Knowledge Base Article
October 2021 Medicare Transmittals and Coverage Updates
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October 2021 Medicare Transmittals and Coverage Updates
Published on
Wednesday, October 27, 2021
Medicare MLN Articles & Transmittals – Recurring Updates
January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Fields and Revisions to Prior Quarterly Pricing Files
- Article Release Date: October 1, 2021
- What You Need to Know: Billing staff need to be aware of these quarterly updates to Medicare ASP and Not Otherwise Classified (NOC) Part B drug pricing files.
- MLN MM12469: (link)
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022
- Article Release Date: October 1, 2021
- What You Need to Know: Billing staff need to be aware of these quarterly updates to Medicare ASP and Not Otherwise Classified (NOC) Part B drug pricing files.
- MLN MM12469: (link)
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022
- Article Release Date: October 1, 2021
- What You Need to Know: Billing staff need to be aware of these quarterly updates to Medicare ASP and Not Otherwise Classified (NOC) Part B drug pricing files.
- MLN MM12469: (link)
New/Modifications to the Place of Service (POS) Codes for Telehealth
- Article Release Date: October 14, 2021
- What You Need to Know: The POS Workgroup has revised the description of existing POS code 2 and added a new POS code 10.
- MLN MM12427: (link)
Claim Status Category and Claim Status Codes Update
- Article Release Date: October 14, 2021
- What You Need to Know: This article updates, as needed, the Claims Status and Claim Status Category Codes approved by the National Code Maintenance Committee.
- MLN MM12299: (link)
April 2022 Update to the Java Medicare Code Editor (MCE) for New Edit 20 – Unspecified Code Edit
- Article Release Date: October 22, 2021
- What You Need to Know: This article tells about system changes needed to update the MCE to accept a new MCE edit 20 (Unspecified Code Edit).
- MLN MM12471: (link)
Revised Medicare MLN Articles & Transmittals
Medicare Clarifies Recognition of Interstate License Compact Pathways
- Article Release Date: Initial article May 5, 2020 – Revision September 16, 2021
- What You Need to Know: The CMS revised this MLN article to clarify recognition of licenses through interstate license compact pathways as valid and full licenses for purposes of meeting federal license requirements.
- MLN SE20008: (link)
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022
- Article Release Date: August 12, 2021 – Revised October 6, 2021
- What You Need to Know: This MLN article was revised to reflect revised CR 12417 which corrected the fixed dollar loss threshold amount to $16,040.
- MLN MM12417: (link)
National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy – This CR Rescinds and Fully Replaced CR 11783
- Article Release Date: May 24, 2021 – Revised October 6, 2021
- What You Need to Know: In this fourth iteration of this MLN article, information has been added on the use of the KX modifier on professional claims. Substantive changes are in dark red font.
- MLN MM12177: (link)
Medicare Coverage Updates
September 27, 2021: Final Decision Memo – Home Use of Oxygen and Home Oxygen to Treat Cluster Headaches
The CMS posted a final national coverage determination (NCD) and decision memo ((link) for two separate, but medically related NCDs.
- NCD 240.2.2: Home Oxygen Use to Treat Cluster Headaches (CH)
- CMS is removing this NCD from the Medicare NCD manual,
- Ending Coverage with Evidence Development (CED), and
- Allowing MACs to make coverage determinations regarding the use of home oxygen and oxygen equipment for CH.
- NCD 240.2: Home Use of Oxygen
- CMS is expanding patient access to oxygen and oxygen equipment in the home, and
- Permitting MACs to cover the use of home oxygen and oxygen equipment in order to treat CH and other acute conditions.
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.
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