Knowledge Base Article

Medicare Transmittals & MLN Articles

November 22, 2023: MLN MM13452: Medicare Physician Fee Schedule Final Rule Summary: CY 2024

This article highlights changes in the CY 2024 Physician Fee Schedule final rule. For example, starting in CY 2024, telehealth services provided to people in their homes will be paid at the non-facility PFS rate. https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf

November 30, 2023: Change Request (CR) 13312: Indian Health Services (IHS) Rural Emergency Hospital (REH) Provider Enrollment

Beginning January 1, 2024, a tribal or IHS operated hospital that converts to an REH (IHS-REH) that provides hospital outpatient services to a Medicare beneficiary may be paid under the outpatient hospital All-Inclusive rate that is established and published annually by the IHS, rather than the rate for REH services. This CR updates Chapter 10 of the CMS Publication 100-08 (Medicare Program Integrity Manual) to include provider enrollment guidance regarding IHS-REHs. https://www.cms.gov/files/document/r12217pi.pdf

December 7, 2023: MLN MM13333: Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates

This article includes information about expanding the HHS 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. https://www.cms.gov/files/document/mm13333-medicare-program-integrity-manual-cy-2024-home-health-prospective-payment-system-updates.pdf

December 7, 2023: MLN SE19007: Activation of Validation Edits for Providers with Multiple Service Locations – Revised

The December 7^th revision of this special edition MLN article adds information on how to verify and update service locations for Medicare enrollment and what claim modifier to use. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se19007.pdf

December 12, 2023: MLN MM13463: DMEPOS Fee Schedule: CY 2024 Update

Make sure your billing staff knows about CY 2024 fee schedule amounts for new and existing codes and payment policy changes. For example, the CY 2024 HH PPS final rule established a new benefit category for standard and custom fitted compression garments and additional lymphedema compression treatment items under Medicare Part B. https://www.cms.gov/files/document/mm13463-dmepos-fee-schedule-cy-2024-update.pdf

December 20, 2023: Change Request (CR) 13222: Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92

Effective January 1, 2024, Section 4124 of the Consolidated Appropriations Act of 2023 establishes Medicare coverage and payment for IOP services for individuals with mental health needs when furnished by hospital outpatient departments, Critical Access Hospital outpatient departments, and Community Mental Health Centers. The original Transmittal 12125 has been rescinded and replaced by Transmittal 12423 (CR 13222) dated December 20, 2023. The purpose of this CR is to implement the new condition code 92 for IOP services and enforce billing requirements (https://www.cms.gov/files/document/r12423cp.pdf). Additional information about condition code 92 is available in a related MLN article 13496. https://www.cms.gov/files/document/mm13496-billing-requirements-intensive-outpatient-program-services-new-condition-code-92.pdf

December 21, 2023: MLN MM13481: Ambulatory Surgical Center Payment System: January 2024 Update

Make sure your billing staff knows about system updates for January, including new codes for covered devices for pass-through payments, biology-guided radiation therapy, dental services, surgical procedures, drugs and biologicals, and skin substitutes. https://www.cms.gov/files/document/mm13481-ambulatory-surgical-center-payment-system-january-2024-update.pdf

December 26, 2023: MLN SE19007: Activation of Validation Edits for Providers with Multiple Service Locations – REVISED

Coverage Updates

December 5, 2023: CMS Released National Coverage Determination (NCD) Dashboard

This NCD Dashboard was last updated November 15, 2023. At that time there were 7 NCDs on the wait list, 2 open NCDs and 3 NCDs finalized in the past 12 months. https://www.cms.gov/files/document/ncd-dashboard.pdf

December 7, 2023: Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) Proposed Decision Memo

CMS received a formal request to reconsider NCD 110.23. Specifically, the American Society of Hematology (ASH), the American Society for Transplantation and Cellular Therapy, the National Marrow Donor Program, and the Center for International Blood and Marrow Transplant Research requested full coverage of allogeneic HSCT for individuals with MDS and the removal of the Coverage with Evidence Development (CED) requirement currently tied to coverage for HSCT for Medicare beneficiaries with MDS.

The proposed decision memo public comment period began December 7, 2023, and ends January 6, 2024. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?NCAId=312

Compliance Education Updates

November 2023: MLN Fact Sheet: Rural Emergency Hospitals

This MLN Fact Sheet was updated to add subsection (d) and Indian Health Services (IHS) hospitals information, add CY 2023 and CY 2023 payment amounts and cost reporting information, and add Technical Assistance Center information. https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf

December 2023: MLN Fact Sheet: Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier

CMS has updated this Fact Sheet to include information on what modifiers different categories of 340B covered entities should use in CY 2024 and starting January 1, 2025. https://www.cms.gov/files/document/mln4800856-medicare-part-b-inflation-rebate-guidance-use-340b-modifier.pdf  

Other Updates

November 29, 2023: New ICD-10-PCS Codes Effective April 1, 2024

CMS is implementing 41 new procedure codes into ICD-10-PCS effective April 1, 2024. They will update the grouper software, code tables, index, and related files by February 1. https://www.cms.gov/files/document/icd-10-ms-drgs-v411-effective-april-1-2024.pdf

New Respiratory Syncytial Virus (RSV) Vaccine Administration CPT Codes

CMS included the following information in the December 7, 2023 edition of MLN Connects:

If your patient does not have Medicare Part D, they will pay for vaccine administration but not the vaccine under Part B. CMS retroactively added two new CPT codes for RSV vaccine administration to the Medicare Physician Fee Schedule effective for dates of service on and after October 6, 2023:

• CPT 96380: Short Descriptor: Admn rsv monoc antb im cnsl,
• CPT 96381: Short Descriptor: Admn rsv monoc antb im njx

Your Medicare Administrative Contractor will adjust claims you bring to their attention. Get information about vaccine coverage under Medicare Part D (PDF).