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September 2022 Medicare Transmittals and MLN Articles

Published on 

Wednesday, September 28, 2022

 | Billing 
 | Coding 
 | Medicare Coverage 
 | Outpatient Services 

Medicare MLN Articles & Transmittals

Exceptions to Average Sales Price (ASP) Payment Methodology – Claims Processing Manual Changes
  • MLN Release Date: August 30, 2022
  • What You Need to Know: Your billing staff need to be made aware of updates to Chapter 17 Section 20.1.3 (Exceptions to Average Sales Price (ASP) Payment Methodology) and Section 20.3 (Calculation of the Payment Allowance Limit for DME MAC Drugs) of the Medicare Claims Processing Manual
  • MLN MM12854: link)
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2023
  • MLN Release Date: September 6, 2022
  • What You Need to Know: This article lists the lab specific NCDs with coding updates effective January 1, 2023.
  • MLN MM12888: link)
Billing for Hospital Part B Inpatient Services
  • Change Request (CR) 12816 Release Date: September 8, 2022
  • What You Need to Know: The purpose of this CR is to provide billing instructions for hospital Part B inpatient services. Specifically, there are additions to the “Not Allowed Revenue Codes.” No policy change is being made in this CR. You can find more information in the following CMS manuals:
    • Section 10 Medicare Benefit Policy Manual, Chapter 6 (link): when to bill Part B for inpatient services
    • Section 70 Medicare Claims Processing Manual, Chapter 1 (link): time limitations for filing Part B claims
    • Section 240 Medical Claims Processing Manual, Chapter 4 (link): services allowed on inpatient Part B claims
  • CR 12816: link)
October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
  • MLN Release Date: September 13, 2022
  • What You Need to Know: CMS advises that your billing staff should know about the new COVID-19 CPT vaccine and administration codes, redosing update for EVUSHELD™, and a new procedure to assess coronary disease severity using computed tomography angiography that is detailed in this article.
  • MLN MM12885: link)
Ambulatory Surgical Center Payment System: October 2022 Update
  • MLN Release Date: September 26, 2022
  • What You Need to Know: Your billing staff needs to know about updates to the ASC payment system, a new OPPS device pass-through code, new HCPCS codes for drugs and biologicals, and new skin substitute products low-cost or high-cost group assignment.
  • MLN MM12915: link)

Revised Transmittals & MLN Articles

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
  • MLN Release Date: August 15, 2022 – Revised September 8, 2022 – Revised September 19, 2022
  • What You Need to Know: The article was revised on September 8th to reflect the change in CR 12870. Specifically, a note was added about code 0340U in dark red font on page 3 of the article. It was once again revised on September 19th to correct an acronym on page three.
  • MLN MM12870: link)
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.