A system edit has been in place for many years enforcing intravitreal injection frequencies based on the relevant Food and Drug Administration (FDA) labels, with a generous buffer to allow for scheduling conflicts. J2781 was included in a recent update to the edit, but after reconsideration, CMS is removing this J code from the edit and allowing MACs to reprocess the claims.
There is no action required from providers.
New:
This article is for laboratories, and other providers billing MACs for laboratory services they provide to Medicare patients.
This article is for physicians, skilled nursing facilities, and other providers billing MACs for services they provide to Medicare patients.
View the most recent updates for our LCDs and articles.
News
Medicare Shared Savings Program: Application Deadlines for January 1, 2026, Start Date
Claims, Pricers & Codes
ICD-10 Coordination & Maintenance Committee: Submit Procedure Code Comments by April 18
From Our Federal Partners
CHAMPVA Claims: Enroll in Direct Deposit to Avoid a Payment Pause
Our Event calendar has been updated and new events are open for registration.
Save the date for the first National Part A/B MAC Ambulance supplier coalition meeting on Thursday May 22 at 2:00 p.m. ET – 4:00 p.m. ET.
Due to Identity Management (IDM) system maintenance, you may not be able to access Novitasphere beginning at 8 p.m. ET on Saturday, March 15 through 4 a.m. ET on Sunday, March 16. We apologize for the inconvenience.
New 2025 Local contractor pricing full downloads are now available. The 2024 local contractor pricing downloads are also updated to reflect final pricing for 2024. Looking for pricing information on a single code, please use our interactive fee schedule lookup tool.
News
Therapy Services: Get Updates for CY 2025
Hospitals: Apply for Additional Residency Positions by March 31
Compliance
Oral Anticancer & Antiemetic Drugs: Prevent Claim Denials
Claims, Pricers & Codes
Updated ICD-10 Medicare Severity Diagnosis-Related Group Version 42.1
Inpatient Psychiatric Facilities Prospective Payment System: April 2025 Coding Updates
MLN Matters® Articles
Roster Billing for Hepatitis B: July 2025 Release
Due to scheduled maintenance, the EDI Gateway and Novitasphere Claim Submission/ERA feature will not be available on Saturday, March 8 from 11:00 a.m. – 3:00 p.m. ET. During this time, you will not be able to send or retrieve electronic files. We apologize for any inconvenience.
Effective April 7, the 2025 Medicare Physician Fee Schedule (MPFS) will reflect updated pricing for codes 0446T, 0448T, and 61715 (26 modifier).
Attend our Medicare Navigator webinars and earn badges for your participation! This program provides a series of webinars focused on assisting providers navigate to, identify and utilize essential resources to complete and submit a variety of Medicare transactions, such as claims and enrollment applications.
Update: On February 25, the White House issued an Executive Order to empower patients with clear, accurate, and actionable healthcare pricing information. Read the fact sheet for more information, which indicates the Departments of the Treasury, Labor, and Health and Human Services will:
Ensure hospitals and insurers disclose actual prices, not estimates, and take action to make prices comparable across hospitals and insurers, including prescription drug prices
Update their enforcement policies to ensure hospitals and insurers are in compliance with requirements to make prices transparent
Existing CMS guidance: Hospital Price Transparency regulations require each hospital operating in the U.S. to provide 1) a comprehensive machine-readable file with the standard charges for all items and services the hospital provides and 2) a display of shoppable services in a consumer-friendly format.
Additional resources available:
Hospital Price Transparency Tools: CMS offers a suite of tools to aid hospitals in implementing hospital price transparency. These tools are designed to help facilitate compliance with regulations and enhance the accessibility of pricing information. The Online Validator ensures machine-readable files meet CMS template layouts and data specifications, enabling hospitals to identify and fix errors before publication. The HPT TXT Generator helps hospitals create the required cms-hpt.txt file, which contains information about the hospital and a direct link to the machine-readable file.
Data Dictionary GitHub Repository: Here hospitals can access the CMS templates and data dictionary with technical instructions for encoding required standard charge information and get technical support.
Compliance: CMS is planning a more systematic monitoring and enforcement approach, per the Executive Order. Consistent with standing CMS policies, non-compliance will be addressed with swift enforcement. See a list of enforcement actions to date and see a list, updated quarterly, of enforcement activities and their outcomes undertaken by CMS since the January 1, 2021, effective date.
All providers are strongly encouraged to use Novitasphere to obtain patient eligibility information.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few new topics include Ambulatory Surgical Centers (ASCs), Intensive Outpatient Program (IOP), and Opioid Use Disorder (OUD).
You ask, we deliver! Our StayConnected and Medicare Navigator education programs represent the most relevant, requested topics by our providers. Our Event Calendar displays a current listing of webinars open to registration. This list is constantly changing from month-to-month, so continue to monitor it for updates.
Please review the new codes that have been added to this article.
New:
This article is for physicians, mass immunizers, and other providers billing MACs for hepatitis B vaccine and administration services they provide to Medicare patients.
Compliance
Mechanical Ventilation: Bill Correctly for Inpatient Claims
Claims, Pricers & Codes
Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for Calendar Quarters in 2023
Hospital Outpatient Prospective Payment System: Correcting Error to Code C1739
Events
Medicare Cost Report E-Filing System Webinar — March 19
View the most recent updates for our LCDs and articles.
This article has resources available for appealing a CERT review decision.
To learn more about coverage guidance, limitations, billing, and coding guidelines, register for our upcoming free event
Wednesday, March 26, 8:00 – 9:30 a.m. CT
Register today to save your seat!
In response to numerous and continued requests from the ambulance community, the A/B Medicare administrative contractors (MACs) have put together a National A/B MAC Ambulance Provider/Supplier Coalition.
This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of urological supplies.
News
Complex Non-Chemotherapeutic Drug Administration: Determining Payment for Services
Claims, Pricers & Codes
Ambulance Fee Schedule: CY 2025 Inflation Factor
Integrated Outpatient Code Editor Version 26.0
New Place of Service Code for Facilities Providing Programs of All-Inclusive Care for the Elderly: Not Applicable to Medicare
Home Health Consolidated Billing: CY 2025 HCPCS Code Update
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – January 2025
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2025 Quarterly Update
Hospital Outpatient Prospective Payment System: January 2025 Update
Payment for Medicare Part B Preventive Vaccines & Their Administration for Rural Health Clinics &
Federally Qualified Health Centers
Travel Allowance Fees for Specimen Collection – 2025 Updates
Our Event Calendar has been updated and new events are open for registration.
February is American Heart Month. We use this month to raise awareness about heart disease and how people can prevent it. Medicare offers preventive services aimed at preventing cardiovascular disease.
CMS published a new FAQ document on calendar year 2025 telehealth claims processing. Take time to review the new information.
This article has resources available for verifying the status of your CERT review.
Please take a few minutes to review our newly developed resources to assist providers in understanding, navigating, and meeting CERT requirements.
Online registration for the Tuesday, February 18 Contractor Advisory Committee (CAC) meeting is now available. Important: Our CAC meeting will be held via webinar only. Please view our CAC meeting web page for specific details and other helpful information.
View the most recent updates for our LCDs and articles.
Did you know you can obtain your 1099 forms from Novitasphere? Please read our new article for additional information.
The February 2025 Electronic Billing Newsletter is now available.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few new topics include Medicare Updates for Part A, Part B, Rural Health Clinics (RHCs), and Federally Qualified Health Clinics (FQHCs).
Novitas seeks your input on establishing pricing under the Medicare program for the 2025 gapfill laboratory test codes. If you have not already done so, please complete our molecular diagnostic pathology survey and associated cost worksheet by February 28. Please complete a separate survey and associated cost worksheet for each test you perform.
The December 2024 Part B top inquiries FAQs, received by our Provider Contact Center, have been reviewed. Please take time to review these FAQs for answers to your questions.
The 2025 Medicare Participation Physicians / Suppliers Directory (MEDPARD) is now available. As in the past, there will be no hardcopy distributions. Beneficiaries can use the Physician Compare website or contact 1-800-MEDICARE for assistance in locating a participating supplier near their home. Please use the online MEDPARD Directory.
Updated information has been added relating to G2211 and modifier 25. Take time to review the new information.
News
Resources & Flexibilities to Assist with the Public Health Emergency in California
CMS Moves Closer to Accountable Care Goals with 2025 Accountable Care Organization Initiatives
Telehealth Flexibilities Extended until March 31
CMS Roundup (January 10, 2025)
Health Professional Shortage Areas: Learn about Physician Bonuses
Hympavzi Covered Under Part B with a Furnishing Fee
Change of Ownership: Both Parties Must Submit Enrollment Applications Within 30 Days
Cervical Health: Encourage Screening
Compliance
Continuous Positive Airway Pressure Devices & Accessories: Prevent Claim Denials
Claims, Pricers & Codes
HCPCS Application Summaries & Coding Decisions
Therapy Code List: 2025 Annual Update
Therapy Services: CY 2025 KX Modifier Threshold Amounts
Publications
Guidelines for Teaching Physicians, Interns & Residents — Revised
Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model — Revised
New:
This article is for laboratories, laboratory technicians, and other providers billing MACs for specimen collection services they provide to Medicare patients.
This article is for skilled nursing facilities and other providers billing MACs for services they provide to Medicare patients.
This article is for ambulatory surgical centers, physicians, suppliers, and other providers billing MACs for services they provide to Medicare patients.
Review the revised listing of CPT category III T codes that require documentation.
Please review the new and revised code list for blood product, miscellaneous codes, ambulatory surgical center devices, radiopharmaceutical, and skin substitute.
Our Event Calendar has been updated and new events are open for registration.
Patient eligibility and duplicates denials continue to be top claim errors. Review the updated quarterly claim denials.
View the most recent updates for our LCDs and articles.
Updated to add billing instructions for cases involving a clinical trial of a different product and to update some HCPCS codes with current CPT codes for CY 2025.
News
Medicare Part B Vaccine Administration: CY 2025 Payment Amounts
Historically Excepted Tribal Federally Qualified Health Centers: CY 2025 Payment Rate
DMEPOS: Adding New Product Category to CMS-855S Enrollment Form on January 27
Hospitals: Apply for Additional Residency Positions by March 31
Opioid Treatment Programs: Get the Latest Updates
Advanced Primary Care Management Services: Get Information about Billing Medicare
Medicare Wellness Visits: Get Your Patients Off to a Healthy Start
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
Infusion Pumps: Prevent Claim Denials
Claims, Pricers, & Codes
Medicare Part B Drug Pricing Files & Revisions: January Update
Rural Health Clinics & Federally Qualified Health Centers: You May Need to Resubmit Claims
Medicare Part A Place of Service: Use the Correct Codes
PrEP for HIV Billing: CMS Requires Diagnosis Codes
MLN Matters® Articles
Billing Instructions: Expedited Determinations Based on Medicare Change of Status Notifications
Clinical Laboratory Fee Schedule: 2025 Annual Update
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-on Code G2211 — Revised
Publications
Ground Ambulance Data Collection System: Cohort Analysis
Intravenous Immune Globulin Items & Services — Revised
Medicare Provider Enrollment — Revised
Revised:
This article is for hospitals, physicians, suppliers, and other providers billing MACs for services they provide to Medicare patients.
All medical professionals who can bill office and outpatient (O/O) evaluation and management (E/M) visits (CPT codes 99202-99205, 99211-99215), regardless of specialty, may use the code with O/O E/M visits of any level. We don’t restrict G2211 to medical professionals based on specialties.
New resources have been developed to assist providers in understanding, navigating and meeting CERT requirements.
Read the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
Read the Fast Facts: CERT documentation submission for helpful information about additional documentation requests (ADRs) regarding the CERT program.
View the most recent updates for our LCDs and articles.
A new feature has been added to our free online portal, Novitasphere. The Provider Data Summary (PDS) feature is now available for Part A and Part B portal users.
The preliminary 2025 portable x-ray transportation payment rates have been posted for notice. Comments will be accepted through February 1, 2025.
This article provides billing instructions to providers regarding CAR T-cell therapy. This article was updated December 30 to add billing instructions for cases involving a clinical trial of a different product.
New:
October 23, 2024, we updated the Medicare coverage requirements to align with ACIP recommendations.
Effective January 9, 2025, CMS will be removing the expedited prior auth review requests. The review timeframe will change from 10 business day to 7 calendar days from the receipt date. For additional information, please refer to Change Request 13711.
Effective January 1, 2017, the JW and JZ modifiers have been required on all claims for drugs and biologicals (hereafter, drug) separately payable under Medicare Part B with unused and discarded amounts (hereafter, discarded amounts) from single-dose containers or single-use packages (hereafter, single-dose containers). Providers must document the amount of discarded drugs in the beneficiary’s medical record. For additional information refer to our drugs and biologicals article. Failure to use the JW and JZ modifiers may result in your claim being rejected as un-processable.
News
MBI Lookup Tools: CMS Seeks Input by February 17
CMS Roundup (December 13, 2024)
Long-Term Care Hospital Provider Preview Reports: Review by January 15
Inpatient Rehabilitation Facility Provider Preview Reports: Review by January 15
Medicare Advantage Organizations & Prescription Drug Plans: Comment on Draft Medicare Transaction Facilitator Agreements by January 31
Health Professional Shortage Area: CY 2025 Bonus Payments
Home Health Quality Reporting Program: Final OASIS-E1 Instruments & Manual
Quarterly Credit Balance Reports No Longer Required
Compliance
Immunosuppressive Drugs: Prevent Claim Denials
Claims, Pricers, & Codes
HIV Pre-Exposure Prophylaxis: Coding Updates
Coding for Appropriate Use Criteria Program for Advanced Diagnostic Imaging Ends December 31
Federally Qualified Health Center Prospective Payment System: CY 2025 Pricer
Skilled Nursing Facility Consolidated Billing: CY 2025 HCPCS Codes
MLN Matters® Articles
CY 2025 Update: DMEPOS Fee Schedule
National Coverage Determination 210.15: Pre-Exposure Prophylaxis (PrEP) for HIV Prevention
From Our Federal Partners
CHAMPVA Policy on Weight Loss Medications Effective January 1
Our Event Calendar has been updated and new events are open for registration.
View the most recent updates for our LCDs and articles.
Medicare providers – please review this notice concerning voluntary refunds for 2024.
New:
This article is for laboratories, and other providers billing MACs for laboratory services they provide to Medicare patients.
Medicare pays for behavioral health services that may improve outcomes for Medicare patients. They include behavioral health integration (BHI) services, psychotherapy for crisis, and opioid use disorder (OUD) screening & treatment. We encourage all providers to help improve your patient’s behavioral health.
New:
This article is for suppliers, and other providers billing MACs for DMEPOS services they provide to Medicare patients.
New:
This article is for physicians, DMEPOS suppliers, Part B suppliers, and other providers billing MACs for HIV preventive services they provide to Medicare patients.
Effective January 1, the application fee is $730 for institutional providers. Please read our new article for additional information.
News
FY 2024 Medicare Fee-for-Service Improper Payment Rate
Revised Home Health Change of Care Notice Form Effective February 1
Skilled Nursing Facility Value-Based Purchasing Program: December 2024 Confidential Feedback Reports
Institutional Provider Enrollment Application Fee: CY 2025
Compliance
Global Surgery: Bill Correctly
Claims, Pricers, & Codes
Rural Health Clinic CY 2025 All-Inclusive Rate
Publications
Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised
From Our Federal Partners
Get Your CHAMPVA Claims Paid with EFT
Effective December 9, we updated both the standard and expedited Prior Authorization Request (PAR) coversheets with new fields which include selection of modifiers RT, LT or 50, site levels, alternative contact information and a comment field for detailed information related to medical review.
Forms can be found on the Novitas' Prior authorization program for certain hospital outpatient department services webpage, along with helpful instructions for completing the PAR cover sheets for hospital outpatient department (OPD) services. It’s important that all fields on the cover sheet are completed to avoid delays.
News
Clinical Laboratory Fee Schedule: CY 2025 Final Payment Determinations
CMS Roundup (November 29, 2024)
Advanced Primary Care Management Services: Get Information about Billing Medicare
Flu Shots: There’s Still Time to Protect Your Patients
Compliance
Diabetic Accessories & Supplies: Prevent Claim Denials
Claims, Pricers, & Codes
Claim Status Category & Claim Status Codes Update
National Correct Coding Initiative: January Update
MLN Matters® Articles
ESRD & Acute Kidney Injury Dialysis: CY 2025 Updates
Medicare Change of Status Notice Instructions
Medicare Physician Fee Schedule Final Rule Summary: CY 2025
Publications
Global Surgery — Revised
Rural Emergency Hospitals — Revised
Review the revised listing of CPT category III T codes that require documentation.
Novitasphere will be unavailable from Friday, December 6 at 5:30 p.m. through Monday, December 9 at 8:00 a.m. ET.
This article provides information regarding unsolicited / voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
New:
This article is for physicians, hospitals, suppliers, and other providers billing MACs for Medicare services paid under the Physician Fee Schedule.
View the most recent updates for our LCDs and articles.
News
Opioid Treatment Programs: CY 2025 Updates
HIV Screening & Prevention
Claims, Pricers, & Codes
Home Health Prospective Payment System Grouper: January Update
Clotting Factor: CY 2025 Furnishing Fee
Events
Hospice Quality Reporting Program Webinar — December 12
MLN Matters® Articles
Medicare Deductible, Coinsurance, & Premium Rates: CY 2025 Update
View the most recent updates for our LCDs and articles.
During national diabetes month, talk with your patients about their risk factors and recommend services to prevent, detect, and treat diabetes.
News
Medicare-Funded Physician Residency Positions
CMS Roundup (November 15, 2024)
Hepatitis B Vaccine: Billing Requirement Update Effective January 1
Hospitals: Use Renewed Beneficiary Notices Starting January 1
National Rural Health Day: Address Unique Health Care Needs
Lung Cancer: Help Your Patients Reduce Their Risk
Compliance
Mechanical Ventilation: Bill Correctly for Inpatient Claims
Enteral Nutrition: Prevent Claim Denials
Events
Environmental Justice Thriving Communities Grantmakers Program — December 4
Optimizing Healthcare Delivery to Improve Patient Lives Conference — December 12
MLN Matters® Articles
Home Health Prospective Payment System: CY 2025 Rate Update
Publications
Medicare Preventive Services — Revised
From Our Federal Partners
First Case of Clade I Mpox Diagnosed in the U.S.
View the most recent updates for our LCDs and articles.
New:
This article is for physicians, hospitals, suppliers, and other providers billing MACs.
Novitasphere is our free online portal full of many great features including claim submission, claim status, and patient eligibility. A redesigned portal is being released on December 9. The redesign includes all the same features with a new look and several enhancements. Several short videos have been created to provide you with a quick glance of the portal. You are invited to visit the Novitasphere Redesign page (JH) (JL) to watch the videos and read more about the redesign. If you do not currently have access, we encourage you to enroll today. Refer to the Novitasphere Enrollment eGuide for complete enrollment instructions.
Novitas, along with other collaborating Medicare Administrative Contractors (MACs), will hold a multi-jurisdictional town hall meeting hosted by CGS on December 10, at 3:00 p.m. ET for those that wish to speak about the final Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers LCD in an open forum.
Our Event calendar has been updated and new events are open for registration.
The 2025 fee schedule is now available for download in PDF, Excel and TXT formats in our online tool. Individual code lookups will be available beginning January 1, 2025.
Checking the status of an application? Instead of calling the Provider Enrollment Help Line, use our self-service resources to obtain application status, such as Provider Enrollment Status Inquiry Tool, Provider Enrollment Gateway or PECOS resources for assistance.
News
2025 Medicare Parts A & B Premiums and Deductibles
Medicare Participation for CY 2025
Ambulance Fee Schedule: CY 2025 Final Policies
Prior Authorization Review Timeframe Change
Skilled Nursing Facilities: Revalidation Due Date Extension
Home Health & Hospice Resources
Help Your American Indian & Alaska Native Patients Achieve Optimal Health
Claims, Pricers, & Codes
PrEP for HIV Pharmacy Claims: New HCPCS Code & FAQ Update
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2025 Update
New Waived Tests
Publications
Checking Medicare Claim Status — Revised
Checking Medicare Eligibility — Revised
View the most recent updates for our LCDs and articles.
Due to system maintenance, Novitasphere will be unavailable Saturday, November 16 from 8 a.m. – 5 p.m. ET. We apologize for any inconvenience.
The cervical fusion article written in collaboration with the AB MAC Prior Authorization Workgroup has been revised to include guidance from the LCD.
Revised:
This article is for laboratory, physicians, suppliers, and other providers billing MACs.
New:
This article is for physicians, suppliers, and other providers billing MACs.
This article is for physicians, suppliers, and other providers billing MACs.
This article is for hospitals, physicians, and suppliers billing MACs.
The anesthesia conversion factors for 2025 have been posted.
CMS has released an updated version of the CMS-855O application (09/23). Learn about the effective dates for the old and new versions.
To check the status of an enrollment application, you can use the Provider Enrollment Status Inquiry Tool. Instead of calling the Provider Enrollment Help Line, use our helpful status tool resources, such as the Provider Enrollment Status Inquiry Tool, for assistance.
Final Rules
Physician Fee Schedule CY 2025 Final Rule
Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Final Rule
ESRD Prospective Payment System CY 2025 Final Rule
Home Health Prospective Payment System CY 2025 Final Rule
News
CMS Roundup (November 1, 2024)
Respiratory Viruses: Get Up to Date on Flu, COVID-19, & RSV Vaccines
Diabetes: Recommend Preventive Services
Compliance
Medical Services Authorized by the Veterans Health Administration: Avoid Duplicate Payments
Claims, Pricers, & Codes
Expanded Diabetes Screening: Claims for HCPCS Code 82947 Returned in Error
Home Intravenous Immune Globulin Items & Services: CY 2025 Rate Update
Discarded Drugs & Biologicals: Updated HCPCS Codes
Events
Greenhouse Gas Reduction Fund Opportunities for the Health Sector Webinar — November 20
Publications
Medicare Provider Compliance Tips — Revised
Information for Patients
Medicare Prescription Payment Plan
View the most recent updates for our LCDs and articles.
View the most recent release of our Electronic Billing newsletter. This newsletter is published quarterly and includes important EDI-related articles.
You can check the status of your PECOS application online. Instead of calling the Provider Enrollment Help Line, use our helpful status tool resources, such as PECOS, for assistance.
News
Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health Care
Compliance
Major Hip & Knee Replacement or Reattachment of Lower Extremity: Prevent Claim Denials
Comprehensive Error Rate Testing Medical Record Requests: Respond Timely
Claims, Pricers, & Codes
PrEP for HIV Billing: CMS Requires Diagnosis Codes
Publications
Prohibition on Billing Qualified Medicare Beneficiaries — Revised
Provider Information on Medicare Diabetes Self-Management Training — Revised
View the most recent updates for our LCDs and articles.
Please take time to review the new article on proper billing and coding for chiropractic services.
CMS has announced the dollar amount that must remain in controversy to sustain appeal rights beginning January 1, 2025. Please review the article for details.
The Novitasphere Submitter ID Update Request, Novitasphere Migration List, EDI Enrollment Affiliated Provider List, and the EDI Submitter Update Request forms were updated to the R2-24 version on September 5. Always complete the forms directly on our website to ensure you are using the most recent forms. Any older versions of these updated forms received November 5 and after will be rejected.
The CDC issued this Health Alert Network Health Advisory to inform of a supply disruption of peritoneal dialysis and intravenous solutions due to Hurricane Helene.
Our Event calendar has been updated and new events are open for registration.
Medicare covers screenings and treatment for patients with OUD. Services include OUD screenings, office-based treatments, screening, brief intervention, and referral to treatment (SBIRT) and the opioid treatment program. We encourage all providers explore these services to help improve your patient’s behavioral health.
Register for our November 5, 2024, Webinar on OUD Screening and Treatment.
Review the revised listing of CPT category III T codes that require documentation.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few new topics include Medicare updates, local coverage determination (LCD) updates and revisions, and Medicare program fundamentals.
Please review the revised listing for drugs codes.
A new issue has been added relating to incorrect frequency denials for trigger point injections.
Once CMS has released the CY 2025 physician fee schedule, it will be posted to our website.
News
CMS Roundup (October 18, 2024)
Rural Health Clinic & Federally Qualified Health Center: Final CY 2024 Payment Policies
Claims, Pricers, & Codes
Home Health Consolidated Billing: New Physician Specialty Code F6 Excluded
MLN Matters® Articles
Allowing Home Health Telehealth Services During an Inpatient Stay
Correction for Inpatient Medicare Part B Ancillary 12X Claims & Manual Updates
Separate Payment for Essential Medicines – New Biweekly Interim Payments for the Inpatient Prospective Payment System
Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2025 Changes — Revised
From Our Federal Partners
Biosimilars: Updated Curriculum Toolkit
Disruptions in Availability of Peritoneal Dialysis & Intravenous Solutions from Baxter International Facility in North Carolina
View the most recent updates for our LCDs and articles.
Did you know that if you submitted your application via the Provider Enrollment Gateway, you can check the status of it in the Gateway? Instead of calling the Provider Enrollment Help Line, use our helpful status tool resources, such as the Provider Enrollment Gateway, for assistance.
Starting September 30, Medicare will cover pre-exposure prophylaxis (PrEP) using antiretroviral drugs to prevent Human Immunodeficiency Virus (HIV) infection in individuals at increased risk of getting HIV, without cost-sharing. See this article for details.
Please review for the update regarding Clinical Laboratory Improvement Amendments (CLIA) claims denied in error.
News
Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting
No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days
Health Literacy: Help Your Patients Get Information & Services
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
Claims, Pricers, & Codes
National Uniform Billing Committee: New Codes Effective July 1
PrEP for HIV Billing: CMS Requires Diagnosis Codes
Events
HCPCS Public Meeting — November 6–8
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – October 2024 — Revised
Publications
Medicare Preventive Services – Revised
View the most recent updates for our LCDs and articles.
View the most recent updates for our LCDs and articles.
A new frequently asked question document has been added to the MDPP Specialty Page. Please take time to review the new information.
Take time to review the updated quarterly top claim denials.
News
Resources & Flexibilities to Assist with the Public Health Emergency in Florida
CMS Roundup (October 4, 2024)
Clinical Laboratory Fee Schedule: Reporting Delayed Until 2026
Respiratory Viruses: Vaccinate against Flu, COVID-19, & RSV
Compliance
Allergy & Immunology Services: Prevent Claim Denials
Outpatient Skin Substitute Claims: New Codes & Updates Effective October 1
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
Multimedia
Hospice Quality Reporting Program: HOPE Tool Web-Based Training
From Our Federal Partners
First Marburg Virus Disease Outbreak in the Republic of Rwanda
Enroll in EFT to Get Paid for CHAMPVA Claims
Information for Patients
2025 Medicare & You Handbook
Online registration for the Friday, October 25 open meeting is now available, and presenter registration will close at noon ET on Wednesday, October 23.
Important: Our open meeting will be held via webinar only. Please view our proposed local coverage determination open meetings web page for specific guidelines and other helpful information.
View the most recent updates for our LCDs and articles.
Revised:
This article is for hospitals, physicians, and other providers billing MACs.
This article is for laboratory, physicians, suppliers, and other providers billing MACs.
This article is for ASCs, physicians, suppliers, and other providers billing MACs for services provided to Medicare patients.
Novitas is conducting a crucial survey to gather comprehensive data on the cost associated with blood and blood-related products and ensure accurate pricing for blood-products provided to End-Stage Renal Disease (ESRD) facilities. All submitted data will be considered proprietary and kept confidential.
The September 2024 Part B top inquiries FAQs, received by our Provider Contact Center, have been reviewed. Please take time to review these FAQs for answers to your questions.
CMS has issued a final National Coverage Determination (NCD) for FDA-approved Pre-exposure Prophylaxis (PrEP) using antiretroviral drugs to prevent HIV infection. The payment allowances below are for dates of service from September 30, 2024, through December 31, 2024.
The Form CMS-855A has been revised to collect the SNF data addressed in this guidance. It will become effective on October 1, 2024.
CMS announces resources and flexibilities available in response to Hurricane Helene for the states of Florida, Georgia, North Carolina, Tennessee, and South Carolina.
News
HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program
Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, North Carolina, Tennessee, & South Carolina
CMS to Provide Hurricane Helene Public Health Emergency Accelerated Payments to Medicare Fee-for-Service Providers and Suppliers
Changes to the Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Rates Due to Court Decision (CMS-1808-IFC)
CMS Covers PrEP to Prevent HIV
Clinical Laboratory Fee Schedule: Submit Comments & Reconsideration Requests by October 25
DMEPOS: Adding New Product Categories to CMS-855S Enrollment Form on October 26
Improve Your Search Results for CMS Content
Help Detect Breast Cancer Early
Claims, Pricers, & Codes
Medicare Part B Drug Pricing Files & Revisions: October Update
PrEP for HIV Billing: CMS Requires Diagnosis Codes
RARCs, CARCs, Medicare Remit Easy Print, & PC Print: October Update
Events
Hospital Price Transparency: Encoding January 2025 Requirements in the Machine-Readable File Webinar — October 21
Publications
Substance Use Screenings & Treatment
View the most recent updates for our LCDs and articles.
Please review the revised listing for drugs codes, skin substitute codes, radio-pharmaceutical and ambulatory surgery center (ASC) device codes
Checking the status of an application? Please use the Provider Enrollment Status Inquiry Tool, Provider Enrollment Gateway or PECOS. Please do not use the Provider Enrollment Help Line.
Review the revised listing of CPT category III T codes that require documentation.
Avoid negative impacts to your claims by providing medical records for laboratory and pathology code claim submissions. Please take a moment to read this article for more information.
Effective October 3, 2024, the CMS-588 EFT forms will no longer be accepted via upload on the Provider Enrollment Gateway tool. The CMS-588 EFT forms must be mailed to the appropriate enrollment mailing address.
News
CMS Roundup (September 20, 2024)
Cardiovascular Disease: Talk with Your Patients about Screening
Claims, Pricers, & Codes
Cardiology CPT Code 75580: Issue with Claims Returned to Provider
Events
Optimizing Healthcare Delivery to Improve Patient Lives Conference — December 12
MLN Matters® Articles
DMEPOS Fee Schedule: October 2024 Quarterly Update
Hospice Claims Edits for Certifying Physicians — Revised
Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2025 Changes — Revised
Publications
Expanded Prepayment Review of Existing Hospices in Arizona, California, Nevada, & Texas
Multimedia
Medicare Ground Ambulance Data Collection System: Reporting Labor Information Video
From Our Federal Partners
Prevention Strategies for U.S. Travelers Visiting Countries with Clade I Mpox Outbreaks
Health Care Preparedness Resources
CMS announces additional resources and flexibilities available in response to Hurricane Francine for the state of Louisiana.
Our Event Calendar has been updated and new events are open for registration.
Reimbursement for influenza, pneumococcal, and hepatitis B vaccine fees and administration fees.
A new issue has been added regarding pricing for the 2024/2025 flu season.
A new issue has been added regarding holding claims for CPT code 90658 (influenza virus vaccine).
A recent report by the Office of the Inspector General (OIG) found providers didn’t always comply with federal requirements when billing surgical services, including missing co-surgery and assistant-at-surgery modifiers. CMS encourages you to bill correctly for global surgery.
There will be Common Working File (CWF) "dark days" October 4, 2024, through Sunday, October 6, 2024, due to the October 2024 release installation. The interactive voice response (IVR) unit will have limited availability.
Please review the annual wellness visit (AWV) telehealth options: Ways to improve your Medicare patient’s access to AWV and talk to your patients about prostate cancer screening, and revisions to pneumococcal vaccines.
Please review the open claim issues log for updated information regarding professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.
News
Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana
Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data
Hospice Outcomes and Patient Evaluation Assessment Tool: Version 1.00 Resources
Hospital Price Transparency: Get Tools to Comply
Risk Less. Do More. Get This Season’s Vaccines
Help Reduce Health Disparities for Hispanic or Latino Patients
Compliance
Tracheostomy Supplies: Prevent Claim Denials
Claims, Pricers, & Codes
ACO REACH Model: Adjusting Claims
Influenza Vaccine: Holding Claims for CPT Code 90658
ICD-10 Medicare Severity Diagnosis-Related Group Version 42
Novitas is conducting a crucial survey to gather comprehensive data on the cost associated with blood and blood-related products and ensure accurate pricing for blood-products provided to End-Stage Renal Disease (ESRD) facilities. All submitted data will be considered proprietary and kept confidential.
View the most recent updates for our LCDs and articles.
New:
This article is for physicians, suppliers, and other providers billing MACs for DMEPOS items and services provided to Medicare patients.
There is only one procedure code with the October release.
News
COVID-19: Updated Vaccines for 2024–2025 Season
Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidance
CMS Roundup (September 6, 2024)
Organizational Providers: Do You Need to Revalidate Your Enrollment Record Soon?
Prostate Cancer: Talk to Your Patients about Screening
Advance Health Equity During National Sickle Cell Awareness Month
Claims, Pricers, & Codes
National Correct Coding Initiative: October Update
Integrated Outpatient Code Editor Version 25.3
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – October 2024
Changes to the Laboratory National Coverage Determination Edit Software: January 2025 Update
Hospital Outpatient Prospective Payment System: October 2024 Update
Dates: September 17 – 19
Our conference offers 44 free, webinars focused on identifying program integrity initiatives, reviewing improper payment findings, and recommending best practices to mitigate billing and documentation errors for all types of Part A and B providers and services.
New:
This article is for ASCs, physicians, suppliers, and other providers billing MACs for services provided to Medicare patients.
News
Osteogenesis Stimulators: Prior Authorization Requirements Suspended
Hospice Benefit: Expanding Prepayment Review in 4 States
Skilled Nursing Facility Advance Beneficiary Notice: Revised Form & Instructions
Hospital Price Transparency: Use a CMS Template Layout
Healthy Aging: Recommend Medicare-Covered Services
National Recovery Month: Take the First Step
Compliance
Global Surgery: Bill Correctly
Claims, Pricers, & Codes
Alzheimer’s Monoclonal Antibody Treatment: New Code for Kisunla Drug
Claim Status Category & Claim Status Codes
DMEPOS: Provider Level Adjustment Codes on Remittance Advice
MLN Matters® Articles
Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2025 Changes
New Waived Tests
Publications
Items & Services Not Covered Under Medicare — Revised
New:
This article is for laboratory physicians, suppliers, and other providers billing MACs for laboratory services they provide to Medicare patients.
The Novitasphere Submitter ID Update Request, Novitasphere Migration List, EDI Enrollment Affiliated Provider List, and the EDI Submitter Update Request forms were updated to the R2-24 version on September 5. Always complete the forms directly on our website to ensure you are using the most recent forms. Any older versions of these updated forms received November 5 and after will be rejected.
View the most recent updates for our LCDs and articles.
MDPP suppliers take time to review our specialty page.
News
CMS Roundup (August 23, 2024)
Physicians, Teaching Hospitals, & Non-Physician Practitioners: Review Your Open Payment Data by December 31
Claims, Pricers, & Codes
Home Health Consolidated Billing: CY 2025 HCPCS Code Update
HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items and Services
Events
ICD-10 Coordination & Maintenance Committee Meeting — September 10–11
MLN Matters® Articles
Inpatient Psychiatric Facilities Prospective Payment System: FY 2025 Updates
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
Annual Wellness Visit: Social Determinants of Health Risk Assessment — Revised
National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation — Revised
Publications
Medicare & Mental Health Coverage — Revised
Dates: September 17 – 19
Learn more about how to become an active partner in protecting the Medicare program. Review our listing of 44 available webinars and register today.
Register for our Medicare Compliance Matters Virtual Symposium session on September 17, relating to promoting patient wellness through expanded behavioral health services. Our session will explore a wide range of Medicare-covered behavioral health services, including mental health and substance use services, to improve patient outcomes and overall wellness.
Online registration for the Friday, September 13 open meeting is now available, and presenter registration will close at noon ET on Wednesday, September 11.
Important: Our open meeting will be held via webinar only. Please view our proposed local coverage determination open meetings web page for specific guidelines and other helpful information.
View the most recent updates for our LCDs and articles.
View the ways to improve your Medicare patient’s access to annual wellness visits (AWV) via telehealth.
How to certify patients for the Medicare home health benefit. Is a face-to-face encounter required? View the Provider compliance fast facts for more information.
Does your plan of care have deficiencies such as poor care planning, mismanagement of aide services or inadequate assessments of patient’s? View Creating an effective hospice plan of care for more information.
Does your medical documentation support the medical necessity for implanted spinal neurostimulators? Is a prior authorization needed?
It is important that you use the most recent version of any EDI form when enrolling for Novitasphere, EDI services, or making any changes to your existing electronic billing setup. All EDI and Novitasphere enrollment forms received must be version R2-23. Any older versions will be rejected.
August is national immunization awareness month. Take this time to help increase your patients’ vaccination rates by recommending vaccines and how to access them, as fewer than 25% of adults get all their recommended vaccines.
Take time to review the CMS Immunization and Vaccine Resources page for additional information.
New:
This article is for hospitals, physicians, and suppliers.
Our Event Calendar has been updated and new events are open for registration.
Different help desks are available for the different types of electronic billing questions. Carefully consider the type of assistance needed before dialing. Calls received to the incorrect help desk will be asked to call back using the correct telephone number. Read the list of topics handled in this article to help you decide what number to call.
OTPs provide medications for people diagnosed with an opioid use disorder (OUD). Medicare pays for OTP services for OUD treatment when eligible. Take time to review the CMS OTP page for additional information.
News
Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law
MolDx Local Coverage Determination Statement
Hospital Price Transparency: Get Resources to Help You Comply
New Residency Programs Request for Information: Submit Comments by October 15
Open Payments: Program Year 2023 Data
Claims, Pricers, & Codes
Seasonal Flu Vaccine Pricing for 2024–2025 Season
Inpatient Rehabilitation Facility Prospective Payment System: FY 2025 Pricer Update
Home Health Prospective Payment System Grouper: October Update
Publications
A Prescriber’s Guide to Medicare Prescription Drug (Part D) Opioid Policies — Revised
Chronic Care Management Services — Revised
From Our Federal Partners
Increased Oropouche Virus Activity & Associated Risk to Travelers
New:
This article is for physicians, suppliers, and other providers billing MACs for pneumococcal vaccine services they provide to Medicare patients.
Revised:
This article is for laboratory, physicians, suppliers, and other providers billing MACs.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few new topics include New Local Coverage Determination: Cervical Fusion, Evaluation and Management Services: Guidelines for Office and "Other" Outpatient Visits, and How to Utilize National Coverage Determinations (NCDs).
Revised:
This article is for hospitals, physicians, and other providers billing MACs.
Dates: September 17 – 19
Registration is now open for our 44 engaging webinars focused on coverage, billing, and purposeful documentation requirements.
EDI and Novitasphere enrollment forms were updated to the R2-23 version on June 25. Always complete the forms directly on our website to ensure you are using the most current form versions. All forms received August 25 and after must be the most current R2-23 version. Any EDI or Novitasphere enrollment forms received with older version numbers will be rejected.
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology code claim submissions indicated in this article. Novitas requests specific documentation with submission of these specific pathology and lab codes effective September 19th.
News
Negotiating for Lower Drug Prices Works, Saves Billions
Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and South Carolina
Hospitals: New EMTALA Poster for Use in Emergency Departments
PrEP for HIV Transition of Coverage: Get Ready Now
CMS Roundup (August 9, 2024)
ESRD: Oral-Only Renal Dialysis Service Drugs & Biological Products — Revised Guidance
Compliance
Patient Lifts: Prevent Claim Denials
Claims, Pricers, & Codes
Telehealth Services: Billing & Payment for Place of Service Code 10
Medicare Physician Fee Schedule Database: October Update
MLN Matters® Articles
Hospice Payments: FY 2025 Update
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2025 Update
Hospital Outpatient Prospective Payment System: July 2024 Update — Revised
Publications
Skilled Nursing Facility Place of Service Codes: Updated Resources
From Our Federal Partners
Increase in Human Parvovirus B19 Activity in the U.S.
If you are a sole owner and receive a revalidation letter notifying you that your sole owner group is up for revalidation, please submit a revalidation application for the group either online through PECOS or Form CMS-855B. It is best practice to submit applications online through PECOS. The CMS-855I form is not required to be submitted when revalidating a group record. For additional information, please refer to Revalidation FAQs
View the most recent updates for our LCDs and articles.
New:
This article is for hospices and other providers billing Medicare Administrative Contractors (MACs) for hospice services they provide to Medicare patients.
Revised:
This article is for physicians, hospitals, suppliers, and providers billing Medicare Administrative Contractors (MACs) for services they provide to Medicare patients.
View the most recent updates to our prior authorization general documentation requirements, facet joint interventions and cervical fusion with disc removal articles. For facet joint interventions, CMS is removing CPT codes 64492 and 64495 from the list of codes requiring prior authorization by August 16, 2024. The associated LCD and LCA have been updated to reflect this and other updates effective August 11, 2024. For cervical fusion, a new LCD and LCA will be effective August 11, 2024, and updates have been made to the documentation requirements for services requiring prior authorization.
Final Payment Rule
Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule
News
Transitional Coverage for Emerging Technologies — Final Notice
Help Improve the Program for Evaluating Payment Patterns Electronic Reports & Comparative Billing Reports — Updated Request for Information
Immunization: Protect Your Patients
Compliance
Medical Services Authorized by the Veterans Health Administration: Avoid Duplicate Payments
Claims, Pricers, & Codes
Clinical Laboratory Improvement Amendments: Reprocessing Denied Claims
Skilled Nursing Facility Prospective Payment System: FY 2025 Pricer Update
Multimedia
Clinical Diagnostic Laboratory Tests: Medicare Advisory Panel Meeting Materials
From Our Federal Partners
Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries
Ready to Get Paid via EFT for CHAMPVA Claims?
Providers have reported that stay of enrollment letters have been found in their spam folder when sent via email. Please ensure your spam folder is monitored for any provider enrollment correspondence.
On October 10, at 6:00 p.m. ET, Novitas Solutions (Jurisdictions H and L) and First Coast Service Options (Jurisdiction N), will host a JH/JL/JN CAC meeting to discuss the quality and strength of the available literature and any compelling clinical data for the topic of Non-invasive arterial studies. Please read this article for more information.
Once enrolled for Novitasphere, you can obtain patient eligibility information with three quick steps.
New:
This article is for physicians, suppliers, and other providers billing MACs for laboratory services they provide to Medicare patients.
Two issues have been added relating to ASC facility services and lab service CLIA claims denied in error.
Save the date and be the first to hear about Novitas and CMS initiatives, Medicare compliance program and improper payments updates, and how you can become a valued partner in ensuring Medicare program integrity. We will offer 45 engaging webinars on what matters most Medicare compliance. Registration will open soon!
Our Medicare experts work hard to host a variety of educational webinars each week. Read just a few comments we’ve received from providers about their experiences with our presentations and talented POE educators.
View the most recent release of our Electronic Billing newsletter. This newsletter is published quarterly and includes important EDI-related articles.
Final Payment Rules
Skilled Nursing Facility FY 2025 Final Rule
Inpatient Rehabilitation Facility FY 2025 Final Rule
Inpatient Psychiatric Facility FY 2025 Final Rule
Hospice FY 2025 Final Rule
News
CMS Roundup (July 26, 2024)
Opioid Treatment Program: Learn How to Bill Medicare
Claims, Pricers, & Codes
DMEPOS: Provider Level Adjustment Codes on Remittance Advice
Publications
Beneficiaries Dually Eligible for Medicare & Medicaid — Revised
Multimedia
Post-Acute Care Quality Reporting Programs: Patient Mood Interview Video Tutorial
View the most recent updates for our LCDs and articles.
View the most recent updates for our LCDs and articles.
News
CMS Announces Resources & Flexibilities to Assist with Public Health Emergency in Texas
CMS Oral Health Cross-Cutting Initiative Fact Sheet
Doctors & Clinicians: Utilization Data on Medicare.gov Compare Tool
Help Improve the Program for Evaluating Payment Patterns Electronic Reports & Comparative Billing Reports
Viral Hepatitis: Talk with Your Patients About Shots & Screenings
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: October Update
Lymphedema Compression Treatment Items: Implementation — Revised
Publications
Ground Ambulance Industry Trends 2017–2022
Multimedia
Post-Acute Care Quality Reporting Programs: FY & CY 2025 Program Updates Web-Based Training
From Our Federal Partners
Disruptions in Availability of Becton Dickinson BACTEC Blood Culture Bottles
For IDE trials which have received CMS approval to bill Medicare, Novitas requests certain information be sent to us before Part A claims are submitted. Please see our updated submission requirements for where to email the required information. The fax number currently used to submit CMS approved IDE information will no longer be available effective October 1, 2024.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few new topics include Medicare Part B Updates – July 2024, Modifier of the Month: 50 versus Anatomical Modifiers, and Medicare Part A Updates – July 2024.
View the most recent updates for our LCDs and articles.
New:
This article is for physicians, hospitals, suppliers, and other providers billing MACs for laboratory services they provide to Medicare patients.
News
Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs
Medicare Ground Ambulance Data Collection System: Submit Comments by September 9
Medicare Providers: Deadlines for Joining an Accountable Care Organization
Skilled Nursing Facility Value-Based Purchasing Program: May 2 Webinar Materials Available
CMS Roundup (July 12, 2024)
Claims, Pricers, & Codes
ICD-10-CM Diagnosis Codes: FY 2025
Events
Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Now Virtual-Only on July 25–26
Publications
Guiding an Improved Dementia Experience Model
Please review the revised listing for drug, skin substitute, radio-pharmaceutical and ambulatory surgery center (ASC) device codes.
View the most recent updates for our LCDs and articles.
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology code claim submissions indicated in this article. We request specific documentation with submission of these pathology and lab codes.
Looking for education that fits your busy schedule? Visit the On-Demand Learning center on our website for a full listing of webinar recordings and click-and-play videos. A few of the new topics include Understanding Behavioral Health Integration (BHI) Services, Local Coverage Determinations (LCDs) Additions and Revisions and more.
ASCA requests related to the CHC cybersecurity incident are no longer being accepted. The electronic billing process has been restored and all impacted providers must resume electronic billing. Effective August 1, paper claims will no longer be accepted for any providers who received the ASCA waiver due to the CHC cybersecurity incident.
The Completing the Medicare Diabetes Prevention Program (MDPP) Enrollment Application (CMS-20134 Form) has been updated with new CDC learning information.
Effective August 11, local coverage determination (LCD) L39793 Cervical Fusion and billing and coding article (LCA) A59668 Billing and Coding: Cervical Fusion applies to cervical fusion for the decompression or stabilization of the cervical spine services.
The Novitas Provider Outreach and Education team and the sponsoring Clinical Medical Director will be hosting a webinar “New Local Coverage Determination: Cervical Fusion” on July 25, 2024, from 2:30 - 4:00 PM ET to review the coverage indications, limitations, medical necessity, provider qualifications and more of this new policy. You can register for this free, informative event by clicking this link.
In addition, we will be hosting a webinar “Updates for the Hospital Outpatient Department (OPD) Prior Authorization (PA) Program” on August 8, 2024, from 1:00 - 2:30 PM ET to review updates and changes to the prior authorization (PA) program for hospital outpatient department (OPD) services, which includes cervical fusion services. You can register for this free, informative event by click this link.
Proposed Rules
Physician Fee Schedule CY 2025 Proposed Rule
Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Proposed Rule
Mitigating the Impact of Significant, Anomalous, & Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in CY 2023 Proposed Rule — Submit Comments by July 29
News
Guiding an Improved Dementia Experience by Clearing the Path for Comprehensive, High-Quality Dementia Care
New Alzheimer’s Drugs: Updates to CMS National Patient Registry
Epileptologists: New Physician Specialty Code
Medicare Diabetes Prevention Program Supplier Enrollment: Updated CDC Organization Codes
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
Help People Living with Disabilities Get the Care They Need
Compliance
Negative Pressure Wound Therapy: Prevent Claim Denials
Claims, Pricers, & Codes
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
Events
Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Now Virtual-Only on July 25–26
Publications
Post-Acute Care Quality Reporting Programs: Technical Expert Panel Measurement Sets Report
Due to scheduled maintenance, the TIBCO Gateway will not be available beginning July 13 at 7 a.m. ET through noon on July 14; therefore, you will be unable to submit EDI transactions or retrieve files. We apologize for any inconvenience.
Due to scheduled maintenance, the Novitasphere Claim Submission feature will not be available beginning July 13 at 7 a.m. ET through noon on July 14; therefore, you will be unable to submit EDI transactions or retrieve files. We apologize for any inconvenience.
Our Event Calendar has been updated and new events are open for registration.
News
ESRD Prospective Payment System CY 2025 Proposed Rule — Submit Comments by August 26
CMS Roundup (June 28, 2024)
Improve Your Search Results for CMS Content
Claims, Pricers, & Codes
RARCs, CARCs, Medicare Remit Easy Print, & PC Print: July Update
MLN Matters® Articles
Changes to the Laboratory National Coverage Determination Edit Software: October 2024 Update
Ambulatory Surgical Center Payment Update – July 2024 — Revised
Diabetes Screening & Definitions Update: CY 2024 Physician Fee Schedule Final Rule — Revised
Publications
Medicare Part D Vaccines — Revised
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas — Revised
Duplicate denials continue to be a top claim error. Take time to review the updated quarterly top claim errors.
View the most recent updates for our LCDs and articles.
New codes have been added to the July 1, 2024, ASC fee schedule. Please take a moment to review.
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