This week in Medicare updates—11/16/2022
Independent Diagnostic Testing Facility (IDTF)
On November 7, CMS revised an MLN Booklet regarding information for IDTFs. CMS added information about indirect IDTFs and their general description, exemptions, and verifications.
2023 Annual Update of Per-Beneficiary Threshold Amounts
On November 8, CMS published Medicare Claims Processing Transmittal 11626 regarding the annual update to the KX modifier thresholds for physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT) services. The CY 2023 thresholds are $2,230 for PT and SLP services combined and $2,230 for OT services. This transmittal was originally dated October 6, but it is no longer sensitive and was posted publicly on November 8.
Effective date: January 1, 2023
Implementation date: January 3, 2023
Billing for Hospital Part B Inpatient Services
On November 9, CMS published Medicare Claims Processing Transmittal 11685 regarding instructions for billing hospital Part B inpatient services. The transmittal revises language in the manual to include revenue codes 0240, 0942 (for rural hospitals providing kidney disease education services), and 0964 (for hospitals that have a CRNA exception) as allowed revenue codes. It also adds COVID-19 vaccines to the list of preventive services.
Effective date: July 1, 2022 - for claims received on or after 7/1/2022
Implementation date: December 12, 2022
Medicare Enrollment of Rural Emergency Hospitals (REHs)
On November 9, CMS published Medicare Program Integrity Transmittal 11694 regarding the addition of information about REH enrollment applications to the manual. This information walks through the process for a CAH or rural hospital wishing to convert to an REH and provides instructions for the contractors on processing these enrollment applications. The transmittal was originally published internally on September 15, but it is no longer sensitive information and is now being posted to the internet.
Effective date: October 28, 2022
Implementation date: October 28, 2022
Updates to Chapter 4 of Program Integrity Manual to Include the Addition of a Congressional Inquiries Section, Update the Vetting Leads with CMS Process, and More
On November 9, CMS published Medicare Program Integrity Transmittal 11696 regarding updates to Chapter 4 of the Program Integrity Manual. These updates include changes to the process for vetting leads for UPICs, describing how UPICs should handle Congressional inquiries, and detailing how to handle the administrative actions process.
Effective date: December 12, 2022
Implementation date: December 12, 2022
Add the CWF Disposition Code to the MCS Medicare Secondary Payer (MSP) ‘I’ Records Details Screens, the MCS Desktop Tool (MCSDT), and MSP CWF Transaction Reject Report H99RB552
On November 9, CMS published One-Time Notification Transmittal 11689 regarding instructions to display the CWF disposition code in addition to the error code currently displayed and received on the CWF MSP maintenance transaction response record. This is being done to assist MACs in the claim adjudication process by further defining what action needs to be taken to resolve an error received from the CWF.
Effective date: April 1, 2023
Implementation date: April 3, 2023
ICD-10 Code Update for Coverage of Intravenous Immune Globulin (IVIG) Treatment of Primary Immune Deficiency Disease in the Home
On November 9, CMS published Medicare Benefit Policy Transmittal 11693 regarding updates to the manual to add new ICD-10-CM code D81.82 (activated phosphoinositide 3-kinase Delta Syndrome [APDS]) to the section on coverage of IVIG treatment for primary immune deficiency disease in the home. The transmittal also removes outdated ICD-9 codes from the manual.
Effective date: October 1, 2022
Implementation date: December 12, 2022
New State Codes for North Carolina
On November 9, CMS published One-Time Notification Transmittal 11695 regarding new state codes for North Carolina in addition to the state code the state already uses. CMS is adding code B6 for North Carolina.
Effective date: April 1, 2023
Implementation date: April 3, 2023
Implementation of CY 2023 ESRD Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) Changes
On November 9, CMS published Medicare Benefit Policy Transmittal 11678 regarding the implementation of changes from the CY 2023 ESRD PPS Final Rule. This includes payment rate updates, outlier policy amounts, consolidated billing requirement changes, and more.
CMS published MLN Matters 12978 on the same date to accompany the transmittal.
Effective date: January 1, 2023
Implementation date: January 3, 2023
NCD 200.3 - Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
On November 9, CMS published Medicare National Coverage Determinations Transmittal 11692 regarding a new section in the manual about NCD 200.3, which provides coverage of monoclonal antibodies directed against amyloid as an Alzheimer’s Disease treatment under very specific coverage criteria. The transmittal includes all of the coverage information and instructs providers to ensure claims for this treatment include ICD-10-CM diagnosis codes Z00.6 along with one of the following codes: G30.0, G30.1, G30.8, G30.9, G31.84. Coverage for this treatment began April 7, 2022.
Effective date: April 7, 2022
Implementation date: December 12, 2022
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2023
On November 10, CMS published Medicare Claims Processing Transmittal 11700, which rescinds and replaces Transmittal 11583, dated September 1, to add business requirement 12888.7.2. The original transmittal was published regarding the January 2023 quarterly update to the edit module for clinical diagnostic laboratory services.
CMS revised MLN Matters 12888 on the same date to accompany the transmittal.
Effective date: January 1, 2023 - Unless noted differently in requirements
Implementation date: January 3, 2023
Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of the Program Integrity Manual
On November 10, CMS published Medicare Program Integrity Transmittal 11701, which rescinds and replaces Transmittal 11580, dated September 1, to revise language in the manual instruction from “on or before December 27, 2020” to “as of December 27, 2020.” The original transmittal was published internally and is being publicly posted as of November 10. The transmittal incorporates changes to provider enrollment policies into the manual. These policies include moving skilled nursing facilities, various provider enrollment ownership changes, and certain other providers and suppliers into the “high” level of categorical screening as well as expanding several provider enrollment denial and revocation reasons.
Effective date: January 6, 2023
Implementation date: January 6, 2023
Home Health Prospective Payment System (HH PPS) Rate Update for CY 2023
On November 10, CMS published Medicare Claims Processing Transmittal 11702 regarding implementation of changes from the CY 2023 HH PPS Final Rule for various payment rates, national per-visit amounts, the cost-per-unit payment amounts, and more.
CMS published MLN Matters 12957 on the same date to accompany the transmittal.
Effective date: January 1, 2023
Implementation date: January 3, 2023
Updated List of Excluded Individuals and Entities (LEIE)
On November 10, the OIG updated its LEIE with an updated LEIE database for download and lists of October 2022 exclusions, reinstatements, and profile corrections.
Analysis of Requirements for Coverage with Evidence Development (CED) - Topic Refinement
On November 10, CMS published an Analysis Document providing information to be used in the December MEDCAC meeting reviewing CMS’ requirements for clinical studies submitted for CMS coverage under Coverage with Evidence Development (CED). The document analyzed CMS’ current requirements and provides data as well as suggestions for how CMS can change these requirements.