Knowledge Base Article

Medicare MLN Articles & Transmittals

Section 127 of the Consolidated Appropriations Act: Graduate Medical Education (GME) Payment for Rural Track Programs (RTPs)

• Article Release Date: April 28, 2022
• What You Need to Know: Your billing staff needs to be aware of a new definition for RTPs, changes in Section 127 of the Consolidated Appropriations Act (CAA), 2021, and the documentation requirements for hospitals requesting indirect and direct GME rate increases.
• MLN MM12709: (link)

Update of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 – Ambulance

• Article Release Date: April 28, 2022
• What You Need to Know: This article reports an update to the Medicare Claims Processing Manual. It also provides background guidance on how ambulance providers should bill for Medicare Part B ambulance services when a patient dies before the ambulance arrives and when a patient dies after being loaded on the ambulance.
• MLN MM12707: (link)

Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as Certain Colorectal Cancer Screening Tests

• Article Release date: April 29, 2022
• What You Need to Know: Beginning January 1, 2022, CMS began to gradually reduce the coinsurance for any procedure beyond a planned colorectal cancer screening test until the procedure is completely free for dates of service on or after January 1, 2030.
• MLN MM12656: (link)

Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model – Implementation

• Article Release Date: April 29, 2022
• What You Need to Know: Information in this article is for hospices, hospitals, and suppliers billing MACs for services provided to Medicare hospice patients enrolled in Medicare Advantage (MA) plans participating in the voluntary Value-Based Insurance Design (VBID) Model’s Hospice Benefit component.
• MLN MM12688: (link)

Quarterly Update for Clinical Laboratory Fee Scheduled (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

• Article Release Date: May 5, 2022
• What You Need to Know: Links in this article will help you find updates pertaining to Advanced Diagnostic Laboratory Tests (ADLTs) and new codes effective July 1, 2022.
• MLN MM12737: (link)

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)---October 2022

• Article Release Date: May 9, 2022
• What You Need to Know: There are no policy changes in this ICD-10 quarterly update. Updates do include newly available codes.
• MLN MM12705: (link)

Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.42

• Article Release Date: May 9, 2022
• What You Need to Know: CMS updated the Medicare coverage for pneumococcal vaccinations to align with the Advisory Committee on Immunization Practices (ACIP) recommendations that vary based on patient age and risk factors.
• MLN MM12723: (link)

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – July 2022 Update

• Transmittal 11408 (Change Request 12747) Release Date: May 12, 2022
• What You Need to Know: CR 12747 details information about new HCPCS and CPT codes, new G codes for the 180-day monitoring period for continuous glucose monitoring (CGM), and codes that are no longer valid.
• Transmittal 11408 (CR 12747): (link)

Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms

• MLN Release Date: May 12, 2022
• What You Need to Know: CMS published this Special Edition (SE) article to alert those that bill Durable Medical Equipment (DME) for services and supplies provided to Medicare patients that effective January 1, 2023, CMS will no longer require Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs)
• MLN SE22002: (link)

Revised Medicare MLN Articles & Transmittals

New Waived Tests

• Article Release Date: January 18, 2022 – Revised April 27, 2022
• What You Need to Know: CR 12581 changed the HCPCS code for the Cardinal Health H. Pylori Rapid Test – Whole Blood/Serum Cassette (Whole Blood) to 86318QW. This MLN article was updated to reflect the code change.
• MLN MM12581: (link)

Update to Chapter 7, “Home Health Services”, of the Medicare Benefit Policy Manual (Pub 100-02)

• Article Release Date: March 28, 2022 – Revised April 28, 2022
• What You Need to Know: CR 12615 changed the background and policy sections of the CR’s business requirements and manual attachment. This MLN article was updated to reflect the changes.
• MLN MM12615: (link)

Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers

• Article Release Date: March 30, 2022 – Revised May 5, 2022
• What You Need to Know: This article was revised to show that RHCs must include modifier CG on claims for mental health visits via telecommunications.
• MLN SE22001: (link)