Knowledge Base Article

Medicare MLN Articles & Transmittals

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year (FY) 2020 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs)

• Article Release Date: February 24, 2022
• What You Need to Know: This MLN article was revised to reflect a revised Change Request (CR) 12403. HCPCS G0465 was added and additional information for HCPCS G0460 was also added. Also, the implementation date has been revised to February 14, 2022.
• MLN MM12628: (link)

April 2022 Update to the Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS)

• Article Release Date: March 7, 2022
• What You Need to Know: This article provides information about coding needs and coding criteria for reprocessing inpatient claims involving Pfizer’s PAXLOVID™ or Merk’s Molnupiravir. Both drugs were granted FDA emergency use authorization in December 2021.
• MLN MM12631: (link)

One-Time Notification: Correction to Processing When Osteoporosis Drugs are Billed for Other Indications

• Transmittal Release Date: March 9, 2022
• What You Need to Know: This Change Request (CR) 12551 permanently removes an edit requiring osteoporosis drugs be billed only by home health agencies.
• Transmittal 11290 (CR 12551): (link)

April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

• Article Release Date: March 11, 2022
• What You Need to Know: This article provides information about the April 2022 quarterly update for the DMEPOS fee schedule and fee schedule amounts for new and existing codes.
• MLN MM12654: (link)

Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

• Article Release Date: March 18, 2022
• What You Need to Know: Make sure your billing staff knows about how to code for difelikefalin injection and modifier use for code J0879.
• MLN MM12583: (link)

April 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)

• Transmittal 11305/Change Request 12666 Release Date: March 24, 2022
• What You Need to Know: The effective date for the updates is April 1, 2022. Examples of items included in this update are:
• o New COVID-19 CPT vaccines and administration codes,
• o Changes for COVID-19 monoclonal antibody therapy product and administration codes,
• o A new HCPCS code describing the InSpace Subacromial Tissue Spacer System procedure to treat irreparably torn rotator cuff tendons, and
• o New separately payable procedure codes for medical procedures.
• Link to CR 12666: (link)

April 2022 Update of the Ambulatory Surgical Center (ASC) Payment System

• Article Release Date: March 24, 2022
• What You Need to Know: Changes to make your billing staff aware of (updates to payment rates for separately payable procedures, services, drugs, and biologicals and descriptors for newly created CPT and Level II HCPCS codes) are detailed in this MLN article.
• MLN MM12679: (link)

Revised Medicare MLN Articles & Transmittals

Internet-Only Manual Updated for Critical Care Evaluation and Management Services

• Article Release Date: Initial article January 22, 2022 – Revised March 2, 2022
• What You Need to Know: This article was revised to reflect a revised Change Request (CR). All other information is the same. As a reminder, CMS has added language to the definition of a Global Surgical Package to direct you to critical care updates in section 30.6.12.7 of the Medicare Claims Processing Manual, Chapter 12.
• MLN MM12550: (link)

Coverage Updates

Revisions to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache)

• Article Release Date: February 16, 2022
• What You Need to Know: You will learn about revisions to NCD 240.2 and 240.2.2. For example, CMS notes that “Medical documentation requirements aren’t contained within the revised NCDs. The absence of medical documentation in these revised NCDs doesn’t otherwise remove or modify Medicare requirements of the Certificate of Medical Necessity (CMN) Form 484 itself or other medical documentation requirements under other existing authorities.”
• MLN MM12607: (link)

March 1, 2022: CMS Posts New Tracking Sheet for the Cochlear Implantation NCD (50.3)

According to a new Tracking Sheet link), “this NCD analysis will align with the scope of the request and focus on individuals with hearing test scores of > 40% and ≤ 60%, for whom coverage is available only when the provider is participating in, and patients are enrolled in a clinical study.” The initial public comment period is from March 1, 2022, to March 31, 2022.