This week in Medicare—2/7/2024
List of CMS Codes with Global Period of Either 010 or 090 Days
On January 29, CMS published Download Links to the 2024 lists of global codes for post-operative visits on its Global Surgery Data Collection webpage to include the changes made for this year.
Participation Continues to Grow in CMS’ Accountable Care Organization (ACO) Initiatives in 2024
On January 29, CMS published a Press Release regarding participation in ACOs in 2024. CMS highlighted 19 new ACOs in the Medicare Shared Savings Program that are receiving more than $20 million in advance investment payments (AIP), an additional 50 ACOs new to the Medicare Shared Savings Program in general, and high participation in two CMS Innovation Center models: the ACO REACH model and the Kidney Care Choices model. CMS said that 13.7 million people with traditional Medicare will be aligned to an ACO in 2024.
Updates to Home Health Agency Cost Report
On January 31, CMS published Provider Reimbursement Manual Transmittal 5 regarding updates to the Home Health Agency Cost Report, Form CMS-1728-20 to clarify existing instructions, forms, and electronic cost report specifications. Revisions apply to worksheets S, D, F-1, and O.
Effective date: Cost reporting periods ending on or after December 31, 2023
2025 Medicare Advantage and Part D Advance Notice
On January 31, CMS published the 2025 Medicare Advantage and Part D Advance Notice regarding Medicare Advantage capitation rates and Parts C and D payment policies for CY 2025. CMS is proposing to continue the phase-in of the updated Part C Risk Adjustment model by blending 67% of the risk score calculated using the updated 2024 MA risk adjustment model with 33% of the risk score calculated using the 2020 MA risk adjustment model. CMS started the three-year phase-in during 2024.
CMS also released the Draft CY 2025 Part D Redesign Program Instructions concurrently with the Medicare Advantage Advance Notice. These instructions describe how CMS will implement changes to the structure of the Part D benefit as mandated by the Inflation Reduction Act of 2022. This includes a newly defined standard Part D benefit design consisting of the annual deductible, initial coverage, and catastrophic coverage; a lower annual out-of-pocket threshold set at $2,000; changes to the liabilities involved, and more.
CMS published a Fact Sheet and Press Release on the Advance Notice as well as a separate Fact Sheet on the Part D redesign. Comments on proposals are due by March 1. The final rate announcement will be published no later than April 1.
Correction Notice: CY 2024 Home Health PPS Rate Update
On January 31, CMS published a Correction Notice in the Federal Register for the CY 2024 Home Health PPS Rate Update Final Rule, dated November 13, 2023, to correct errors from sections about the quality reporting program, a table regarding proposed measures for the Home Health Value-Based Purchasing Model, and in the discussion about the Hospice Informal Dispute Resolution and Special Focus Program.
Effective date: This correcting document is effective January 31, 2024.
CLIA Fees: Histocompatibility, Personnel, and Alternative Sanctions for Certificate of Waiver Laboratories Correction Notice
On February 1, CMS published a Correction Notice in the Federal Register to correct errors from a final rule on CLIA fees that had been published in the Federal Register on December 28, 2023. The corrections pertain to two inadvertently omitted paragraph references to individuals who meet the regulatory qualifications to perform blood gas analysis, incorrect effective dates, and inadvertently omitted paragraph references for an amendatory instruction.
Dates: This correction is effective January 27, 2024
New CPT Codes for RSV Vaccine Administration
On February 1, CMS published a Notice in MLN Connects regarding the addition of two new CPT codes for RSV vaccine administration. CMS added the following two codes to the PFS files:
- 96380, Admn rsv monoc antb im cnsl
- 96381, Admn rsv monoc antb im njx
These codes are effective for dates of service on and after October 6, 2023.
ICD-10 and Other Coding Revisions to NCDs–July 2024 Update
On February 1, CMS published One-Time Notification Transmittal 12493 regarding the quarterly updates to ICD-10 conversions and other coding updates specific to NCDs. The NCDs affected by this round of updates include NCD 110.23, NCD 150.3, NCD 160.18, and more.
CMS released MLN Matters 13507 to accompany the transmittal.
Effective date: July 1, 2024 - Or as indicated in individual BR
Implementation date: March 4, 2024 - MACs - BRs 1-6; July 1, 2024 - FISS - BRs 2 & 4
Making Care Primary (MCP) Model Implementation
On February 2, CMS published Demonstrations Transmittal 12496, which rescinds and replaces Transmittal 12390, dated November 30, 2023, regarding the implementation of the MCP model. The transmittal revises Appendices A, B, and C with updated sets of HCPCS codes. New BRs (13392.96) were added to instruct FISS to create a PARM for MACs to maintain the codes listed in Appendices A, B, and C, as the services/codes may change in the future. BRs 13392.97-97.1 instruct MCS to ensure that only participating providers accepting assignment will be included in the MCP Model. This correction CR also revises business requirements 13392.1.1, 13392.5, through 13392.9, 13392.10, 13392.11, 13392.12.3, 13392.13, 13392.33, and 13392.84 through 13392.85.1.
The original transmittal discussed billing instructions for the new ambulatory care management (ACM) code and MCP e-Consult Code (MEC).
Effective date: July 1, 2024
Implementation date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 – Complete Coding, Testing, and Implementation; October 7, 2024 - Implementation of BR 13392.12.4 for CWF only.