January 2025 Newsletter

We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services. 

CMS Releases January HCPCS File

The Centers for Medicare & Medicaid Services (CMS) has released its most recent set of codes, some of which impact home health care billing. They were updated 12/17/2024. The file is available for download under the name “January 2025 Alpha-Numeric HCPCS File” [1].

NCD for Transcatheter Tricuspid Valve Replacement Proposed

CMS has posted a National Coverage Determination for Transcatheter Tricuspid Valve Replacement. This proposal has been made after an evidence-based process that included opportunities for public participation. This was done in response to a complete formal request for coverage of the EVOQUE tricuspid valve replacement system. CMS reports that the manufacturer tested the processes and concepts of Transitional Coverage of Emerging Technology (TCET) [2].

Updates to ASC Payment System

CMS has released updates to the Ambulatory Surgical Center Payment system, effective January 1, 2025 for medical coding in USA. This falls under change request 13934 and affects ambulatory surgical centers, physicians, suppliers, and other providers billing MACs for services provided to Medicare patients [3].

CMS Publishes Model Software Mappings

CMS has released the Model Software/ICD-10 Mappings, critical for USA medical billing. Downloads include [4]: 

• 2025 Midyear/Final Model Software
• 2025 Midyear/Final ICD-10 Mappings
• 2025 Initial Model Software
• 2025 Initial ICD-10-CM Mappings

Input Request for MBI Lookup Tools and Preventing Theft and Misuse

CMS has released a request seeking information and input on their approaches to preventing Medicare Beneficiary Identifier (MBI) theft and misuse, including with hospital billing. The agency is looking for information on externally-controlled and CMS-controlled options for MBI Lookup Tools. Anyone interested in sharing information on best practices or safeguards can make online submissions by Feb 17, 2025 [5]. 

Final Decision Memo on Implantable Pulmonary Artery Pressure Sensors Posted

CMS has released the final decision memo for Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management. The agency received a complete formal request for provision of coverage for the CardioMEMS HF System. Public comments are available for review [6].

Statement on Lowering the Cost of Prescription Drugs

CMS has released a statement on lowering the cost of prescription drugs as a top priority for the current administration. The agency has released a list of 15 drugs for the second cycle of the Medicare Drug Price Negotiation Program in accordance with the statutory requirements of the Inflation Reduction Act [7].

Blanket Waivers for California Wildfires

CMS has announced it is taking steps to support providers impacted by the California Wildfires, under section 1135 of the Social Security Act. This includes discretionary SNF coverage and extended coverage of certain telehealth services until the end of March 2025. These waivers are for hospitals, psychiatric hospitals, cancer centers and long-term care hospitals, and as such, impact the hospital revenue cycle [8].

Request for Application for Rural Community Hospital Demonstration

CMS has announced a request for applications (RFA) for the Rural Community Hospital Demonstration. This demonstration is congressionally mandated and tests the advisability and feasibility of cost-based reimbursement for small rural hospitals that have fewer than 51 beds and are not eligible for status as Critical Access Hospitals. The deadline for application is March 1, 2025, 11:59PM EST [9]. This request could impact hospital accounts receivable.

Hospital Price Transparency Compliance Updates Released

CMS has posted FAQs addressing compliance with hospital price transparency. Some of those included are new and are effective as of January 1, 2025, finalized under Calendar Year 2024 Outpatient Prospective Payment System/Ambulatory Services Center Final Rule. Others are modifications to existing requirements that were detailed in prior FAQs [10]. Hospital coding leaders will want to review these updates.