Insights

Skilled Nursing Facility Prospective Payment System Final Rule For Fiscal Year 2023

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS 1765-F) that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2023. ...

Inpatient Rehabilitation Facility Prospective Payment System Final Rule For Fiscal Year 2023

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1767-F) to update Medicare payment policies and rates under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for fiscal year ...

Inpatient Psychiatric Facility Prospective Payment System Final Rule For Fiscal Year 2023

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1769-F) to update Medicare payment policies and rates for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year (FY) 2023. Here’s a summary of the ...

Hospice Payment Rate Update Final Rule For Fiscal Year 2023

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1773-F) that updates Medicare hospice payments wage index, quality reporting programs, and policies for Fiscal Year (FY) 2023 in accordance with existing statutory and regulatory requirements. Here’s a ...

AMA Announces CPT Code Update For Monkeypox Vaccination & Testing

The American Medical Association (AMA) announced an editorial update to Current Procedural Terminology (CPT), that includes a new laboratory test code for the orthopoxvirus and two codes for the vaccines being utilized to prevent monkeypox infection. ...

New Codes For COVID-19 Novavax Vaccine, Adjuvanted

The U.S. Food and Drug Administration (FDA) authorized emergency use of the Novavax COVID-19 vaccine, Adjuvanted for the prevention of COVID-19 disease in patients 18 years and older. The U.S. Centers for Medicare & Medicaid Services (CMS) issued 3 new ...

New Codes For Moderna Vaccines For Children 6 Months Through 17 Years

The U.S. Food and Drug Administration (FDA) amended the Moderna COVID-19 vaccine emergency use authorization to authorize use for all patients 6 months through 17 years of age. The U.S. Centers for Medicare & Medicaid Services (CMS) issued 7 new Current ...

Use ICD-10 Code U09.9 For Long COVID

For a post COVID-19 condition, unspecified, like Long COVID, use code DX U09.9. Add other codes for conditions related to the COVID-19 infection, like R50.9 for fever. ...

2023 E/M Code Descriptors & Guidelines Summary Of Revisions

After implementing the 2020 Medicare Physician Fee Schedule Final Rule provision, which included revisions to the Evaluation and Management (E/M) office visit Current Procedural Terminology (CPT) (99201-99215) code descriptors and documentation standards that directly addressed the continuing problem of administrative ...

New Codes For Pfizer-Biontech Vaccines For Children 6 Months Through 4 Years

On June 17, 2022, the U.S. Food and Drug Administration (FDA) amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization to authorize use for all patients 6 months through 4 years of age. CMS issued new CPT codes effective June 17, 2022: ...

New ICD-10-CM Diagnosis Codes: Fiscal Year 2023

The fiscal year 2023 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis code files and guidelines are now available. ...

New ICD-10-PCS Procedure Codes: Fiscal Year 2023

The Centers for Medicare & Medicaid Services (CMS) has published the 2023 ICD-10 Procedure Coding System (ICD-10-PCS) codes and guidelines for the 2023 fiscal year. ...

AMA Announces CPT Update For Moderna Pediatric COVID-19 vaccine

The American Medical Association (AMA) announced an editorial update to Current Procedural Terminology (CPT), that includes new product and administration codes assigned to the Moderna COVID-19 vaccine for children 6 months through 5 years old. The provisional CPT codes are ...

New Administration Code for Pfizer Pediatric COVID-19 Vaccine Booster Dose

On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization (PDF) to authorize the use of a single booster pediatric dose (orange cap) for all patients 5 – 11 years old. ...

Corrections To Home Health Billing For Denial Notices And Calculation Of 60-Day Gaps In Services

The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 12657, removing the requirement to submit a Notice of Admission (NOA) before billing for home health denials. CMS will process home health claims without an election period on ...

CMS Finalizes 2023 Notice Of Benefit And Payment Parameters

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, finalizing many of the proposed changes. Overall, the final rule seeks to ...

AMA Announces CPT Update For COVID-19 Booster Candidates

The American Medical Association (AMA) announced an editorial update to Current Procedural Terminology (CPT), that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline. ...

CMS Releases New Codes for Moderna Vaccine Booster Doses

On March 29, the Food and Drug Administration (FDA) authorized a second Moderna COVID-19 vaccine booster dose for adults aged 50 and older and certain immunocompromised adults. Following this, the Centers for Medicare & Medicaid Services (CMS) released Current Procedural ...

HHS Extends COVID-19 Public Health Emergency

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, Secretary of Health and Human Services, Xavier Becerra, renewed the COVID-19 public health emergency (PHE), just ahead of its April 16 expiration date, providing an extension ...

CMS To Cover Second COVID-19 Booster Shot at No Cost

The Centers for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from ...

CMS Finalizes 2023 Payment Changes For Medicare Advantage and Part D Plans

The Centers for Medicare & Medicaid Services (CMS) announced Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). ...

CMS Releases Billing Code For Preventive COVID-19 Antibody Treatment

On February 24, 2022, the U.S. Food and Drug Administration (FDA) revised the emergency use authorization for tixagevimab co-packaged with cilgavimab (EVUSHELD™) to change the initial dose for the authorized use as pre-exposure prophylaxis of COVID-19 in certain adults and ...

North Carolina & Florida Home Health Agencies to See Review Choice Demonstration Changes

The Centers for Medicare & Medicaid Services (CMS) announced that beginning April 1, 2022, home health agencies in Florida (FL) and North Carolina (NC) will be subject to a 25% reduction in payment if they choose not to participate in ...

CMS to Implement Claim Edit for Hospice Transfers

Effective July 1 2022, a claims processing edit to prevent gap billing between hospice transfers will be implemented. Per Change Request (CR) 12619 Gap Billing Between Hospice Transfers, a patient can change hospices only once per benefit period (60-day or ...

CMS Releases Billing Code For New COVID-19 Omicron Variant Treatment

On February 11, the US Food and Drug Administration (FDA) authorized the emergency use of the monoclonal antibody bebtelovimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients when all of these apply: ...

CMS Delays Hospital Star Ratings Update Until July 2022

The Centers for Medicare & Medicaid Services (CMS) announced that it will delay updating the Overall Hospital Quality Star Ratings on the Care Compare website from April until July 2022 so it can correct a calculation error in the calendar ...

CMS Expands Medicare Coverage For Lung Cancer Screening

The Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination (NCD) that expands coverage for lung cancer screening with low dose computed tomography (LDCT) to improve health outcomes for people with lung cancer. ...

New HCPCS Code For Convalescent Plasma In Outpatient Setting

On December 28, the US Food and Drug Administration (FDA) revised the emergency use authorization for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. ...

CPT Update For Pediatric COVID-19 Vaccine Announced

The American Medical Association (AMA) announced an editorial update to the Current Procedural Terminology (CPT) code set to include new product and administration codes assigned to the Pfizer-BioNTech COVID-19 vaccine for children 6 months to under 5 years of age. ...

CMS Updates DMEPOS Requirements

The Centers for Medicare & Medicaid Services (CMS) has added 31 items and deleted 5 items on the Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Master List. Additionally, effective April 13, 2022, CMS is selecting items beyond Power Mobility ...

CPT Code For The Third Dose Of Pfizer’s Pediatric COVID-19 Vaccine Announced

The American Medical Association (AMA) announced an update to the Current Procedural Terminology (CPT) code set that includes a new vaccine administration code for a third dose of the pediatric COVID-19 vaccine developed by Pfizer. ...

CMS Announces New ICD-10 Codes For COVID-19 Monoclonal Antibodies

The Centers for Medicare & Medicaid Services (CMS) is implementing 2 new procedure codes, in addition to the 7 new procedure codes announced in November 2021, bringing the total to 9 new procedure codes, to describe the introduction or infusion ...

CMS Announces New HCPCS Code For Remdesivir Antiviral Medication

The Centers for Medicare & Medicaid Services (CMS) issued a new Healthcare Common Procedure Coding System (HCPCS) code for the antiviral medication VEKLURYTM (remdesivir) when administered in the outpatient setting. The new code is in response to the recent statement from ...

AHA Updates Guidance On Using Z-Codes For Social Needs

The American Hospital Association (AHA) has posted updated guidance to help hospitals and clinicians use ICD-10-CM “Z codes” to capture data on the social needs of patient populations, including non-medical factors that may influence a patient’s health status. ...

CMS Issues The Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Final Rule

The Centers for Medicare & Medicaid Services (CMS) issued the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) final rule (CMS-1738-F, CMS-1687-F, and CMS-5531-F) that updates payment and benefit category policies and other provisions for DMEPOS items. ...

New ICD-10 Codes Announced For Reporting COVID-19 Therapeutics, Vaccination Status

Effective April 1, 2022, the Centers for Disease Control and Prevention (CDC) will implement three new ICD-10 diagnosis codes for reporting COVID-19 vaccination status and the Centers for Medicare & Medicaid Services (CMS) will implement seven new ICD-10 procedure codes ...

Medicare Premiums, Deductibles & Coinsurance Increase For 2022

The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts. ...

CMS Announces Extreme and Uncontrollable Circumstances Policy To Individual MIPS Eligible Clinicians

Due to the 2019 coronavirus pandemic public health emergency, the Centers for Medicare & Medicaid Services (CMS) is applying the automatic extreme and uncontrollable circumstances (EUC) policy to all individual MIPS eligible clinicians for the 2021 MIPS performance year. The ...

Home Health Payment System Final Rule For Calendar Year 2022

The Centers for Medicare & Medicaid Services (CMS) issued a rule that finalizes a nationwide expansion of the successful Home Health Value-Based Purchasing (HHVBP) Model and makes updates to the Medicare Home Health Prospective Payment System (PPS) and the home ...

Medicare Physician Fee Schedule Final Rule For Calendar Year 2022

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. ...

CMS Releases Billing Codes for J&J and Moderna Boosters

The Centers for Medicare & Medicaid Services (CMS) released Medicare Part B billing codes and payment allowances for reporting and administering single booster doses of Johnson & Johnson and Moderna COVID-19 vaccines to eligible adults as authorized by the Food and Drug Administration ...

CMS Issues Guidance On Required Medicaid & CHIP COVID-19 Coverage

The Centers for Medicare & Medicaid Services (CMS) issued guidance on Medicaid and Children’s Health Insurance Program (CHIP) coverage of COVID-19-related treatment under the American Rescue Plan Act of 2021 (ARP). ...

AMA Announces CPT Codes for Pfizer’s Pediatric COVID-19 Doses

The American Medical Association (AMA) issued new Current Procedural Terminology (CPT) vaccine and administration codes for pediatric doses of the COVID-19 vaccine developed by Pfizer. The provisional codes will be effective for use if Pfizer’s two-dose COVID-19 vaccine for children ...

GAO Reports On Provider Performance And Experiences Under MIPS

The Centers for Medicare & Medicaid Services (CMS) administers the Merit-based Incentive Payment System (MIPS), under which MIPS-eligible providers receive a “final score” based on their performance on four measures (quality, cost, promoting interoperability and improvement activities). Their score is ...

CMS Releases Surprise Billing Interim Final Rule Part II Regulations

On September 30, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), released an interim final rule with comment ...

CMS Releases 2022 Medicare Advantage and Prescription Drug Plans Information

The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare Open Enrollment to help Medicare enrollees decide on ...

CMS Will Pay For Beneficiaries’ COVID-19 Booster Shots

Following the Food and Drug Administration’s (FDA) recent action that authorized a booster shot of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & ...

CMS Issues Additional Instructions For Submitting Home Health Notices Of Admission (NOAs)

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424, which updates chapter 10 of the Medicare Claims Processing Manual to include additional instructions for submitting home health Notices of Admission (NOAs). ...
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