This week in Medicare updates—12/7/2022
National Coverage Determination (NCD) 110.24: Chimeric Antigen Receptor (CAR) T-Cell Therapy
On November 28, CMS published Medicare Claims Processing Transmittal 11721 regarding updated instructions on how to process claims in the Part B physician office and independent clinics for CAR T-Cell therapy. Providers will need to utilize the new modifier -LU (fractionated payment CAR T-cell therapy), modifier -76 (repeat procedure or service by same physician or other qualified healthcare professional), and modifier -KX (requirements specified in the medical policy have been met) to attest they are a REMS-approved facility. Modifier -LU applies retroactively for use on physician claims where the place of service for CAR-T was an office with dates of service from January 1, 2022 forward. Claims were previously being held because these places of service could not bill the correct amount.
Effective date: January 1, 2022
Implementation date: January 3, 2023
Practitioner & DMEPOS Supplier Information on Power Mobility Devices
On November 29, CMS revised an MLN Booklet regarding information for practitioners and DMEPOS suppliers on power mobility devices. CMS updated language throughout the booklet as well as the order of information and formatting to make it more clear for providers to understand. CMS also added information on Medicare coverage for options, accessories, repairs, and replacements and provided information to help avoid improper payments.
FY 2023 IPPS and Long-Term Care Hospital PPS Changes
On December 1, CMS published Medicare Claims Processing Transmittal 11727 regarding the FY 2023 update to the IPPS and LTCH PPS as finalized in the FY 2023 IPPS and LTCH PPS Final Rule. The transmittal includes the 2023 rates, device policies, post-acute transfer and special payment policy, and more. The transmittal is no longer sensitive and may now be posted to the internet.
CMS published MLN Matters 12814 on the same date to accompany the transmittal.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic
On December 1, the HHS OIG published a Report in conjunction with the OIGs for the Department of Defense, Office of Personnel Management, Department of Veterans’ Affairs, Department of Labor, and Department of Justice, to examine telehealth across select health care programs within those agencies and potential program integrity risks during the first year of the COVID-19 pandemic. The report showed an unsurprisingly dramatic increase in telehealth use during the first year of the pandemic, as approximately 37 million individuals–13 times the number of individuals from the previous year–across healthcare programs in those six agencies used telehealth during the first year of the pandemic.
The percentage of individuals using telehealth varied by program, as the VA had the most telehealth usage (87%), followed by Tricare (49%) then Medicare (43%). The Department of Justice prisoner health care services saw the lowest rate of telehealth usage (2%). The report also looked at ways the agencies made telehealth available during the pandemic, how the coverage compared across agencies, and potential program integrity risks across programs. It identified potential risks–such as upcoding, duplicate claims, high-volume billing, unnecessary durable medical equipment, or laboratory tests associated with telehealth visits–which will likely be future areas of focus for the OIG.
The report contained no recommendations, as the insights are intended to help stakeholders better understand future opportunities and challenges related to telehealth use.
CY 2023 Update for DMEPOS Fee Schedule
On December 2, CMS published Medicare Claims Processing Transmittal 11722 regarding the CY 2023 updates to the DMEPOS fee schedule. Changes affect continuous glucose monitors, diabetic testing supplies, therapeutic shoe modification codes, and standard changes to update factors and fee schedule amounts.
CMS published MLN Matters 13006 on the same date to accompany the transmittal.
Effective date: January 1, 2023
Implementation date: January 3, 2023