NOTE: All in-article links open in a new tab.

November 2022 Medicare Transmittals, Coverage and Compliance Education Updates

Published on 

Wednesday, November 30, 2022

 | Billing 
 | Coding 
 | Medicare Coverage 
 | Outpatient Services 

Medicare Transmittals & MLN Articles

Telehealth Home Health Services: New G-Codes
  • MLN Release Date: November 2, 2022
  • What You Need to Know: Starting on or after January 1, 2023, Home Health (HH) providers may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. Starting July 1, 2023, providers will be required to report this information. This MLN article details the three G-codes that will need to be used when submitting the use of telecommunication technology on the HH claim.
  • MLN MM12805: link)
Billing for Hospital Part B Inpatient Services
  • Transmittal Issue Date: November 9, 2022.
  • What You Need to Know: The purpose of this Change Request (CR) 12965 is to provide billing instructions for hospital Part B inpatient services. For example, effective 7/1/2022 three new “Not Allowed Revenue Codes” were added to the list of codes a Medicare Administrative Contractor will set a revenue code edit to prevent payment on Type of Bill 012X. The implementation date for the updates is December 12, 2022.
  • CR 12965: link)
ESRD & Acute Kidney Injury Dialysis: CY 2023 Updates
  • MLN Release Date: November 10, 2022
  • What You Need to Know: This article details information about rates and policies for the ESRD Prospective Payment System and payment for renal dialysis services provided to patients with acute kidney injury in ESRD facilities.
  • MLN MM12978: link)
Home Health Prospective Payment System: CY 2023 Updates
  • MLN Release Date: November 10, 2022
  • What You Need to Know: This article highlights changes related to 30-day period payment rates, national per-visit amounts, and cost-per-unit payment amounts used for calculating outlier payments under the Home Health Prospective Payment System. These changes will be effective January 1, 2023.
  • MLN MM12957: link)
Medicare Physician Fee Schedule Final Rule Summary: CY 2023
  • MLN Release Date: November 17, 2022
  • What You Need to Know: This article details updates effective January 1, 2023 to the telehealth originating site facility fee payment amount, expansion of coverage for colorectal cancer screening, coverage of audiology services, and other covered services.
  • MLN MM12982: link)
New Waived Tests
  • MLN Release Date: November 23, 2022
  • What You Need to Know: This article highlights seven newly added waived complexity tests that must have the modifier QW to be recognized as a waived test.
  • MLN MM12996: link)

Revised Medicare MLN Articles & Transmittals

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2023
  • MLN Release Date: September 6, 2022 – Revised November 10, 2022
  • What You Need to Know: This article was revised due to a revised Change Request (CR) 12888. No substantive changes were made to the article.
  • MLN MM12888: link)

Coverage Updates

ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2023 Update
  • MLN Release Date: November 9, 2022
  • What You Need to Know: This MLN is related to CR 12960 which is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. Relevant NCD coding changes in CR 12960 include:
    • NCD 20.4 (Implantable Automatic Defibrillators ICDs): ICD-10 diagnosis code I47.2 end effective date was September 30, 2022. New codes effective on or after October 1, 2022 includes I47.20, I47.21, and I47.29.
    • NCD 210.10 (Screening for STIs): CPT 0353U is a new code for this NCD with an effective date October 1, 2022.

CMS notes that MACs will adjust any claims processed in error associated with CR 12960 that you bring to their attention.

  • MLN MM12960: link)

Compliance Education Updates

Medicare Provider Compliance Tips – Revised

CMS noted in the Thursday, November 3, 2022 edition of MLN Connects (link) that the educational tool Medicare Provider Compliance Tips has been updated with the latest improper payment rates, denial reasons, and codes. Additional information and new tips have been added to several of the topics included in this tool (i.e., new tips for cataract removal, lipid panels and psychiatry).

Federally Qualified Health Center — Revised
Excerpt from 11/23 MLN Matters newsletter:

This MLN booklet (link)">link) was reviewed in October 2022 and includes the following changes:

  • Payment for hospice attending physician services by specific providers
  • Mental health services using telecommunications
  • Concurrent billing for chronic care management and transitional care management services
  • Changes to care management services codes
  • CMS also added information on COVID-19 shot and monoclonal antibody therapy administration.
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.