This week in Medicare updates—9/6/2023
OIG Featured Topic: Managed Care
On August 28, the OIG published a Featured Topic page regarding managed care. The OIG designated oversight of managed care as a priority area, and it published a link to the strategic plan on this topic and a variety of resources on the featured topic web page.
October 2023 Update to HCPCS Files
On August 28, CMS published the Download Link for the October 2023 update to the HCPCS files.
Evaluation and Management (E/M) Services Guide
On August 29, CMS updated its E/M Services Guide to align it with the new guidelines and rules for E/M visits that went into effect on January 1, 2023. The guide clarifies various topics, such as noting that a chief complaint is still essential per Medicare even though that had been removed from the CPT guidelines. CMS also uses different time reporting for critical care under code 99292 (report after 104 minutes for CMS, report after 75 minutes for CPT). Most of the guide has been revised, and facilities should review the booklet in its entirety to ensure compliance with these changes.
CMS Announces First 10 Drugs Selected for Medicare Drug Price Negotiation
On August 29, CMS published a Press Release and Fact Sheet to announce it has selected the first 10 Part D drugs selected for price negotiation under the Inflation Reduction Act. The drugs included are:
- Eliquis
- Jardiance
- Xarelto
- Januvia
- Farxiga
- Entresto
- Enbrel
- Imbruvica
- Stelara
- Fiasp/NovoLog
The next step in the price negotiation process will be for companies to submit data and information on the drugs to CMS by October 2. CMS will hold meetings with the drug companies on data submission and will hold public patient-focused listening sessions about these drugs between October 30-November 15. CMS will send an initial offer with a proposed maximum fair price for each drug by February 1, 2024.
Hurricane Idalia Emergency Waivers for Florida
On August 31, CMS published multiple resources on its Current Emergencies webpage regarding special flexibilities for those affected by Hurricane Idalia in Florida. A public health emergency was declared in Florida on August 30 and is effective retrospective to August 27. Waivers include special enrollment opportunities for hurricane victims, DMEPOS flexibilities, and more.
CMS published a News Alert regarding the waivers on the same date.
FY 2024 IPPS and Long-Term Care Hospital (LTCH) PPS Changes
On August 31, CMS published Medicare Claims Processing Transmittal 12234 regarding the implementation of policies and rate changes finalized through the FY 2024 IPPS and LTCH PPS Final Rule. The transmittal instructs the MACs on which files and systems to update with these changes and provides links to where the data files, tables, and implementation files can be accessed.
Effective date: October 1, 2023
Implementation date: October 2, 2023
New Dental Specialty Codes for Medicare
On August 31, CMS published Medicare Claims Processing Transmittal 12231 regarding new provider specialty codes for dentists. These codes follow the establishment of Medicare coverage for certain dental services. Providers may begin self-designating these new specialty codes beginning January 1, 2024.
Effective date: January 1, 2024
Implementation date: January 2, 2024
October 2023 Integrated Outpatient Code Editor (I/OCE) Specifications Version 24.3
On August 31, CMS published Medicare Claims Processing Transmittal 12226 regarding the October updates to the I/OCE. A table summarizing the updates is located on page 3 of the transmittal.
Effective date: October 1, 2023
Implementation date: October 2, 2023
October 2023 Update of the OPPS
On August 31, CMS published Medicare Claims Processing Transmittal 12227 regarding the October updates to the OPPS. The updates include new COVID-19 vaccine codes, eight new codes with pass-through status, retroactive vaccine code status indicator changes, and more.
Effective date: October 1, 2023
Implementation date: October 2, 2023
October 2023 Update of the Ambulatory Surgical Center (ASC) PPS
On August 31, CMS published Medicare Claims Processing Transmittal 12229 regarding the October updates to the ASC PPS. The updates include 14 new HCPCS codes for drugs and biologicals, retroactive changes to HCPCS code J0174, a new HCPCS code for renal/kidney histotripsy, and more.
Effective date: October 1, 2023
Implementation date: October 2, 2023
Extended Comment Period for Proposed Rule: Remedy for 340B Drug Payment Policy for CYs 2018-2022
On August 31, CMS published a Draft Copy of a Notice to extend the comment period for the 340B Drug Payment Remedy Proposed Rule from September 5 to September 11. All comments are now due by 5 p.m. on September 11.
CMS will publish this notice in the Federal Register on September 5.