fitness benefits.

  CGS Humana
Number of States Available 38 50
Medicare Services Medicare Parts A and B services, Medicare Administrative Contractor for Durable Medical Equipment in Jurisdictions B and C, and Home Health and Hospice in the Plains States and mid-Atlantic area Medicare Advantage HMO, PPO; Private Fee-for-Service (PFFS) Plans;  Medicare Advantage Prescription Drug Plans; Stand-Alone Medicare Prescription Drug Plans; Medicare Supplement Insurance (Medigap) Plans; Dual-Eligible Special Needs Plans; Chronic Condition Special Needs Plans; Limited Income Newly Eligible Transition Plans
Customer Service Options Telephone, online, myCGS portal, and CGS Medicare app Telephone, online, in-person, chat (for members)
AM Best Rating N/A A- (Excellent)

Final Verdict

CGS is an administrative contractor for CMS. Consumers may never even know that CGS is processing their claims. Those seeking Medicare coverage should review Medicare health plans in their area because CGS isn't an insurance provider.

See our picks for the best Medicare Advantage plans in 2023.

Methodology

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

Article Sources
Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy.

  1. CGS Administrators. “About.”

  2. U.S. Centers for Medicare and Medicaid Services. “MAC Performance Compliance.”

  3. CGS Administrators. “Medicare Home.”

  4. Kaiser Family Foundation. “Medicare Advantage 2021 Spotlight: First Look.”