Insights

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. ...

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. ...

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. ...

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 ...

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. ...

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 ...

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 ...

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. ...

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. ...

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 ...

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. ...

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 ...

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 ...

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. ...

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 ...

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). ...

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 ...

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 ...

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 ...

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 ...

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 & ...

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). ...

The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), except when the vaccine is given in a hospital outpatient department, rural health clinic (RHC) or federally qualified health center ...

By November 1, 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin reprocessing claims for outpatient clinic visit services provided at excepted off-campus Provider-Based Departments (PBDs) so they’re paid at the same rate as non-excepted off-campus PBDs ...

The American Medical Association (AMA) released updates to the Current Procedural Terminology (CPT) code set for 2022. The new code set aims to streamline reporting and tracking of COVID-19 reporting, among other updates. ...

In an effort to increase access to COVID-19 vaccinations, the Centers for Medicare & Medicaid Services (CMS) is expanding opportunities for people to receive vaccinations at home. Healthcare providers can now receive additional payments for administering vaccines to multiple residents ...

The U.S. Food and Drug Administration (FDA) amended the emergency use authorizations for both the Pfizer-BioNTech and the Moderna COVID-19 vaccines to allow for the use of an additional dose in certain immunocompromised individuals, especially solid organ transplant recipients or ...

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The rule revises the Medicare IPPS ...

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that updates Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) for Fiscal Year (FY) 2022 and finalizes changes to the ...

The Centers for Medicare & Medicaid Services (CMS) has issued a fiscal year (FY) 2022 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule, which updates Medicare payment policies and rates for IRFs, finalizes policies under the IRF Quality ...

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2022, in accordance with existing statutory and regulatory requirements. This rule rebases the hospice ...

According to the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNFs) Prospective Payment System (PPS) final rule for Fiscal Year (FY) 2022, SNFs will see an increase in Medicare Part A payments of approximately $410 million in ...