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July 2024 Monthly Medicare Updates

Published on 

Monday, August 12, 2024

 | Case Management 
 | Coding 
 | Documentation 
 | Medicare Coverage 

Medicare Transmittals & MLN Articles

June 24, 2024: Changes to the Laboratory National Coverage Determination Edit Software: October 2024 Update

CMS advises providers to make sure your billing staff know about newly available codes, recent coding changes, and how to find NCD coding information.

https://www.cms.gov/files/document/mm13672-changes-laboratory-national-coverage-determination-edit-software-october-2024-update.pdf

 

June 25, 2024: MLN MM13656: Ambulatory Surgical Center Payment Update – July 2024

Initially released on June 13, 2024, this article was updated to remove HCPCS codes J3393, J3394, J9172, J9322, and J9324 from table of the change request, which now has 12 codes. https://www.cms.gov/files/document/mm13656-ambulatory-surgical-center-payment-update-july-2024.pdf

 

June 25, 2024: MLN MM13487: Diabetes Screening & Definitions Update: CY 2024 Physician Fee Schedule Final Rule

Initially released May 3, 2024, this article was updated to clarify claims processing requirements for ICD-10-CM diagnosis code Z13.1 and previously processed claims. https://www.cms.gov/files/document/mm13487-diabetes-screening-definitions-update-cy-2024-physician-fee-schedule-final-rule.pdf

 

June 27, 2024: Change Request (CR) 13649: Utilization of KX Modifier Medicare Physician Fee Schedule Payment for Dental Services Inextricably Linked to Covered Medical Services

This CR provides instructions to A/B MACs regarding usage of the KX modifier for dental services inextricably linked to covered medical services under the Medicare Physician Fee Schedule. CMS includes four examples of types of evidence that providers must submit to demonstrate the inextricable link between the dental service and covered medical service. https://www.cms.gov/files/document/r12702otn.pdf

 

July 18, 2024: MLN MM13717: Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: October Update

Make sure your billing staff knows about the next private payor data reporting period of January 1, 2025 – March 31, 2025, and new and deleted HCPCS codes.

https://www.cms.gov/files/document/mm13717-clinical-laboratory-fee-schedule-laboratory-services-reasonable-charge-payment-october.pdf

 

July 18, 2024: MLN MM13286: Lymphedema Compression Treatment Items: Implementation

Now in it’s fourth iteration, this MLN article was updated on July 18th to add information on how to prevent claims denial due to duplicate payments for compression bandaging systems. https://www.cms.gov/files/document/mm13286-lymphedema-compression-treatment-items-implementation.pdf

 

Compliance Education Updates

July: CMS’ Oral Health Cross-Cutting Initiative Fact Sheet

In the July 25, 2024, edition of MLN Connects, CMS released this Fact Sheet noting that overall health and well-being are impacted by oral health, affecting individuals, families, and communities. CMS is committed to eliminating barriers to oral health as part of our broader goal of improving quality, equity, and outcomes in the health care system. The CMS Oral Health Cross-Cutting Initiative aligns our programs and policies to better address oral health needs, and the fact sheet highlights this important work and accomplishments to date.

 

June 27, 2024: CDC Recommendations Updated 2024-2025 COVID-19 and Flu Vaccines for Fall/Winter Virus Season

The CDC encourages providers to begin their influenza vaccination planning efforts now and to vaccinate patients as indicated once 2024-2025 influenza vaccines become available.

https://www.cdc.gov/media/releases/2024/s-t0627-vaccine-recommendations.html

 

July 10, 2024: CY Proposed Rules Hospital OPPS/ASC CY 2025 Proposed Rule and Physician Fee Schedule Proposed Rule (CMS-1807-P) – Medicare Shared Savings Program and Proposals

 

CY 2025 OPPS/ASC Proposed Rule

 

July 30, 2025: Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F)

The FY 2025 payment update percentage is 2.9% (an estimated increase of $790 million in payments from FY 2024).

 

Link to related CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2025-hospice-payment-rate-update-final-rule-cms-1810-f

 

July 31, 2024: FY 2025 Inpatient Rehabilitation Facility PPS Final Rule (CMS-1804-F)

In this final rule, CMS finalized the update to the IRF PPS payment rates by 3.0%. In addition to annual updates, this rule includes an update to the IRF PPS wage index using the latest Core-Based Statistical Areas (CBSAs) from the OMB and provides a transition for those IRFs who lose the rural adjustment due to their labor market area transitioning from rural to urban.

 

Link to related CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-inpatient-rehabilitation-facility-prospective-payment-system-final-rule-cms-1804-f

July 31, 2024: FY 2025 Medicare Inpatient Psychiatric Facilities PPS (IPF PPS) and Quality Reporting (IPFQR) Updates Final Rule (CMS-1806-F)

CMS is updating the IPF PPS payment rates by 2.8%, total estimated payments to IPFs are estimated to increase by 2.5%, or $65 million, in FY 2025 related to IPF payments in FY 2024. Among other things, this rule finalizes CMS’ proposal to revise patient-level adjustment factors and to increase the per-treatment amount for Electroconvulsive Therapy (ECT).

 

Link to related CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-medicare-inpatient-psychiatric-facilities-prospective-payment-system-ipf-pps-and-0

 

July 31, 2024: Fiscal Year 2025 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1802-F)

CMS is updating SNF payment policies, which would result in a net increase of 4.2%, or approximately $1.4 billion, in Medicare Part A payments to SNFs in FY 2025. CMS finalized changes in the Patient-Driven Payment Model (PDPM) ICD-10 Code Mappings to allow providers to provide more accurate, consistent, and appropriate primary diagnoses that meet the criteria for skilled intervention during a Part A SNF stay.

 

Link to related CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-skilled-nursing-facility-prospective-payment-system-final-rule-cms-1802-f

 

New Alzheimer’s Drugs: Updates to CMS National Patient Registry

On July 2, 2024, CMS announced that Medicare coverage is now available for Kisunla™ (donanemab-azbt) following the FDA’s move to grant traditional approval to the drug that treats people with Alzheimer’s disease. Kisunla joins Leqembi® (the brand name for lecanemab-irmb) as the second monoclonal amyloid beta antibody treatment granted traditional FDA approval for Alzheimer’s disease.

Medicare Part B covers these 2 drugs with traditional FDA approval in this class when a prescribing clinician or their staff decides the Medicare coverage criteria are met and submits information to help answer treatment questions in a qualifying study.

More Information:

Medicare Coverage for Alzheimer’s Drugs fact sheet: information for your patients
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.