December Medicare Transmittals and Other Updates
2018 Annual Update to the Therapy Code List
Updates the list of “sometimes therapy” and “always therapy” codes with new codes for 2018.
Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Application of Oxygen)
Effective April 3, 2017, coverage of topical oxygen for the treatment of chronic wounds will be determined by the MACs.
Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services
Describes replacement of HCPCS codes G0202, G0204, and G0206 with CPT codes 77067, 77066, and 77065, effective January 1, 2018. Also applies the waiver of deductible and coinsurance to 76706, 77067, prolonged preventive services, and anesthesia services furnished in conjunction with and in support of colorectal cancer services.
Payment Reduction for X-Rays Taken Using Computed Radiography
Announces a 7% payment reduction for computed radiography x-rays for CY 2018 – CY 2020 and a 10% reduction for CY2023 and beyond.
Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
The Calendar Year (CY) 2018 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests and updates for laboratory costs subject to the reasonable charge payment.
January 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.0
Updates to the Integrated Outpatient Code Editor (I/OCE) instructions and specifications that Medicare uses under the Outpatient Perspective Payment (OPPS) and Non-OPPS for hospital outpatient departments, and other select providers.
January 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Changes to the OPPS to be implemented in the January 2018 update.
Summary of Policies in the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List
A summary of policies in the Calendar Year (CY) 2018 MPFS Final Rule and announces the Telehealth Originating Site Facility Fee payment amount and makes other policy changes related to Medicare Part B payment. These changes are applicable to services furnished in CY 2018.
Medicare Special Edition Articles
Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program – REVISED
Revisions concerning Remittance Advice and MSN modifications, implementation of HETS QMB, and clarification that QMBs cannot elect to pay Medicare cost-sharing but may need to pay a small Medicaid copay in certain circumstances.
Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other Facilities – REVISED
Revised to include information from OIG report.
Inpatient Rehabilitation Facility (IRF) Medical Review Changes
In order for IRF services to be covered, submitted documentation must sufficiently demonstrate that a beneficiary’s admission to an IRF was reasonable and necessary, according to Medicare guidelines.
Medicare Coverage Updates
Proposed Decision Memo for Implantable Cardioverter Defibrillators (CAG-00157R4)
Proposed changes to NCD 20.4 for ICDs.
Medicare Press Releases
First Breakthrough-Designated Test to Detect Extensive Number of Cancer Biomarkers
On November 30, FDA approved the FoundationOne CDx (F1CDx), the first breakthrough-designated, Next Generation Sequencing (NGS)-based In Vitro Diagnostic (IVD) test that can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type. CMS at the same time proposed coverage of the F1CDx.
CMS Finalizes Comprehensive Care for Joint Replacement Model Changes, Cancels Episode Payment Models & Cardiac Rehabilitation Incentive Payment Model
On November 30, CMS finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model.
Medicare Educational Resources
Inpatient Rehabilitation Facility Reference Booklet
This guide provides education about common documentation errors, scenarios and solutions for IRF services identified by Medicare Administrative Contractors and the Comprehensive Error Rate Testing (CERT) program.