This week in Medicare—9/4/2024
Updates to the MCS, the VMS, and the CWF Processes to Capture and Further Automate the Medicare Secondary Payer (MSP) Processes
On August 27, CMS published Medicare Secondary Payer Transmittal 12812, which rescinds and replaces Transmittal 12773, to update the effective and implementation dates for April 2025 to include the CWF and MCS maintainers and directions that this instruction is for claims processed on or after this date. The transmittal also updates business requirements 13591.6 and 13591.6.1.
Effective date: January 1, 2025 – requirements, design, and coding (CWF and MCS); April 1, 2025 – requirements, design and coding, testing, for claims processed on or after this date, and implementation (CWF, MCS, VMS)
Implementation date: January 6, 2025 – requirements, design, and coding (CWF and MCS); April 7, 2025 – requirements, design and coding, testing, and implementation (CWF, MCS, VMS)
HCPCS Quarterly Update
On August 27, CMS published the October 2024 HCPCS Quarterly Update files.
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) National Coverage Determination (NCD) 110.23
On August 28, CMS published Medicare National Coverage Determinations Transmittal 12813 and Medicare Claims Processing Transmittal 12813, which rescind and replace Transmittal 12781, to replace the Pub. 100-03 NCD Manual with the correct document that includes section d-g for Section 1. Allogeneic Hematopoietic Stem Cell.
The original transmittals were issued to announce expanded coverage for allogeneic HSCT using bone marrow, peripheral blood, or umbilical cord blood stem cell products for Medicare patients with MDS. CMS issued a final decision regarding this expanded coverage in March 2024.
Effective date: March 6, 2024
Implementation date: October 7, 2024
Fee-for-Service Skilled Nursing Facility Advance Beneficiary Notice (ABN)
On August 28, CMS published new FFS SNF ABN forms on its beneficiary notices initiatives webpage. Downloads include the form instructions, the form itself, and a fillable PDF version of the form.
The revised form will become mandatory to use by October 31, 2024, but facilities may switch over sooner than that.
October 2024 Integrated Outpatient Code Editor (I/OCE) Specifications Version 25.3
On August 29, CMS published Medicare Claims Processing Transmittal 12815 regarding the October 2024 release of the I/OCE. The data files are available on the I/OCE quarterly release files webpage.
Effective date: October 1, 2024
Implementation date: October 7, 2024
October 2024 Update of the Hospital OPPS
On August 29, CMS published Medicare Claims Processing Transmittal 12816 regarding the October 2024 updates to the OPPS. Updates include a clarification on device pass-through codes C1601, C1747, and C1606; a variety of status indicator changes; 45 new proprietary laboratory analyses codes, and more.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Changes to the Laboratory NCD Edit Software for January 2025
On August 29, CMS published Medicare Claims Processing Transmittal 12817 regarding changes for the January 2025 quarterly release of the edit module for clinical diagnostic laboratory services. There is a lengthy list of NCDs affected by these changes, including NCDs for thyroid testing, lipid testing, tumor antigen immunoassays, fecal occult blood tests, and more.
CMS published MLN Matters 13785 on the same date to accompany the transmittal.
Effective date: January 1, 2025 – Unless noted differently in requirements
Implementation date: January 6, 2025
Enhancing Oncology Model (EOM) Monthly Enhanced Oncology Services (MEOS) Prohibited Codes Regular Updates
On August 29, CMS published Demonstrations Transmittal 12814 regarding updates to the code list in Appendix A of the EOM MEOS Payment. The EOM is a voluntary five-year model building on lessons learned from the oncology care model. The prohibited codes list includes codes that cannot be billed in the same month for the same beneficiary as the MEOS payment, and it will be updated over time to coincide with regular coding changes.
Effective date: January 1, 2025
Implementation date: January 6, 2025
Medicare & Mental Health Coverage
On August 29, CMS updated an MLN Booklet on Medicare coverage of mental health services to add billing and payment information about marriage/family therapist/mental health counselor services, commonly used mental health-related codes, and information about intensive outpatient program services.
Organ Procurement Organization (OPO) Conditions for Coverage – Reporting Data Related to Pancreata Procured for Research
On August 29, CMS published a Memorandum to CMS Location Offices regarding changes to the reporting codes OPOs use to report data related to pancreata procured for research. The existing codes were not specific enough to capture whether a pancreas was used for islet cell research, so CMS together with HRSA and OPTN developed new codes to differentiate between pancreata used for islet cell transplantation or research and non-islet cell research. The memo discusses the definition of “used” for research, what the OPTN will do to help implement the use of these new codes, and the codes themselves.
Effective date: Immediately. Please communicate to all appropriate staff immediately.
American Dental Association (ADA) Paper Claims in the Medicare Adjudication Portal (MAP) for 837D Dental Claims
On August 30, CMS published One-Time Notification Transmittal 12818 regarding instructions to contractors on implementing manual entry for ADA claim forms in the MAP system.
Effective date: October 7, 2024
Implementation date: October 7, 2024