CMS announces additional resources and flexibilities available in response to Hurricane Debby in states of Florida, Georgia, and South Carolina.
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.
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
New:
This article is for hospitals and LTCHs.
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.
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.
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.
New:
This article is for IPFs, and other providers billing MACs for inpatient psychiatric services provided to Medicare patients.
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.
Incorrect incarceration information has been posted to the Common Working File (CWF). This is causing previously paid claims to receive Informational Unsolicited Response (IUR) adjustments or new claims to be automatically rejected with reason code U538H.
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.
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
New reason code range of 326x4 is assigning on claims that were returned to provider (RTP) prior to the July 1, 2024, release or in process over the installation of the July release on July 1, 2024. To prevent these reason codes from assigning, a brand new claim will need to be submitted. If you have submitted your claim prior to July 1, 2024, and received a reason code within the range of 326x4, please submit a brand new claim.
View the most recent updates for our LCDs and articles.
News
CY 2025 Home Health Prospective Payment System Proposed Rule
PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies
Claims, Pricers, & Codes
Medicare Part B Drug Pricing Files & Revisions: July Update
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2024 Update
Events
2024 Virtual National Provider Compliance Conference — August 7 & 8
MLN Matters® Articles
DMEPOS Fee Schedule: July 2024 Quarterly Update
Multimedia
Medicare Ground Ambulance Data Collection System: Webinar Recordings
From Our Federal Partners
Increased Risk of Dengue Virus Infections in the U.S.
Health Care Preparedness Resources
View the most recent updates for our LCDs and articles.
EDI and Novitasphere enrollment forms have been updated. Always use the most recent version of the forms when initially enrolling or updating your existing EDI account. The new version is R2-23 - any older form versions will be rejected as of August 25.
Revised:
This article is for physicians, suppliers, and other providers billing MACs.
There will be Common Working File (CWF) “dark days” June 28-30, due to the July 2024 release installation. The interactive voice response (IVR) will have limited availability.
Registration is officially open for the 2024 Virtual National Provider Compliance Conference (NPCC) on Wednesday, August 7.
New:
This article is for laboratory physicians, suppliers, and other providers billing MACs for laboratory services they provide to Medicare patients.
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. New content is posted monthly.
Smart edits were introduced in July of 2023 to analyze claim data and will be removed effective June 28th. No action is needed. The removal of these edits will not impact your electronic billing routine. The typical workday using electronic billing will remain the same.
The lists of the current Smart edits and more details on the process are available on the Smart Edit web page.
Please take a moment to review an updated full version of the March 9, 2024, ASC fee schedule.
News
CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack
Federal Study Examines Care Following Nonfatal Overdose Among Medicare Beneficiaries; Identifies Effective Interventions & Gaps in Care
CMS Roundup (June 14, 2024)
Medical Records Request Scam: Watch out for Phishing
Provider & Supplier Enrollment Site Visits: CMS has Authority to Conduct
Cognitive Health: Medicare Covers Services
Compliance
Global Surgery: Bill Correctly
Claims, Pricers, & Codes
Outpatient Institutional Providers: Find Out When to Split Claims for Updated Rates
Events
Clinical Laboratory Fee Schedule Annual Public Meeting: Now Virtual-Only on June 25
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – July 2024
Medicare Benefit Policy Manual Update: DMEPOS Benefit Category Determinations
From Our Federal Partners
Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury & Overdose
Severe Illness Potentially Associated with Consuming Diamond Shruumz Brand Chocolate Bars, Cones, & Gummies
CHAMPVA Claims: Enroll in Direct Deposit — Reminder
The Opt Out Affidavit Form has been revised.
View the most recent updates for our LCDs and articles.
Reminder: Novitas-Solutions will be closed on Wednesday June 19th in honor of Juneteenth. Our self-service tools, Novitasphere, and IVR will still be available. Utilizing these options may help you to avoid a potentially higher call volume and wait time the following day.
Please take minute to review the updates to Completing the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) application, Enrollment guide: Chapter 8 - Additional enrollment information for Part B, Opt Out Affidavit Form, and Determining your Medicare effective date.
June is Men’s Health awareness month which is a perfect time to talk with your patients Consider these discussions during your patients upcoming annual wellness visit, which you can offer via telehealth. View the many preventive services Medicare covers including alcohol misuse screening and counseling, cancer screening for colorectal and prostate, cardiovascular disease screening and more.
Novitas offers free, virtual education on these topics. Visit our Event Calendar to view a full listing of webinar opportunities.
Our event calendar has been updated and new events are open for registration.
View the most recent updates for our LCDs and articles.
New:
This article is for physicians, suppliers, and other providers billing MACs for services they provide to Medicare patients.
This article is for suppliers, and other providers billing MACs for DMEPOS they provide to Medicare patients.
News
Medicare Shared Savings Program: Apply for January 1 Start Date by June 17
Men’s Health: Encourage Your Patients to Prioritize Their Health
Compliance
Hospital Beds & Accessories: Prevent Claim Denials
Claims, Pricers, & Codes
ICD-10-PCS Procedure Codes: FY 2025
Events
Clinical Laboratory Fee Schedule Annual Public Meeting: Now Virtual-Only on June 25
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: July 2024 Update
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: October 2024 Quarterly Update
Multimedia
Medicare Ground Ambulance Data Collection System: Labor Costs Webinar Recording
Information for Patients
Medicare Information in Other Languages
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. We post new content monthly.
View the most recent updates for our LCDs and articles.
New:
This article is for SNFs and other providers billing MACs for services they provide to Medicare patients.
News
CMS Roundup (May 31, 2024)
Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool
Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback Reports
Medicare Providers: Deadlines for Joining an Accountable Care Organization
Advancing Health Equity During Pride Month
Claims, Pricers, & Codes
DMEPOS: Clarification of Claim Liability for Overlapping Inpatient Hospital Stays
Integrated Outpatient Code Editor Version 25.2
National Correct Coding Initiative: July Update
MLN Matters® Articles
National Coverage Determination 200.3: Monoclonal Antibodies for the Treatment of Alzheimer’s Disease
Publications
Medicare Preventive Services — Revised
Online registration for the Friday, June 21 open meeting is now available. Due to the Juneteenth holiday, presenter registration will close at noon ET on Tuesday, June 18.
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.
Review the recently updated Radioactive diagnostic agents for positron emission tomography of prostate-specific membrane antigen positive lesions in men with prostate cancer article.
New:
This article is for physicians, hospitals, suppliers, and other providers billing MACs for services they provide to Medicare patients.
Novitasphere is an online portal that provides many great features at no cost. Some of the features provide highly sensitive data that must be protected with security requirements. Read this article to understand some of those requirements.
Mental and physical health are equally important components of overall health. Medicare covers preventive services, like depression screening which increases the risk for many types of physical health problems, particularly long-lasting conditions like diabetes, heart disease, and stroke.
Encourage your patients to prioritize whole health, prevention, care, and wellbeing. Medicare covers preventive services to help support a healthy lifestyle.
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.
Updates have been made to the following revalidation documents: Cycle 2 revalidation and Enrollment Revalidation.
News
Hospice Interdisciplinary Team: Addition of Marriage and Family Therapists & Mental Health Counselors
Revised Part B Inflation Rebate Guidance: Using the 340B Modifier — Reminder
MLN Matters® Articles
HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: October 2024
Medicare Claims Processing Manual Update: Gap-Filling DMEPOS Fees
Publications
SBIRT Services — Revised
View the most recent updates for our LCDs and articles.
Keeping proper medical documentation promotes patient’s clinical outcome. Review the CMS video: Provider Minute: The Importance of Proper Documentation and the documentation checklists.
A correction was installed on May 23, 2024, for bill types 11x that incorrectly assigned reason code 38001 to IRF claims. These claims can now be resubmitted.
Stay compliant by reviewing these fast facts, Home Health Care: Proper Certification Required, Home Health LUPA Threshold: Bill Correctly, and Implanted Spinal Neurostimulators: Document Medical Records.
New:
This article is for physicians, hospitals, and other providers billing MACs for treatment of AD in Medicare patients.
Please take a minute to review the new Health Equity specialty page on our website.
Revised:
This article is for physicians, hospitals, suppliers, and other providers billing MACs for laboratory services they provide to Medicare patients.
News
Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date
Medicare Providers: Deadlines for Joining an Accountable Care Organization
Institutional Providers: Medicare Enrollment & Certification Roadmap
Improve Your Search Results for CMS Content
Compliance
Medical Services Authorized by the Veterans Health Administration: Avoid Duplicate Payments
Claims, Pricers, & Codes
Pass-Through Device: Correct Returned Claims
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2024 Update
National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation
Hospice Claims Edits for Certifying Physicians — Revised
From Our Federal Partners
Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia: Ensure Travelers are Current on Meningococcal Vaccination
View the most recent updates for our LCDs and articles.
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.
Did you know that the annual wellness visits (AWV) can be offered via telehealth. Learn more by reviewing our Preventive services/screenings article.
The appeals department is receiving appeals regarding the incorrect usage of modifiers associated with PET scans. Review our positron emission tomography (FDG) for oncologic conditions and modifier usage article to ensure you are billing correctly.
News
Administration Acts to Improve Access to Kidney Transplants
DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment
Lymphedema Compression Treatment Items: New DMEPOS Benefit Category
Hospice: New Requirement for Physicians Who Certify Patient Eligibility Effective June 3
Medicare Physician Fee Schedule Database: July Update
Women’s Health: Talk with Your Patients About Prevention, Care, & Wellbeing
Compliance
Diabetic Shoes: Prevent Claim Denials
Claims, Pricers, & Codes
Home Health Claims: Additional Enforcement of Required County Codes
Events
Overcoming COVID-19 Vaccine Payment Challenges Webinar — May 30
MLN Matters® Articles
Annual Wellness Visit: Social Determinants of Health Risk Assessment
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
Diabetes Screening & Definitions Update: CY 2024 Physician Fee Schedule Final Rule
ESRD Prospective Payment System: Quarterly Update
Updates for Split or Shared Evaluation and Management Visits
Multimedia
Skilled Nursing Facility Quality Reporting Program: Social Determinants of Health Video
Skilled Nursing Facility Quality Reporting Program: Annual Payment Update Webinar Materials
Information for Patients
Mental Health & Substance Use Disorders: Updated Medicare.gov Content
View the most recent updates for our LCDs and articles.
New:
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. Novitas posts new content monthly.
New:
This article is for physicians, suppliers, and other providers billing MACs.
Our event calendar has been updated and new events are open for registration.
New:
This article is for physicians, suppliers, and ESRD facilities billing MACs for services they provide to Medicare patients.
News
HHS Releases New Data Showing Over 10 million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of Medicare Drug Price Negotiation Program
CMS Roundup (May 3, 2024)
Medicare Shared Savings Program: Prepare to Apply & Register for June 5 Webinar
Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by July 1
Home Health Quality Reporting Program: Draft OASIS-E1 Instruments & Manual
Mental Health: It’s Important at Every Stage of Life
Claims, Pricers, & Codes
Skilled Nursing Facility Prospective Payment System: Patient Driven Payment Model FY 2024 ICD-10 Code Mappings
Events
HCPCS Public Meeting — May 28–30
Publications
Part B Drug Payment Limits Overview
Resource of Health Equity-related Data Definitions, Standards, and Stratification Practices
From Our Federal Partners
Providers Accepting CHAMPVA: Enroll in Direct Deposit Now
Social determinants of health risk assessment is now an optional element of an annual wellness visits (AWV). Separately payable from AWV with no coinsurance and deductible when part of AWV, with the same date of services as AWV, and modifier 33.
Under the ASC payment system, payment is based on acquisition cost/invoice. If an invoice is not included, the claim may be denied.
This article is for physicians, suppliers, and other providers billing MACs.
This article is for hospitals, physicians, and other providers billing MACs.
This article is for physicians, hospitals, suppliers, and other providers billing MACs.
This article is for physicians, suppliers, and other providers billing MACs.
News
CMS Statement on Proposed Local Coverage Determination for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
Quality in Motion: Acting on the CMS National Quality Strategy
ESRD: Oral-Only Renal Dialysis Service Drugs & Biological Products
Claims, Pricers, & Codes
Clinical Laboratory Improvement Amendments: Adjusting Claims
Events
CMS National Provider Enrollment Conference in San Diego — August 28 & 29
Publications
Skilled Nursing Facility Place of Service Codes: Updated Resources
View the most recent release of our Electronic Billing Newsletter. This newsletter is published quarterly and includes important EDI-related articles.
Read this article prior to submitting EDI enrollment forms. The article reviews current inventory trends and form submission reminders.
Novitasphere provides accurate and up-to-date information on eligibility details with a simple search using the patient’s full name and Medicare Beneficiary Identifier (MBI). An MBI Lookup feature is also available in Novitasphere that will allow you to lookup the MBI if you do not have that information. Read this article for more details on the Novitasphere portal features and how to obtain access.
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?
Does your medical documentation support the medical necessity for implanted spinal neurostimulators? Is a prior authorization needed?
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. New topics include Submitting Electronic Claims using PC-ACE, Verifying beneficiary benefit eligibility and more.
News
Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule
CMS Roundup (Apr 19, 2024)
Hospice: Certifying Physicians Must Enroll in or Opt-Out of Medicare: Delayed until June 3
Comprehensive Error Rate Testing Program: Reduced Sample Size Starting with Reporting Year 2025
Skilled Nursing Facility Value-Based Purchasing Program: FY 2026 Early Look Performance Score Report
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
Claims, Pricers, & Codes
Hospital Outpatient Prospective Payment System: Correcting Errors to Codes 0621T, J7353, & C9167
MLN Matters® Articles
Medicare Claims Processing Manual Update: Inpatient Rehabilitation Facility
National Coverage Determination 20.7: Percutaneous Transluminal Angioplasty
DMEPOS Fee Schedule: April 2024 Quarterly Update — Revised
From Our Federal Partners
Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections
Claims for CPT 0621T or HCPCS J7353, may be processed incorrectly. Providers should bring impacted claims to our attention to be adjusted. Providers may also choose to adjust impacted claims on their own using the TOB xx7 and the claims will be suspended to be corrected by the MAC upon receipt.
Revised:
CMS revised the effective, implementation dates, and the web address of CR 13449.
Expand patient access to annual wellness visits (AWV) by offering the service via telehealth at your patient’s next visit. Learn more by reviewing our Preventive services/screenings article.
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.
We post new content monthly. Newly topics include LCDs, FQHC series, Podiatry services and more.
News
Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule
CMS Roundup (Apr 19, 2024)
Hospice: Certifying Physicians Must Enroll in or Opt-Out of Medicare by May 1
Comprehensive Error Rate Testing Program: Reduced Sample Size Starting with Reporting Year 2025
Skilled Nursing Facility Value-Based Purchasing Program: FY 2026 Early Look Performance Score Report
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
Claims, Pricers, & Codes
Hospital Outpatient Prospective Payment System: Correcting Errors to Codes 0621T, J7353, & C9167
MLN Matters® Articles
Medicare Claims Processing Manual Update: Inpatient Rehabilitation Facility
National Coverage Determination 20.7: Percutaneous Transluminal Angioplasty
DMEPOS Fee Schedule: April 2024 Quarterly Update — Revised
From Our Federal Partners
Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections
Now that Change Healthcare and Optum have restored their customers’ ability to electronically bill Medicare, providers should discontinue submitting paper claim forms.
View the most recent updates for our LCDs and articles.
Online registration for the Friday, May 24 open meeting is now available and presenter registration will close at noon ET on Wednesday, May 22. 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.
Please take a minute to review our new article on Marriage and Family therapist (MFT). This article is also linked in our Qualification and documentation requirements for providers and suppliers article.
Our event calendar has been updated and new events are open for registration.
Please take a moment to review the updated information regarding the National Clinical Trail number.
News
PrEP for HIV: Prepare for Potential Medicare Part B Coverage
Events
Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1
Publications
Medicare Preventive Services — Revised
Original Medicare vs. Medicare Advantage — Revised
New:
Learn about changes in coverage for PTA of the carotid artery concurrent with stenting effective October 11, 2023:
Patients don’t have to enroll in a clinical trial.
Facilities don’t need CMS approval to perform this service.
You must engage in formal shared decision-making with the patient.
MACs can decide if this service is covered if it’s not addressed in this NCD.
Your MAC will adjust claims processed in error that you bring to their attention.
Visit the Event Calendar to register today.
Now that Change Healthcare and Optum have restored their customers’ ability to electronically bill Medicare, providers should discontinue submitting paper claim forms.
Revised:
CMS revised the article to show the addition of 4 HCPCS Level II codes to CWF category 58, the effective date, and the web address of CR13574.
New:
Make sure your billing staffs know:
Hospitals may open a new IRF unit at any time during the cost reporting year.
Any IRF unit excluded during a cost reporting year will stay excluded for the rest of the cost reporting year.
View the most recent updates for our LCDs and articles.
Proposed Payment Rule
CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety
News
CMS Roundup (Apr. 5, 2024)
Medicare Shared Savings Program: Application Toolkit Materials
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
Help Improve the Health of Minority Populations
Compliance
Advance Care Planning: Bill Correctly for Services
Claims, Pricers, & Codes
COVID-19 Monoclonal Antibody: New Codes for PEMGARDA
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – April 2024
Publications
Medical Record Maintenance & Access Requirements — Revised
From Our Federal Partners
Extended & Large-Scale Emergency Resources
Highly Pathogenic Avian Influenza Virus: Identification of Human Infection and Recommendations for Investigations and Response
Change Healthcare connections have been transitioned to Optum. Discuss setup changes with your clearinghouse representatives today to resume electronic billing. Paper claims should no longer be submitted as an alternative due to this cybersecurity incident.
All impacted providers are instructed to resume electronic billing as soon as possible.
Did you know? Responding to medical records requests from any Medicare Contractor is a requirement from CMS. Non-response to these requests will result in claim denials. Non-response and insufficient documentation are the most common causes for Comprehensive Error Rate Testing (CERT) denials. To ensure you receive requests verify your “Medicare Record Corresponding Mailing Address” is current in PECOS. Make sure you examine the Additional Documentation Request (ADR) request carefully and submit complete medical record documentation, in a timely manner, to the correct address listed. Visit our Education Spotlight page and our CERT specialty page for CERT information.
Proposed Payment Rules
FY 2025 Skilled Nursing Facility Prospective Payment System Proposed Rule
FY 2025 Inpatient Psychiatric Facilities Prospective Payment System & Quality Reporting Updates Proposed Rule
FY 2025 Hospice Payment Rate Update Proposed Rule
News
ESRD Claims: Manual Update to Revise Section Title & Correct Condition Codes
Compliance
Surgical Dressings: Prevent Claim Denials
Claims, Pricers, & Codes
Medicare Part B Drug Pricing Files & Revisions: April Update
DMEPOS: Provider Level Adjustment Codes on Remittance Advice
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: April 2024 Update
From Our Federal Partners
Providers Accepting CHAMPVA: Enroll in Direct Deposit Now
Increase in Invasive Serogroup Y Meningococcal Disease in the U.S.
Health Care Preparedness Resources
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.
We post new content monthly. Newly topics include Enrolling in electronic billing, Rural emergency hospital guidelines, Behavioral health services and more.
View the most recent updates for our LCDs and articles.
View the most recent updates for our LCDs and articles.
Please read this article for more information.
Proposed Payment Rule
FY 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule
News
CMS Roundup (Mar 22, 2024)
Hospital Price Transparency: Tools to Help Hospitals Comply by July 1
Claims, Pricers, & Codes
Integrated Outpatient Code Editor Version 25.1
MLN Matters® Articles
DMEPOS Fee Schedule: April 2024 Quarterly Update
Electronic Medical Documentation Requests via the Electronic Submission of Medical Documentation System — Revised
This updated article provides claim submission details needed by providers impacted by the recent Change Healthcare cybersecurity incident.
This updated article provides remittance details needed by providers impacted by the recent Change Healthcare cybersecurity incident.
There will be Common Working File (CWF) “dark days” March 29-31, due to the April 2024 release installation. The interactive voice response (IVR) will have limited availability. Additionally, the Customer Contact Center will be closed Friday, March 29.
New:
Make sure your billing staffs know about these payment system updates for April:
New CPT & HCPCS codes.
Covered devices for OPPS pass-through payments
Edit for Level 6 intraocular procedures ambulatory payment classification (APC)
iDose TR (travoprost intracameral implant) for the treatment of glaucoma
Clarification on the OPPS status indicator for the cardiovascular remote interrogation device evaluation
Payment for intensive cardiac rehabilitation services (ICR) in an off-campus, non-excepted provider-based department (PBD) of a hospital
Drugs, biologicals, and radiopharmaceuticals
Skin substitutes
Our Event Calendar has been updated and new events are open for registration.
New:
Make sure your billing staff knows about updates to CY 2024 fee schedule amounts for new and existing DMEPOS codes and changes in payment policy.
News
New Initiative to Increase Investments in Person-Centered Primary Care
Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare
Electronic Funds Transfer: Revised CMS-588 Required on May 1
Health-Related Social Needs FAQs
Promote Kidney Health During National Kidney Month
MLN Matters® Articles
Changes to the Laboratory National Coverage Determination Edit Software: July 2024 Update
Medicare Claims Processing Manual Updates – HCPCS Billing Codes & Advance Beneficiary Notice of Non-coverage Requirements
Please review the Medicare’s annual wellness visit (AWV) telehealth options: Ways to improve your Medicare patient’s access to AWV within this article.
On February 21, CMS issued Change Request (CR) 13294 to implement the Medicare program final action: Treatment of Medicare Part C days in the calculation of a hospital’s Medicare disproportionate patient percentage, to provide guidance for the treatment of Medicare Part C days in the calculation of a provider's Medicare disproportionate share hospital adjustment.
This CR provides guidance to MACs on how to address Medicare cost reports including original notices of program reimbursement currently on hold, reopenings on hold, and remanded Provider Reimbursement Review Board appeals. For additional information, including the background, Final Rule policy, and timelines for MAC actions, please review CR 13294.
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.
We post new content monthly. New topics include LCDs, MSP, global surgery and more.
This updated article provides claim submission and ERA details needed by providers impacted by the recent Change Healthcare cybersecurity incident.
CMS revised the Medicare Enrollment Application - Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588). Please refer to our article for more information.
New:
Make sure your billing staffs know about Newly available codes, Recent coding changes, and how to find NCD coding information.
View the most recent updates for our LCDs and articles.
Updates have been made to the frequently asked questions and the OTP specialty page. Take time to review these updates.
New:
Make sure your staff knows about:
Using HCPCS codes G0402, G0438, and G0439 for billing initial preventive physical examination (IPPE) and annual wellness visit (AWV) services.
Not billing CPT codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for IPPE and AWV services.
Giving your patients an advance beneficiary notice of non-coverage (ABN) for certain preventive services.
News
CMS Roundup (Mar 8, 2024)
Marriage and Family Therapists & Mental Health Counselors: Updated Enrollment FAQs
Skilled Nursing Facilities: Billing Medicare for Respiratory Vaccines
Colorectal Cancer: Screening Saves Lives
Claims, Pricers, & Codes
Web Pricer: Send Us Your Feedback by April 15
ICD-10 Medicare Severity Diagnosis-Related Group Version 41.1 — Updated
MLN Matters® Articles
New Waived Tests
Stay of Enrollment
Publications
Federally Qualified Health Center — Revised
Information for Rural Health Clinics — Revised
Medicare & Mental Health Coverage — Revised
This article provides details needed by providers impacted by the recent Change Healthcare cybersecurity incident.
News
HHS Statement Regarding the Cyberattack on Change Healthcare
Final Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs
Current Status of Blood Tests for Organ Transplant Rejection
Opioid Use Disorder: Medicare Pays for Certain Treatment Services
Skilled Nursing Facility Value-Based Purchasing Program: March Confidential Feedback Reports
Marriage and Family Therapists & Mental Health Counselors: Manual Updates
Nutrition-Related Health Conditions: Recommend Medicare Preventive Services
Compliance
Comprehensive Outpatient Rehabilitation Facility Services: Prevent Claim Denials
Claims, Pricers, & Codes
National Correct Coding Initiative: April Update
RARCs, CARCs, Medicare Remit Easy Print, & PC Print: April Update
Publications
Proper Use of Modifiers 59, XE, XP, XS, & XU — Revised
View the most recent updates for our LCDs and articles.
Educational events reviewing the Novitasphere features are coming soon!
Novitasphere includes features to submit electronic claim files and retrieve remittance information. The Claims Submission/ERA feature in Novitasphere provides a direct connection to the Novitas system to transfer electronic claim files.
New:
Make sure your staff knows about a new provider enrollment status called a stay of enrollment and updates to the Medicare Program Integrity Manual, Chapter 10.
Events
ICD-10 Coordination & Maintenance Committee Meeting — March 19–20
MLN Matters® Articles
Appropriate Use Criteria for Advanced Diagnostic Imaging: CY 2024 Update
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
Publications
Medicare Coverage of Diabetes Supplies
Medicare Ground Ambulance Data Collection System: Tip Sheet for Rural & Super Rural Organizations
This article is for the activation of systemic edits for outpatient prospective payment system (OPPS) providers that have multiple service locations submitting claims to A/B MACs based upon guidance in Special Edition article SE19007.
View the most recent updates for our LCDs and articles.
Novitas seeks your input on establishing pricing under the Medicare program for the 2024 Gapfill laboratory test codes. If you have not already done so, please complete our Molecular diagnostic pathology survey and associated cost worksheet by March 15. Please complete a separate survey and associated cost sheet for each test you perform.
Our Event Calendar has been updated and new events are open for registration.
Effective January 1, 2024, providers and suppliers should no longer include AUC consultation information on Medicare FFS claims. However, claims containing AUC related codes with dates of service in 2023 and 2024 will continue to process. Please read this article for more information.
New:
Make sure your billing staff knows about the next private payor data reporting period: January – March 2025 and new and deleted HCPCS codes.
News
CMS Issues Additional Guidance on Program to Allow People with Medicare to Pay Out-of-Pocket Prescription Drug Costs in Monthly Payments
Compliance
Medical Services Authorized by the Veteran’s Health Administration: Avoid Duplicate Payments
MLN Matters® Articles
Limitation on Recoupment of Medicare Overpayments
Pulmonary Rehabilitation, Cardiac Rehabilitation, & Intensive Cardiac Rehabilitation Expansion of Supervising Practitioners
Publications
Health Equity Services in the 2024 Physician Fee Schedule Final Rule
New:
Make sure your billing staff knows about rescinding of appropriate use criteria (AUC) program regulations, pausing the AUC program for advanced diagnostic imaging for reevaluation, and elimination of AUC consultation information on Medicare Fee-for-Service (FFS) claims.
The Claims Submission/ERA feature in Novitasphere provides a direct connection to the Novitas system to transfer electronic claim files and retrieve electronic reports. This feature, along with the PC-ACE software program, provides a free billing solution for your Medicare claims.
If you are not familiar with Novitasphere, it is our free online portal for providers, billing services, and clearinghouses. The Novitasphere Enrollment eGuide will walk you through the steps needed to gain access.
This article has been updated to include more guidance and examples related to the interrupted stay and lower level of care change (LLOC) billing for skilled nursing facilities (SNFs). To ensure proper billing please take time to review the article.
New:
Make sure your staff knows about limits on recouping of overpayments, when to request an extended repayment plan (ERS) or choose an immediate recoupment, and how we pay interest on overpayments.
News
CMS Roundup (Feb 9, 2024)
Marriage and Family Therapists & Mental Health Counselors: New Specialty Codes for Medicare
Medicare Physician Fee Schedule Database: April Update
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2024 Update
Activation of Validation Edits for Providers with Multiple Service Locations — Revised
Publications
Medicare Preventive Services — Revised
Online registration for the Friday, March 1 open meeting is now available and presenter registration will close at noon ET on Wednesday, February 28. Important: Our open meeting will be held via webinar only. The Novitas Solutions proposed local coverage determinations (LCDs) are now posted.
Open meetings are to allow interested parties the opportunity to make presentations of information and offer comments related to new proposed LCDs and/or the revised portion of a proposed LCD that are in the 45-day open comment period. Interested parties may also request to attend as an observer. If you are interested in attending as a presenter or observer, please view our proposed local coverage determination open meetings web page for specific guidelines and other helpful information.
Please follow the link above to view LCDs posted for comment and notice and an article revision.
New benefit category for marriage and family therapists and mental health counselors effective January 1, 2024.
New:
Make sure your billing staff knows about updates to pulmonary, cardiac, and intensive cardiac rehabilitation services effective January 1, 2024, including expanding the types of practitioners who may supervise these services.
Ensure your staff is aware, CMS has provided clarification regarding the Medicare guidance as described in CMS IOM, Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, section 30.5 that relates to complex administration CPT codes 96401-96549.
Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as long as…
News
Medicare Shared Savings Program: Application Deadlines for a January 1, 2025, Start Date
New Dental Specialty Codes for Medicare
Hospices & Skilled Nursing Facilities: Report All Managing Employees
Skilled Nursing Care & Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: Reminder
Help Address Heart Disease Disparities
Claims, Pricers, & Codes
ICD-10 Medicare Severity Diagnosis-Related Group Version 41.1
Events
Medicare Ground Ambulance Data Collection System: Office Hours Session – February 29
Publications
Medicare Ground Ambulance Data Collection System: Updated GADCS User Guide
On February 8, 2024, all impacted end stage renal dialysis (ESRD) claims, bill types 72x, with dates of service on or after July 1, 2022, were automatically adjusted.
New:
Make sure your billing staffs knows about newly available codes, recent coding changes, and NCD coding information.
News
Participation Continues to Grow in CMS’ Accountable Care Organization Initiatives in 2024
CMS Roundup (Jan 26, 2024)
Claims, Pricers, & Codes
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration
Events
Medicare Cost Report E-Filing System Webinar — February 14
Publications
Medicare Provider Enrollment — Revised
Practitioner & DMEPOS Supplier Information on Power Mobility Devices — Revised
Novitas seeks your input on establishing pricing under the Medicare program for the 2024 Gapfill laboratory test codes. If you have not already done so, please complete our Molecular Diagnostic Pathology Survey and associated cost worksheet by March 15, 2024. Please complete a separate survey and associated cost sheet for each test you perform.
Self-Administered Drug Exclusion List (A53127) has been revised and will become effective March 17, 2024.
The Peripheral Venous Ultrasound LCD is now effective after being posted for notice. The related billing and coding article is also now effective.
Please review our updated article detailing 2024 information.
News
CMS Announces New Actions to Help Hospitals Meet Obligations under EMTALA
CMS Announces New Model to Advance Integration in Behavioral Health
Doctor & Clinician Utilization (Procedure Volume) Data on Medicare.gov Compare Tool: Now Available
Continuous Glucose Monitor Supplies: Option to Bill for 90 Days
Grandfathered Tribal Federally Qualified Health Centers: CY 2024 Rate
Skilled Nursing Facility: Updates to Services Excluded from Consolidated Billing
Poverty: Help Improve Access to Health Care
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
MLN Matters® Articles
Billing Requirements for Intensive Outpatient Program Services for Federally Qualified Health Centers & Rural Health Clinics
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2024 Quarterly Update
How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-on Code G2211
Refillable DMEPOS Documentation Requirements
Several articles have been revised to reflect the 2024 Annual CPT/HCPCS Code updates effective for dates of service on and after January 1.
Our Event Calendar has been updated and new events are open for registration.
Due to scheduled maintenance, the TIBCO Gateway will not be available Saturday, January 27 from 7 a.m. to 3 p.m. ET. We apologize for any inconvenience.
Obtaining the required NPIs and CCNs/PTANs required to be reported on the PAR can be challenging. Review a recently added frequently asked question for guidance.
The annual listing has been updated for the DME MAC and Part B MAC jurisdictions to reflect codes that are either added/discontinued or deleted each year.
New:
Make sure your billing staff knows about IOP scope of benefits, certification and plan of care requirements, payment policies, and coding and billing requirements.
Make sure your billing staff knows about correct use of HCPCS code G2211 and modifier 25, documentation requirements for G2211, and patient coinsurance and deductible.
News
CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process
Acute Hospital Care at Home Data Release
CMS Roundup (Jan 12, 2024)
Medicare Part B Vaccine Administration: CY 2024 Payment Amounts
Glaucoma Awareness Month: Act to Prevent Vision Loss
Events
Immunization Strategies for Long-Term Care: Stories from the Field Webinar — January 31
Medicare Cost Report E-Filing System Webinar — February 14
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: January 2024 Update
Specimen Collection Fees & Travel Allowance: 2024 Update
The Self-Administered Drug Exclusion List posted for notice on November 30, 2023, became effective on January 14.
Payment rates for the opioid treatment program are now available for 2024.
New:
Make sure your billing staff knows updates to the lists of HCPCS codes that are subject to the CB provision of the SNF prospective payment system (PPS). Additions and deletions of certain angiography, chemotherapy, radioisotope, customized prosthetic devices, and blood clotting factors from the Medicare Part A and Part B SNF files.
News
Marriage and Family Therapist & Mental Health Counselor Services: Overpayments to Critical Access Hospitals Billing under Method II
Medicare Part A Cost Report Exhibits: New Electronic Templates
Additional Residency Positions: Apply by March 31
Therapy Services: Per-Beneficiary CY 2024 Threshold Amounts
COVID-19 Vaccine CY 2024 Geographically-Adjusted Payment Rates
Medicare Diabetes Prevention Program: CY 2024 Payment Rates
Ambulance Fee Schedule: CY 2024 Inflation Factor
Medicare Wellness Visits: Healthy Start to 2024
Claims, Pricers, & Codes
Therapy Code List: 2024 Annual Update
Events
Medicare Ground Ambulance Data Collection System Overview Webinar — January 18
From Our Federal Partners
Health Care Preparedness Resources
New:
MM13503 - Specimen Collection Fees and Travel Allowance: 2024 Update
Make sure your billing staffs know about specimen collection fees and travel allowances for 2024 and other policy updates and reminders.
Revised:
CMS made no substantive changes to the article other than to update the web address of the CR transmittal.
CMS made no substantive changes to the article other than to update the web address of the CR transmittal.
The quarterly FAQs have been updated. Please check out our FAQs for answers to your questions.
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with substance use disorders. This article addresses institutional billing requirements for these new services.
News
CMS Roundup (Dec 29, 2023)
In-Home Vaccine Administration: Additional Payment
Organizational Providers: Do You Need to Revalidate Your Enrollment Record Soon?
Value-Based Insurance Design Model: Learn about the Hospice Benefit Component
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
Cervical Health: Encourage Screening
Claims, Pricers, & Codes
Skilled Nursing Facility Consolidated Billing: CY 2024 HCPCS Codes
Integrated Outpatient Code Editor: Version 25.0
MLN Matters® Articles
Ambulatory Surgical Center Payment System: January 2024 Update
New Condition Code 92: Billing Requirements for Intensive Outpatient Program Services
Activation of Validation Edits for Providers with Multiple Service Locations — Revised
New Waived Tests — Revised
The email address for support with the Novitas Learning Center, including questions regarding the MyCEUCertificate Gateway, webinar registration, or WebEx issues has changed to LearningCenterHelpDesk@novitas-solutions.com.
An FAQ has been added relating to the reporting of the JW and JZ modifiers. Please take time to review the recent update.
A new billing and coding article has been added and an LCD and billing and coding articles have been retired. View the recent updates, available on the LCD and article update history page.
New:
Editor's Note:
Happy holidays from the MLN Connects team. We’ll release the next regular edition on Thursday, January 4, 2024.
News
CMS Roundup (Dec 15, 2023)
Opioid Use Disorder Screenings & Treatment: Medicare Pays for Services
Opioid Treatment Programs: New Information for 2024
Skilled Nursing Facility Consolidated Billing: Are You Following the Requirements?
Compliance
Global Surgery: Bill Correctly
Claims, Pricers, & Codes
Vagus Nerve Stimulators: Transitional Pass-through Status for HCPCS Code C1827 — Updated
MLN Matters® Articles
DMEPOS Fee Schedule: CY 2024 Update
Multimedia
Medicare Diabetes Prevention Program Orientation Video
From Our Federal Partners
Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV & Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023–2024 Winter Season
Several billing and coding articles have been revised. View the recent updates, available on the LCD and article update history page.
Our Event Calendar has been updated and new events are open for registration.
A new dedicated national clinical trial number has been added to the billing instructions. Take time to review the updated information.
Direct Data Entry (DDE) providers submitting ambulance mileage services starting on October 2, 2023, were incorrectly receiving reason code 32226. A correction was successfully installed on December 18,2024. Providers should resubmit their claims.
Would you like to know more about how LCDs are developed? Do you have questions about local and national coverage guidelines? Are you interested in how to become more involved in the LCD development process?
Visit our new Journey to LCD Coverage to find more information related to LCDs, including the LCD development process and how to become involved, as well as how local and national coverage guidelines relate to claims processing.
There will be Common Working File (CWF) 'Dark' days from December 29, 2023, through Sunday, December 31, 2023, due to the January 2024 release updates. The interactive voice response (IVR) will have limited availability. Additionally, the Customer Contact Center will be closed Monday, January 1, 2023.
View our new article on Telemedicine and remote services. Several updates have been made to our Telehealth service article and Telehealth specialty page.
News
CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program
Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised
Billing for Flu, Pneumococcal, & COVID-19 Vaccines
Expanded Home Health Value-Based Purchasing Model: October 2023 Interim Performance Reports
Claims, Pricers, & Codes
New Place of Service Code 27 for Outreach Site/Street
National Correct Coding Initiative: January Update
MLN Matters® Articles
Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting & Reporting Data for the Private Payor Rate-Based Payment System — Revised
Clinical Laboratory Fee Schedule: 2024 Annual Update
Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates
Activation of Validation Edits for Providers with Multiple Service Locations — Revised
Publications
Medicare Diabetes Prevention Program Expanded Model — Revised
Rural Emergency Hospitals — Revised
Multimedia
Expanded Home Health Value-Based Purchasing Model: Agency Perspectives Video Series
From Our Federal Partners
Severe & Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico
The following LCD, which was posted for comment on August 3, 2023, has been posted for notice. The LCD and related billing and coding article will become effective January 28, 2024.
The following response to comments article contains summaries of all comments received and Novitas’ responses:
The following billing and coding article has been revised:
The following LCD, related billing and coding article and response to comments article have been retired:
New:
The following LCD, which was posted for notice on October 26, 2023, became effective on December 10, 2023.The related billing and coding article for this LCD is also now effective:
New:
Make sure your billing staff knows about expanding the HHA 36-month rule, moving hospices into the high level of categorical risk-screening, and other updates to Chapter 10 of the Medicare Program Integrity Manual.
News
Citrix Bleed Vulnerability: Act Now
Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now
Health Professional Shortage Area: CY 2024 Bonus Payments
Skilled Nursing Facility Value-Based Purchasing Program: December Confidential Feedback Reports
Flu Shots: There’s Still Time to Protect Your Patients
Claims, Pricers, & Codes
Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration
Discarded Drugs & Biologicals: JZ Modifier Use for Pharmacies
National Correct Coding Initiative: Annual Policy Manual Update
ICD-10: New Procedure Codes Effective April 1
MLN Matters® Articles
Edits to Prevent Payment of G2211 with Office/Outpatient Evaluation and Management Visit and Modifier 25
New Waived Tests
Update for Blood Clotting Factor Add-on Payments — Revised
This article has been updated to include examples related to the reporting of occurrence span code M1 and recommended remarks to include on the claim. Please take time to review the article to ensure proper billing.
News
Quality Payment Program: Preview Your Performance Information by December 12
HIV: Screening is Knowledge
Claims, Pricers, & Codes
Resubmit Telehealth Claims with Modifier CS
Federally Qualified Health Center Prospective Payment System: CY 2024 Pricer
Rural Health Clinic CY 2024 All-Inclusive Rate
MLN Matters® Articles
Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease
ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates
Medicare Physician Fee Schedule Final Rule Summary: CY 2024
Information for Patients
Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings
The following billing and coding articles have been revised:
The following article has been revised and will become effective January 14, 2024:
New:
Make sure your billing staff knows about changes and instructions effective January 1, 2024. Delay in Clinical Laboratory Fee Schedule (CLFS) data reporting period. Mapping for new test codes. Updates for costs subject to the reasonable charge payment.
New:
Make sure your billing staff knows about complexity add-on code G2211. Medicare pays separately starting January 1, 2024. We don’t pay when you report an associated O/O E/M visit with modifier 25.
News
CMS Roundup (Nov 17, 2023)
Provider Enrollment Application Fee: CY 2024
Clinical Laboratory Fee Schedule: CY 2024 Final Payment Determinations & Reporting Delay
Medicare Ground Ambulance Data Collection System: 5 Top Tips
Respiratory Virus Season: Protect Your Patients
Events
Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar — November 29
Ambulance Open Door Forum — November 30
MLN Matters® Articles
Lymphedema Compression Treatment Items: Implementation
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2024 Update —Revised
Publications
New Ownership Reporting Requirements for Providers Using the Form CMS-855A
Intravenous Immune Globulin Demonstration — Revised
Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model — Revised
New:
Make sure your billing staff knows CMS removed NCD 220.6.20 NCD Manual, effective October 13, 2023. Your MACs will make coverage determinations for Positron Emission Tomography (PET beta amyloid imaging for dementia and neurodegenerative disease.
News
Unprecedented Efforts to Increase Transparency of Nursing Home Ownership
Hospital Price Transparency: Use Required CMS Template Layout to Encode Hospital Standard Charge Information
Quality Payment Program: Preview Your Performance Information by December 12
Medicare Participation for CY 2024
Hospice: New Requirement for Physicians Who Certify Patient Eligibility
Medicare Ground Ambulance Data Collection System: CY 2024 Final Policies, Printable Instrument, & FAQs
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
National Rural Health Day: Address Unique Health Care Needs
Lung Cancer: Help Your Patients Reduce Their Risk
Compliance
Skilled Nursing Facility: Appropriate Use of Place-Of-Service Codes
Claims, Pricers, & Codes
Vagus Nerve Stimulators: Transitional Pass-through Status for HCPCS Code C1827 — Updated
MLN Matters® Articles
Home Health Prospective Payment System: CY 2024 Update
Provider Enrollment Changes to the Medicare Program Integrity Manual
Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Claims
Allowing Audiologists to Provide Certain Diagnostic Tests Without a Physician Order — Revised
Multimedia
Home Health Agency Perspectives on Innovation: Panel Materials
The following billing and coding articles have been revised:
The following billing and coding article has been revised:
Update has been made for end stage renal dialysis (ESRD) denying incorrectly with reason code 37187. The mass adjustments have been initiated as Type of Bill 72J on November 7, 2023. These adjustments should be near finalization.
The comment period is now closed for the proposed LCD listed below. Comments received will be reviewed by our contractor medical directors. The response to comments article will be posted to our website when the final LCD is posted for notice.
New:
Make sure your billing staff knows about these changes effective January 1, 2024, Medicare enrollment of MFTs and MHCs, and other provider enrollment policy updates like denial reasons and revocations.
News
CMS Roundup (Nov 3, 2023)
Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now
American Indians or Alaska Natives: Help Your Patients Achieve Optimal Health
Claims, Pricers, & Codes
Home Health Prospective Payment System Grouper: January Update
Events
CMS Hospice Forum — November 14
Optimizing Healthcare Delivery to Improve Patient Lives Conference — November 15
HCPCS Public Meeting — November 28–30
Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar — November 29
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2024 Update
Removal of a National Coverage Determination & Expansion of Coverage of Colorectal Cancer Screening — Revised
Publications
Home Health & Hospice Resources
Independent Diagnostic Testing Facility — Revised
The parameters of who may serve as a Medicare Contractor Advisory Committee (CAC) member were expanded by Change Request 10901 and the companion MLN Matters article. Novitas Solutions invites you to volunteer as a CAC member or alternate to represent your organization during our CAC meetings as part of our LCD development process.
Revised:
CMS made no substantive changes to the Article other than to update the web address of the CR transmittal.
CMS added 2 new CPT codes effective January 1, 2024, based on CR 13279.
CMS made no substantive changes to the Article other than to update the web address of the CR transmittal.
CMS added clarifying information about the -KX modifier for screening colonoscopy claims in the context of a complete colorectal cancer screening.
Update has been made for Direct Data Entry (DDE) providers submitting ambulance mileage services incorrectly receiving reason code 32226. A correction has been developed and is tentatively scheduled for November 27,2023. Providers will be able to resubmit DDE claims that have incorrectly been returned when the correction has been installed.
Final Rules
News
CY 2024 Home Health Prospective Payment System Final Rule
CY 2024 End-Stage Renal Disease Prospective Payment System Final Rule
Behavioral Health: Medicare Pays for 3 Services
Lymphedema Compression: Medicare Pays for Treatment Items
Diabetes: Recommend Preventive Services
Flu Shots Can Take Flu from Wild to Mild
Claims, Pricers, & Codes
Vagus Nerve Stimulators: Transitional Pass-through Status for HCPCS Code C1827
Publications
Interns & Residents Duplicate FTEs Audit Reviews
Expanded Home Health Value-Based Purchasing Model: October Newsletter
Medicare Payment Systems — Revised
The following billing and coding articles have been revised:
The following LCD and related billing and coding article have been retired:
The following billing and coding article has been retired:
News
New:
Make sure your billing staffs knows about newly available codes, recent coding changes, and NCD coding information.
Make sure your billing staffs knows about Newly available codes, Recent coding changes, and NCD coding information.
Medicare providers – please review this notice concerning voluntary refunds for 2023.
News
Help CMS Improve Provider Resources — Respond by November 9
CMS Roundup (Oct 20, 2023)
Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October
Claims, Pricers, & Codes
Conditional Payment Claims: Continue to Submit to Your Medicare Administrative Contractor
Home Health Consolidated Billing Enforcement: CY 2024 HCPCS Code
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
Events
Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar — November 29
MLN Matters® Articles
Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update
Processing Claims Affected by Retroactive Entitlement
Publications
Medicare Secondary Payer: Don’t Deny Services & Bill Correctly — Revised
Information for Patients
2024 Medicare & You Handbook
The following LCD posted for comment on June 1, 2023, has been posted for notice. The LCD and related billing and coding article will become effective December 10, 2023.
The following Response to comments article contains summaries of all comments received and Novitas’ responses:
As a reminder, the comment period for the following proposed LCD is currently open and will close on November 11, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Submit comments
The following billing and coding articles have been revised to reflect the Annual ICD-10 code updates effective for dates of service on and after October 1, 2023:
New:
Make sure your billing staff knows when certain claims are payable beyond the timely filing limit. Also, how to handle claims when you can’t submit a patient assessment.
News
2024 Medicare Parts A & B Premiums and Deductibles
Help CMS Improve Provider Resources — Respond by November 9
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
Health Literacy: Help Your Patients Get Information & Services
Claims, Pricers, & Codes
Discarded Drugs & Biologicals: When to Use JW & JZ Modifiers
Events
Provider Compliance Focus Group Meeting — November 2
Expanded Home Health Value-Based Purchasing Model: Preparing for CYs 2024 & 2025 Webinar — November 9
MLN Matters® Articles
Update for Blood Clotting Factor Add-on Payments
Publications
Complying with Medical Record Documentation Requirements — Revised
Expanded Home Health Value-Based Purchasing Model Resource Index — Updated
From Our Federal Partners
Health Care Preparedness Resources
The following LCD has been revised:
News
CMS Roundup (Oct 6, 2023)
Protect Your Patients: Give Them a Flu Shot
Publications
Direct Data Entry: 10-Digit Screen Expansion
Medicare Preventive Services — Revised
Medicare Provider Compliance Tips — Revised
New:
Make sure your billing staff knows about additional diagnosis codes eligible for payment for blood clotting factors and adjustment of certain claims with the added codes.
The top denial claims, top rejection claims and top returned to provider claims have been updated. Please take time to review this information.
CMS has announced the dollar amount that must remain in controversy to sustain appeal rights beginning January 1, 2024. Please review the article for details.
On October 3, the FDA amended the emergency use authorization of the Novavax COVID-19 vaccine, Adjuvanted to include the 2023–2024 formula to address currently circulating variants to provide better protection against the serious consequences of COVID-19, including hospitalization and death.
In response, CMS updated the payment allowance effective October 3, 2023, for the Novavax vaccine for CPT code 91304. The federal government is not purchasing these products. Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy. Use CPT code 90480 to bill for the administration of the vaccine.
Additionally, codes 0041A, 0042A and 0044A are no longer payable as of October 3, 2023.
As a result of these changes, updates have been made to the following references:
News
The following local coverage articles have been revised:
A document note has been added to the following articles:
News
Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare
CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies
Action Plan for Sickle Cell Disease Month
CMS Burden Reduction News & Insights Fall Newsletter
New COVID-19 Treatments Add-On Payment Ended September 30
Clinical Laboratory Fee Schedule: Submit Your Comments
DMEPOS: New Provider Enrollment Appeals & Rebuttals Contractor Starts October 9
Help Detect Breast Cancer Early
Claims, Pricers, & Codes
RARCs, CARCs, Medicare Remit Easy Print, & PC Print: October Update
Publications
Medicare Provider Compliance Newsletter
Multimedia
Post-Acute Care Quality Reporting Programs: Brief Interview for Mental Status Video
Update has been made for end stage renal dialysis (ESRD) where an error was discovered with the transmission of data from the Eligibility Database (EDB) to the Common Working File (CWF) that resulted in a change in the date of first dialysis. The error began May 1, 2022, and resulted in some beneficiary records reflecting the ESRD eligibility date in the date of first dialysis field rather than the initial date of first dialysis.
October 02, 2023, all beneficiary files have been corrected. Providers may submit adjustments to correct claim payments where the onset adjustment was not applied correctly. Please include remarks on your adjustment submission indicating “onset adjustment correction.”
Representatives from all four DME MAC jurisdictions and the A/B MACs to explain coverage criteria, medical records requirements, certifying physician and practitioner roles. We hope you’ll join the Medicare administrative contractors for this valuable education opportunity!
The webinar is Wednesday, October 17 at noon ET / 11 a.m. CT / 10 a.m. MT. The time is usually one hour. Please register for this educational opportunity.
Please note: The Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L35041/A54117) will not become effective on 10/01/2023.
A new Proposed LCD will be published for comment and presented at an open meeting in the near future.
In the meantime, current coverage has not changed. The following LCD and article remain in effect.
Our Medical Policy team has evaluated all active local coverage articles for any impact in response to the 2024 annual ICD-10-CM code update. The following is a list of the impacted articles. The revised articles will be published to the MCD and on our website towards the end of October. Please continue to watch our website for updates.
Billing and coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and coding: Biomarkers for Oncology (A52986)
Billing and coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and coding: Electroretinography (ERG) (A56672)
Billing and coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and coding: Intraoperative Neurophysiological Testing (A56722)
Billing and coding: Magnetic Resonance Angiography (MRA) (A56085)
Billing and coding: Monitored Anesthesia Care (A57361)
Billing and coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and coding: Oximetry Services (A57205)
Billing and coding: Pharmacogenomics Testing (A58801)
Billing and coding: Psychiatric Codes (A57130)
Billing and coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (A54982)
Billing and coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Billing and coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and coding: Vestibular and Audiologic Function Studies (A57434)
News
CMS Statement on Current Status of Blood Tests for Organ Transplant Rejection
CMS Roundup (Sept 22, 2023)
Cardiovascular Disease: Talk with Your Patients about Screening
Claims, Pricers, & Codes
ICD-10 Coordination & Maintenance Committee: Meeting Materials & Deadlines
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update
Publications
Expanded Home Health Value-Based Purchasing Model: September Newsletter
Checking Medicare Eligibility — Revised
Online registration for the Friday, October 13 open meeting is now available and presenter registration will close at noon ET on Wednesday, October 11. IMPORTANT: Our open meeting will be held via webinar only. The Novitas Solutions proposed Local Coverage Determination (LCD) is now posted.
Open meetings are to allow interested parties the opportunity to make presentations of information and offer comments related to new proposed LCDs and/or the revised portion of a proposed LCD that are in the 45-day open comment period. Interested parties may also request to attend as an observer. If you are interested in attending as a presenter or observer, please view our Proposed Local Coverage Determination Open Meetings page for specific guidelines and other helpful information.
The following LCD and related billing and coding article, which were posted for notice on August 3, 2023, will not become effective at this time. Please refer to below NOTE:
Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L35041)
Billing and Coding: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A54117)
NOTE: Please refer to the current LCD and related article located on our website:
The following proposed LCD has been posted for comment. The comment period will end on November 11, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
The following billing and coding articles have been revised:
The following LCD and related billing and coding article have been retired:
On September 11, the FDA approved and authorized for emergency use updated Moderna and Pfizer-BioNTech COVID-19 vaccines.
In response, CMS identifies an effective date of September 11, for CPT code 90480 and codes 91318-91322. The federal government is not purchasing these products. Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy.
Additionally, codes 91312, 91313, 91314, 91315, 91316, 91317, 0121A, 0124A, 0134A, 0141A, 0142A, 0144A, 0151A, 0154A, 0164A, 0171A, 0172A, 0173A, 0174A are no longer payable as of September 12, 2023.
As a result of these changes, updates have been made to the following references:
News
CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Georgia
Organ Transplantation Affinity Group: Strengthening Accountability, Equity, And Performance
Psychotherapy for Crisis: Medicare Pays for Services
Flu Shot: Encourage Preferred Vaccines for Patients 65+
Help Reduce Health Gaps for Hispanic or Latino Patients
MLN Matters® Articles
Limitation on Recoupment of Overpayments
Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2024 Changes
Information for Patients
HHS Takes the Most Significant Action in a Decade to Make Care for Older Adults & People with Disabilities More Affordable and Accessible
There will be Common Working File (CWF) Dark Days from Friday, Friday, September 29,2023, through Sunday, October 1, 2023, due to the October 2023 release updates. The interactive voice response (IVR) will have limited availability.
New:
Make sure your billing staff knows about these changes of newly available codes, recent coding changes, and how to find NCD coding information.
The comment period is now closed for the following proposed LCD. Comments received will be reviewed by our contractor medical directors. The response to comments article and finalized billing and coding article will be related to the final LCD when it is posted for notice.
Update has been made for end stage renal dialysis (ESRD) denying incorrectly with reason code 37187. A correction has been installed on September 13, 2023. This will prevent claims from continuing to process incorrectly.
Impacted claims will be identified and mass adjusted automatically. We will post an update when the mass adjustments begin.
News
COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older
News
Inflation Reduction Act Continues to Lower Out-of-Pocket Prescription Drug Costs for Drugs with Price Increases Above Inflation
CMS Roundup (Sept 8, 2023)
New Provider Types 2024: Marriage and Family Therapists & Mental Health Counselors
PECOS 2.0 Is Coming Soon
Medicare Secondary Payer: Are You Getting Diagnosis Codes?
Social Determinants of Health: Collect Data with ICD-10-CM Z Codes
ESRD: Submitting Dialysis Claims That Include Capital Related Assets Eligible for the TPNIES
Medicare Physician Fee Schedule Database: October Update
Prostate Cancer: Encourage Your Patients to Get Screened
Claims, Pricers, & Codes
National Correct Coding Initiative: October Update
Integrated Outpatient Code Editor: Version 24.3
MLN Matters® Articles
Ambulatory Surgical Center Payment System: October 2023 Update
DMEPOS Fee Schedule: October 2023 Quarterly Update
Hospital Outpatient Prospective Payment System: October 2023 Update
Publications & Multimedia
Expanded Home Health Value-Based Purchasing Model: Updated Resource & Event Materials
National Government Services (NGS), along with CGS Administrators, Noridian Healthcare Solutions, Novitas Solutions, First Coast Service Options, Palmetto GBA, and WPS Government Health Administrators (WPS), will host a multi-jurisdictional Contractor Advisory Committee (CAC) meeting via teleconference/webinar. Discussions will focus on botulinum toxins.
Date: Thursday, October 19, 2023
Time: 2:00 p.m. to 5:00 p.m. ET
The purpose of the meeting is to obtain advice from subject matter experts (SMEs) regarding the strength of published evidence on botulinum toxins. The SME panel will respond to a series of key questions. CAC panels do not make coverage determinations, but Medicare administrative contractors (MACs) benefit from their advice. The public is invited to attend as observers.
Registration is required. The registration link, agenda, discussion questions, and bibliography are available on the NGS Website.
New:
Make sure your staff knows about how Medicare recoups overpayments and appeals and reconsiderations affect these recoupments.
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our contractor medical directors. The response to comments article and finalized billing and coding article will be related to the final LCD when it is posted for notice.
When submitting a prior authorization request (PAR), be mindful of specific guidelines relating to proper submission to avoid potential non-affirmations. Please review this new article that identities common issues and related recommendations from the Novitas Prior Authorization team to assist with proper submission.
News
New Version of CMS.gov
HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes
CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Florida
Laboratory Tests for Blood Counts: Comparative Billing Report in September
Expanded Home Health Value-Based Purchasing Model: Submit Technical Expert Panel Nominations by September 27
Physicians & Non-Physician Practitioners: Revised Medicare Enrollment Application Required November 1
DMEPOS: New Benefit Category Determinations
Short-Term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic Reports
Healthy Aging: Recommend Services for Your Patients
MLN Matters® Articles
Changes to the Laboratory National Coverage Determination Edit Software: January 2024 Update
Inpatient Psychiatric Facilities Prospective Payment System: FY 2024 Updates
Publications
Evaluation and Management Services Guide — Revised
Multimedia
Medicare Ground Ambulance Data Collection System Video
From Our Federal Partners
Severe Vibrio vulnificus Infections in U.S. Associated with Warming Coastal Waters
Increased Respiratory Syncytial Virus Activity in Parts of Southeastern U.S.: New Prevention Tools Available to Protect Patients
Information for Patients
CMS Hosts Patient-Focused Listening Sessions this Fall
As a reminder, the comment period for the following proposed LCD is currently open and will close on September 16, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Submit comments
The following article, which was posted for notice on July 20, 2023, became effective on September 3, 2023:
Effective 30 days from the posting of this updated article, the description of the service must be reported in the narrative section and must provide enough details for processing. If the description of the service is too large for the narrative field, records should be submitted with the initial claim submission. If we are unable to process the service based on remarks and no records are submitted to support the service billed, the service will be rejected (Part B) or the claim will be returned as unprocessable (Part A) and the claim must be resubmitted with the appropriate information.
Starting approximately around July 17, 2023, some ESRD claims are not receiving reimbursement with reason code 37187 or reimbursing very low amounts for dialysis services.
News
HHS Selects the First Drugs for Medicare Drug Price Negotiation
Medicare Shared Savings Program Saves Medicare More Than $1.8 Billion in 2022 and Continues to Deliver High-quality Care
CMS Issues Draft Guidance on New Program to Allow People with Medicare to Pay Out-of-Pocket Prescription Drug Costs in Monthly Payments
CMS Roundup (Aug. 25, 2023)
CMS.gov Website Refresh – Provide Feedback on Test Website by September 5
Claims, Pricers, & Codes
HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items and Services
Home Health Prospective Payment System Grouper: October Update
Updated ICD-10 Medicare Severity Diagnosis-Related Group Version 41
From Our Federal Partners
Locally Acquired Malaria Cases Identified in Florida, Texas, & Maryland — Important Updates
As a reminder, the comment period for the following proposed LCD is currently open and will close on September 9, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Submit Comments
The following billing and coding articles have been revised:
New:
Make sure your billing staff knows about FY 2024 market basket update, FY 2024 wage index update, and IPF Quality Reporting Program (IPFQR).
News
Seasonal Flu Vaccine Pricing for 2023–2024 Season
Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 Proposals
Behavioral Health Integration Services: Are Your Patients Eligible?
Claims, Pricers, & Codes
HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items & Services
New Place of Service Code 27 – Outreach Site/Street
Events
ICD-10 Coordination & Maintenance Committee Meeting — September 12–13
Optimizing Healthcare Delivery to Improve Patient Lives Conference – November 15
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
Activation of Validation Edits for Providers with Multiple Service Locations — Revised
Prior authorization (PA) for facet joint interventions was effective for dates of service on and after July 1, 2023. The A/B MAC Prior Authorization Collaboration Workgroup developed a new article on facet joint interventions. This new article has been added to the Prior authorization (PA) program for certain hospital outpatient department (OPD) services webpage. Please carefully review this information.
Please take time to review this article on Correctly bill Units for the Tablo home dialysis machine for hemodialysis that has been added to the ESRD specialty page.
New:
Make sure your billing staff knows about private payor data reporting. You must report data between January – March 2024, General specimen collection fee increase, and new and deleted HCPCS codes.
News
CMS.gov Website Refresh – Test Website Available for Feedback
CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in Hawaii Due to Recent Wildfires
Clotting Factor: CY 2024 Furnishing Fee
Claims, Pricers, & Codes
COVID-19: CPT Codes for Vaccines No Longer Authorized
Inpatient Rehabilitation Facility Prospective Payment System: FY 2024 Pricer Update
Skilled Nursing Facility Prospective Payment System: FY 2024 Pricer Update
MLN Matters® Articles
Hospice Payments: FY 2024 Update
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2024 Update
National Coverage Determination 30.3.3 – Acupuncture for Chronic Low Back Pain
Power Seat Elevation Equipment on Power Wheelchairs
Publications
Medicare Provider Enrollment — Revised
The following LCD and related Billing and Coding Article have been retired:
On April 18, 2023, the FDA amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines to simplify the vaccination schedule for most individuals.
In response, CMS added a termination date of April 18, 2023, to the following CPT codes: 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A 91300, 91301, 91305, 91306, 91307, 91308, 91309, 91311.
In addition, CMS added a termination date of June 1, 2023, to the following Janssen CPT codes: 0031A, 0034A, and 91303.
As a result of the change, updates have been made to the following references:
News
Immunization: Protect Your Patients
Claims, Pricers, & Codes
Outpatient Rehabilitation Claims with Reason Code W7072: Do You Need to Resubmit Claims?
MLN Matters® Articles
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: October 2023 Update
Publications
Expanded Home Health Value-Based Purchasing Model: New Resource & Updated FAQs
Multimedia
Skilled Nursing Facility: Minimum Data Set Resident Assessment Instrument Training Materials
New:
Make sure your billing staffs are aware of these changes - newly available codes, recent coding changes, and how to find NCD coding information.
Make sure your billing staff knows about updated frequency edits for acupuncture for chronic low back pain (cLBP), and relevant codes for acupuncture and dry needling services starting January 1, 2024.
New:
Make sure your billing staffs knows about updates to the lists of HCPCS codes that are subject to the CB provision of the SNF prospective payment system. Additions and deletions of certain chemotherapy, blood clotting factors, and therapies inclusion codes from the Medicare Part A SNF files.
Certain outpatient claims that returned in error with CPT codes 98980 and/or 98981 along with revenue codes 42x, 43x and 44x for type of bill 22X, 23X, and 85X, processed on or after January 1, 2023, through implementation of the July 2023 Integrated Outpatient Code Editor quarterly release were corrected on 7/3/2023.
Any claims that have returned in error with reason code W7072 should be resubmitted.
Medical policy
The following LCD which posted for comment on April 14, 2022, and on August 11, 2022, has been posted for notice. The LCD and related billing and coding article will become effective September 17, 2023.
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
The following proposed LCD has been posted for comment. The comment period will end on September 16, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
Submit comments
The following billing and coding articles have been revised:
Online registration for the Friday, August 18, open meeting is now available and will close at noon ET on Wednesday, August 16. Important: Our open meeting will be held via webinar only. Our proposed local coverage determination (LCD) is now posted.
Open meetings are to allow interested parties the opportunity to make presentations of information and offer comments related to new proposed LCDs and/or the revised portion of a proposed LCD that are in the 45-day open comment period. Interested parties may also request to attend as an observer. If you are interested in attending as a presenter or observer, please view our proposed local coverage determination open meetings page for specific guidelines and other helpful information.
Final FY 2024 Payment Rules
Information was updated for not otherwise classified (NOC) and added for end stage renal disease (ESRD) related to the proper use of the JW and JZ modifiers. Please review this article for more information. Additionally, CMS recently update the Medicare Program Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions article.
New:
Make sure your billings staff knows about changes, effective October 1, 2023, billing J0889 for daprodustat, and new ICD-10-CM codes for comorbidity payment adjustment, and acute kidney injury.
Prior authorization (PA) for facet joint interventions was effective for dates of service on and after July 1, 2023. The PA article Hospital outpatient department services frequently asked questions (FAQs) has been updated to include FAQs for facet joint interventions. Please take time to review the updated information. Additionally, a checklist for facet joint interventions has been linked the PA program for certain outpatient department services homepage and general documentation requirements article.
It has been found that not all beneficiary files have been corrected. Providers should wait for updated information before adjusting any claims.
Please continue to monitor our Listservs and our Claims issue page. We will notify you of the appropriate corrective action in the near future.
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Online registration for the Friday, August 11, open meeting is now available and will close at noon ET on Wednesday, August 9. Important: Our open meeting will be held via webinar only. Our proposed local coverage determination (LCD) is now posted.
Open meetings are to allow interested parties the opportunity to make presentations of information and offer comments related to new proposed LCDs and/or the revised portion of a proposed LCD that are in the 45-day open comment period. Interested parties may also request to attend as an observer. If you are interested in attending as a presenter or observer, please view our Proposed local coverage determination open meetings page for specific guidelines and other helpful information.
The following proposed LCD has been posted for comment. The comment period will end on September 9, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
The following draft billing and coding article is related to the above proposed LCD.
On August 1, 2023, CMS will deploy full production activation editing and MACs are instructed to permanently turn on editing for reason codes 34977, 34978, 34984, 34985, 34986, and 34987. These reason codes will be set up to return to provider (RTP) claims that do not match exactly. Validation will be exact matching based on the information on the CMS-855A form submitted by the provider and entered into PECOS. Please review our Hospital off-campus outpatient department reporting article and SE19007 - Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations for guidance.
The edit implementation schedule is as follows:
Implementation Date |
Reason Code(s) |
Region |
8/1/2023 |
34977 and 34978 |
WPS JH, WPS JL |
8/8/2023 |
34977 and 34978 |
Arkansas, Louisiana, Mississippi, and Delaware |
8/15/2023 |
34977 and 34978 |
Oklahoma, District of Columbia, New Jersey, Maryland, and Pennsylvania |
8/22/2023 |
34977 and 34978 |
Colorado, New Mexico, and Texas |
9/5/2023 |
34984 and 34985 |
All states in JH and JL |
9/12/2023 |
34986 and 34987 |
All states in JH and JL |
Visit our calendar of events for our upcoming webinar “Provider - Based Hospital Off-Campus Practice Location Address Requirements” on August 16, 2023.
Please take a moment to review this article on updated addendum D instructions.
The top denial claims, top rejection claims and top returned to provider claims have been updated. Please take time to review this information.
Please review our revised article Appropriate use of not otherwise classified codes when billing drugs and biologicals.
New:
Make sure your billing staffs know about how CMS handles payment for Medicare patients disenrolling from PACE and condition codes and value code we require to prevent claims denials.
Make sure your billing staff knows about edit updates for SNFs billing on type of bill (TOB) 21X, swing bed TOB18X, and hospitals billing during an interrupted stay.
The following billing and coding articles have been revised:
The following article has been revised to reflect the July 2023 CPT/HCPCS code quarterly updates and will become effective September 3, 2023:
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Compliance
Inpatient Admission Before Part A Entitlement: Bill Correctly
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Activation of Validation Edits for Providers with Multiple Service Locations — Revised
Publications
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Noridian Healthcare Solutions along with CGS Administrators, National Government Services (NGS), Palmetto GBA, WPS Government Health Administrators (WPS), First Coast Service Options, and Novitas Solutions will host a Multi-Jurisdictional Contractor Advisory Committee (CAC) Meeting via teleconference. Discussions will focus on cervical fusion.
Date: Wednesday, August 16
Time: 1:00 p.m. to 4:00 p.m. CT (2:00 p.m. to 5:00 p.m. ET)
The Centers for Medicare & Medicaid Services (CMS) assigned Medicare Administrative Contractors (MACs) the task of developing Local Coverage Determinations (LCDs). The purpose of the CAC meeting is to provide a formal mechanism for healthcare professionals to be informed of the evidence used in developing an LCD and promote communications between the MACs and the healthcare community. The CAC panel will discuss the clinical literature related to Cervical Fusion. Discussions will occur between CAC panelists and Contractor Medical Directors. The public may attend; however, questions from the public will not be entertained.
Interested stakeholders are invited to listen via teleconference; however, advance registration is required. Registration deadline to participate by listen-only mode will close on Wednesday, August 16, at 11:00 a.m. CT/noon ET.
Once registered you will receive the teleconference information via email prior to the meeting. Lines will remain muted throughout the conference except for the invited CAC panelists and the MAC hosts.
View meeting details on the Noridian CAC Meeting web page or the Novitas Multi-Jurisdictional CAC Meeting web page.
Note: Complete details will be posted at a later date.
On August 1, 2023, CMS will deploy full production activation editing and MACs are instructed to permanently turn on editing for reason codes 34977, 34978, 34984, 34985, 34986, and 34987. These reason codes will be set up to return to provider (RTP) claims that do not match exactly. Validation will be exact matching based on the information on the CMS-855A form submitted by the provider and entered into PECOS. Please review our Hospital off-campus outpatient department reporting article and SE19007 - Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations for guidance.
The reason code implementation schedule is as follows:
Implementation Date |
Reason Code(s) |
Region |
8/1/2023 |
34977 and 34978 |
WPS JH, WPS JL |
8/8/2023 |
34977 and 34978 |
Arizona, Louisiana, Mississippi, and Delaware |
8/15/2023 |
34977 and 34978 |
Oklahoma, District of Columbia, New Jersey, Maryland, and Pennsylvania |
8/22/2023 |
34977 and 34978 |
Colorado, New Mexico, and Texas |
9/5/2023 |
34984 and 34985 |
All states in JH and JL |
9/12/2023 |
34986 and 34987 |
All states in JH and JL |
Visit our calendar of events for our upcoming webinar “Provider - Based Hospital Off-Campus Practice Location Address Requirements” on July 26, 2023.
It has been found that not all beneficiary files have been corrected. Providers should wait for updated information before adjusting any claims.
Please continue to monitor our Listservs and our Claims issue page. We will notify you of the appropriate corrective action in the near future.
Effective for dates of service on and after July 6, 2023, Medicare will pay for Leqembi (lecanemab-irmb) for monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease. To ensure proper billing please take time to review the article.
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The response to comments article and finalized billing and coding article will be related to the final LCD when it is posted for notice.
Proposed Rules
The following LCD and related billing and coding article have been retired:
As a reminder, the comment period for the following proposed LCD is currently open and will close on July 15, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Submit Comments
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Claims, Pricers, & Codes
Institutional Providers: Resubmit Audiology Claims Returned with Reason Code 34963
Inpatient Prospective Payment System-Excluded Hospitals: Correcting Issue with Excluded Units
ICD-10-CM Diagnosis Codes: FY 2024 Coding Guidelines & Conversion Table
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Expanded Home Health Value-Based Purchasing Model: Overview of the Interim Performance Report Webcast — July 27
MLN Matters® Articles
ICD-10 & Other Coding Revisions to Laboratory National Coverage Determinations: October 2023 Update
Ambulatory Surgical Center Payment System: July 2023 Update — Revised
New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI — Revised
Publications & Multimedia
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas
Expanded Home Health Value-Based Purchasing Model: New Resources
From Our Federal Partners
Rural Emergency Hospitals: Requirements in CMS Emergency Preparedness Final Rule
Learn how to bill for Rebyota fecal microbiota, live-jslm (J1440) to avoid rejections.
Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval
Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following the Food and Drug Administration’s (FDA) move to grant traditional approval to the drug that treats individuals with Alzheimer’s disease. The Centers for Medicare & Medicaid Services had previously announced this would be the case and released more details on coverage.
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CY 2024 Home Health Prospective Payment System Proposed Rule
HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices
CMS Roundup (June 30, 2023)
Skilled Nursing Facility: COVID-19 Enforcement Discretion for Pharmacy Billing Ended June 30
Medicare Providers: Deadlines for Joining an Accountable Care Organization
Help People with Disabilities Get the Care They Need
MLN Matters® Articles
Corrections to Home Health Claims Edits
Publications
Medicare & Mental Health Coverage — Revised
From Our Federal Partners
Wildfire Smoke Exposure Poses Threat to At-Risk Populations
The following LCD and related billing and coding article, which was posted for Notice on June 2, 2023, will not become effective on July 17, 2023, as previously communicated. A new Proposed LCD will be published for comment and presented at an open meeting in the near future. Please continue to watch our website for updates.
The following LCDs will remain in effect at this time:
The following billing and coding article has been revised:
As a reminder, the comment period for the following proposed LCD is currently open and will close on July 15, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
New:
Make sure your billing staffs are aware of these changes newly available codes, recent coding changes, and how to find NCD coding information.
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