This week in Medicare updates—5/31/2023
Checking Medicare Claim Status
On May 22, CMS published an MLN Fact Sheet regarding how to obtain claim status information electronically. The fact sheet discusses what happens after claim submission, how to determine an accepted claim’s status, when to check an accepted claim’s payment status, which NPI number to use to submit a Part B claim, and more.
April 2023 Livanta Claims Review Advisor
On May 22, Livanta published the April edition of its Claims Review Advisor. This edition covered higher-weighted DRG reviews, and it looked specifically at malnutrition. Livanta noted that hospitals often over-report severe malnutrition as an MCC, as it was coded in error in more than 12% of reviewed cases. The report discusses OIG and CMS actions regarding malnutrition, good documentation practices, recent Coding Clinic guidance on the topic, and a sample malnutrition scenario.
Behavioral Health Integration Services
On May 22, CMS updated an MLN Booklet regarding behavioral health integration (BHI) services. While the updates contain no substantive changes, the service line remains a problem spot for some providers, and therefore the booklet is worth reviewing in its entirety. The booklet covers general information about BHI, discusses when and how to use HCPCS codes G2214 and G0323, reviews applicable CPT codes, discusses various care team members, provides an overview of service components, and more.
How to Use the Physician Fee Schedule (PFS) Look-Up Tool
On May 22, CMS updated an MLN Booklet regarding how to use the PFS Look-Up Tool. Changes include updated rate changes throughout to accompany 2023 changes, updated instructions and screenshots for searching the PFS, and more.
Mental Health Visits Via Telecommunications for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC)
On May 23, CMS revised Special Edition MLN Matters 22001, which was initially published on March 30, 2022, to note the change from the Consolidated Appropriations Act of 2023 which delays requiring in-person visits for mental health services until January 1, 2025. CMS also added modifier 93 for reporting audio-only visits for mental health at these facilities. The original article was published regarding regulatory changes and billing information for mental health visits done by telecommunications.
Update to Chapter 3 of the Program Integrity Manual for the Voluntary Prior Authorization (PA) Process for DMEPOS Accessories
On May 25, CMS published Medicare Program Integrity Transmittal 12056 regarding an update to the manual to describe the process in which certain DMEPOS accessories can be voluntarily added to prior authorization requests in order to simplify operational processes. This process was created in the 2019 End Stage Renal Disease and DMEPOS Final Rule and is being added to the manual now.
Effective date: June 26, 2023
Implementation date: June 26, 2023
July 2023 Integrated Outpatient Code Editor (I/OCE) Specifications Version 24.2
On May 25, CMS published Medicare Claims Processing Transmittal 12059 regarding the July 2023 update to the I/OCE. The transmittal includes an attachment describing all of the changes for the July update.
Effective date: July 1, 2023
Implementation date: July 3, 2023
July 2023 Update of the Ambulatory Surgical Center (ASC) Payment System
On May 25, CMS published Medicare Claims Processing Transmittal 12060 regarding the July 2023 updates to the ASC payment system. Changes include 12 new skin substitute HCPCS codes that will be active July 1, 20 new separately payable drug and biological HCPCS codes, and more.
CMS published MLN Matters 13216 on the same date to accompany the transmittal.
Effective date: July 1, 2023
Implementation date: July 3, 2023
COVID-19 Pfizer and Moderna Vaccine Coding Updates
On May 25, CMS published a Note in MLN Connects regarding simplified coding structures for the Moderna and Pfizer COVID-19 vaccines. The changes were made in April when the FDA amended the EUAs for the vaccines to simplify the vaccination schedule for most people. There are six new CPT codes (four for the Pfizer vaccines and two for Moderna vaccines) that are effective April 18. There were also revisions to code descriptions to replace the term “booster dose” with “additional dose.” The FDA also noted that the monovalent versions of the Moderna and Pfizer vaccines are no longer authorized for use in the United States as of April 18, 2023.
CMS updated its COVID-19 Vaccines and Monoclonal Antibodies webpage on May 22 to incorporate these coding changes.