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January 2022 Medicare Transmittals and Coverage Updates

Published on 

Wednesday, January 26, 2022

 | Billing 
 | Coding 
 | Medicare Coverage 
 | Outpatient Services 

Medicare MLN Articles & Transmittals – Recurring Updates

Clinical Laboratory Fee Schedule – Medicare Travel Allowance for Collection of Specimens
  • • Article Release Date: January 18, 2022
  • • What You Need to Know: This article provides information about CY 2022 changes to travel allowances when you bill on a per mileage basis and on a flat rate basis.
  • • MLN MM12593: https://www.cms.gov/files/document/mm12593-clinical-laboratory-fee-schedule-medicare-travel-allowance-fees-collection-specimens.pdf
Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Visits, Teaching Physicians, and Physician Assistants
  • • Article Release Date: January 18, 2022
  • • What You Need to Know: You will learn about Medicare manual revisions for critical care services, split/shared E&M visits, teaching physician services and physician assistant billing and payment.
  • • MLN MM12543: https://www.cms.gov/files/document/mm12543-internet-only-manual-updates-iom-critical-care-split-shared-evaluation-and-management-visits.pdf
New Waived Tests
  • • Article Release Date: January 18, 20221
  • • What You Need to Know: You will learn about the latest tests approved by the FDA as waived tests under CLIA, laboratory claim edits, and facility certification requirements.
  • • MLN MM12581: https://www.cms.gov/files/document/mm12581-new-waived-tests.pdf
CY 2022 Telehealth Update Medicare Physician Fee Schedule
  • • Article Release Date: January 19, 2022
  • • What You Need to Know: There are two additional modifiers for CY 2022 for telehealth services and this article includes a link to the updated telehealth services list.
  • • MLN MM12549: https://www.cms.gov/files/document/mm12549-cy2022-telehealth-update-medicare-physician-fee-schedule.pdf
Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement (CLIA) Edits
  • • Article Release Date: January 20, 2022
  • • What You Need to Know: You will learn about discontinued and new HCPCS codes and which codes are subject to and excluded from CLIA edits.
  • • MLN MM12573: https://www.cms.gov/files/document/mm12573-healthcare-common-procedure-coding-system-hcpcs-codes-subject-and-excluded-clinical.pdf
Expedited Review Process for Hospital Inpatients in Original Medicare
  • • Article Release Date: January 21, 2022
  • • What You Need to Know: CMS has reformatted the manual section of chapter 30 of the Medicare Claims Processing Manual to improve “readability and understanding.” CMS makes a point to note in bold font that no policy or instructional changes have been made.
  • • MLN MM12546: https://www.cms.gov/files/document/mm12546-expedited-review-process-hospital-inpatients-original-medicare.pdf

Revised Medicare MLN Articles & Transmittals

International Classification of Diseases, 10th revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) – April 2022 (CR 1 of 2)
  • • Article Release Date: Initial article November 1, 2021 – Revised January 13, 2022
  • • What You Need to Know: The CR release date, transmittal number, and the web address of the CR has been updated. The revisions did not affect the substance of the article.
  • • MLN MM12480: https://www.cms.gov/files/document/mm12480-international-classification-diseases-10th-revision-icd-10-and-other-coding-revisions.pdf
Calendar year (CY) 2022 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
  • • Article Release Date: Initial article December 13, 2021 – Revised January 13, 2022
  • • What You Need to Know: This article was revised to show the delay in the CLFS data reporting period for clinical diagnostic lab tests and note the delay in the application of the 15% phase-in reduction.
  • • MLN MM12558: https://www.cms.gov/files/document/mm12558-calendar-year-cy-2022-annual-update-clinical-laboratory-fee-schedule-and-laboratory-services.pdf

Medicare Coverage Updates

January 11, 2022: Proposed Decision Memo for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease

CMS published a Proposed Decision Memorandum (https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&ncaid=305&fromTracking=Y&)88 in which they are proposing to cover FDA approved monoclonal antibodies that target amyloid for the treatment of Alzheimer’s disease through Coverage with Evidence Development (CED). The public comment period is from January 11, 2022 through February 20, 2022. You can read more about this proposed policy in a related CMS Press Release (https://www.cms.gov/newsroom/press-releases/cms-proposes-medicare-coverage-policy-monoclonal-antibodies-directed-against-amyloid-treatment)88.

Medicare Educational Updates

CMS MLN Fact Sheet: Original Medicare vs. Medicare Advantage

This MLN Fact Sheet (https://www.cms.gov/files/document/mln8659122-original-medicare-vs-medicare-advantage.pdf)88 describes what providers need to know about how different coverage affects seeing patients, processing claims and filing appeals.

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.