This week in Medicare—12/13/23
Medicare NCCI Policy Manual
On December 4, CMS published the 2024 NCCI Policy Manual to its website. The manual is available for download either as a complete document or in chapter-specific files. It is effective January 1, 2024.
Revised FAQ on JW/JZ Modifiers
On December 4, CMS revised an FAQ on the JW/JZ modifiers to note under Question 6 that the JZ modifier should be reported when submitting claims for single-dose container drugs that were dispensed but not administered. This policy is effective January 1, 2024.
Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with Revenue Code 0905 for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
On December 5, CMS published One-Time Notification Transmittal 12392, which rescinds and replaces Transmittal 12263, dated September 26, to update the policy section to reflect the CY 2024 OPPS Final Rule, adding the final rate for BR 13264.2.1, updating BRs 13264.3, 13264.7, and 13264.14 for the IOCE/FQHC Pricer, deleting BR 13264.3.1 – BR 13264.3.2, and updating primary services A/B. The transmittal also updates Attachment A: IOP Codes and Services File, and it removes the sensitive/controversial disclaimer. The original transmittal was issued to implement the IOP billing requirements for FQHCs and RHCs.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Hospice Benefit Policy Manual Updates Related to the Addition of Marriage and Family Therapists (MFT) or Mental Health Counselors (MHC) to Hospice Interdisciplinary Team
On December 6, CMS published Medicare Benefit Policy Transmittal 12400, which rescinds and replaces Transmittal 12385, dated November 30, to replace Xs in the document with a link to the final rule. The original transmittal was published regarding updates to the manual to include MFTs or MHCs in the hospice interdisciplinary group as finalized via the CY 2024 Physician Fee Schedule final rule.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of the Program Integrity Manual
On December 7, CMS published Medicare Program Integrity Transmittal 12393 regarding updates to Chapter 10 of the manual with changes from the CY 2024 Home Health Prospective Payment System Final Rule. This includes changes to section 10.1.1 to revise the definition of managing employee, changes to section 10.6.1.1.5 regarding majority ownership changes within 36 months of enrollment changes, and changes to section 10.6.15 to show the revised screening requirements for hospices.
CMS published MLN Matters 13333 on the same date to accompany the transmittal.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Update to Medicare Claims Processing Manual, Chapter 32, Sections 320.3.3 and 370.1 for Coding Revisions to the NCDs – April 2024 Change Request 13390
On December 7, CMS published Medicare Claims Processing Transmittal 12396 regarding updates the Sections 320.3.3 and 370.1 of Chapter 32 of the manual to coincide with coding changes for NCDs 20.9.1 (Ventricular Assist Devices) and 20.30 (Microvolt T-Wave Alternans [MTWA]) that were made via a different transmittal.
Effective date: January 9, 2024
Implementation date: January 9, 2024
Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions
On December 7, CMS published One-Time Notification Transmittal 12397 regarding clarification to the MACs regarding the Medicare guidance/policy related to complex administration of CPT codes 96401-96549. CMS states that the A/B MACs shall not make claim adjustments or edits to claims for CPT codes 96401-96549 based solely on the specific drug or agent being administered.
Effective date: December 21, 2023
Implementation date: December 21, 2023
CY 2024 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On December 7, CMS published Medicare Claims Processing Transmittal 12398 regarding the annual update to the DMEPOS fee schedule amounts, coding changes, and policy changes.
CMS published MLN Matters 13463 on the same date to accompany the transmittal.
Effective date: January 1, 2024
Implementation date: January 2, 2024
April 2024 Bi-Annual Update of ICD-10-CM
On December 7, CMS published Medicare Claims Processing Transmittal 12399 regarding instructions to the contractors on how to download the update file for the April 2024 ICD-10-CM codes. The file will be available approximately six weeks prior to the April effective date.
Effective date: April 1, 2024
Implementation date: April 1, 2024
New ICD-10-PCS Codes for April 2024
On December 7, CMS published a List of 41 new ICD-10-PCS codes which will be effective April 1, 2024. CMS said it will update the grouper software, code tables, index, and related files by February 1, 2024.
January 2024 Update to HCPCS Files
On December 7, CMS updated the Download Link for the January 2024 update to the HCPCS files. This is the third update for these files.
New CPT Codes for RSV Vaccine Administration
On December 7, CMS published a Note in MLN Connects stating that it retroactively added the following new CPT codes for RSV vaccine administration to the Physician Fee Schedule effective for dates of service on and after October 6, 2023:
- 96380 – Short descriptor: Admn rsv monoc antb im cnsl
- 96381 – Short descriptor: Admn rsv monoc antb im njx
CMS said the MACs will retroactively adjust claims brought to their attention. CMS covers vaccine administration but not the vaccine itself under Part B when patients do not have Part D.
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS)
On December 7, CMS published a Proposed Decision Memo regarding the expansion of Medicare coverage for allogeneic HSCT under NCD 110.23. CMS proposes expanding coverage under the NCD to patients using bone marrow or peripheral blood stem cell products when patients have myelodysplastic syndromes designated as high-risk or very high-risk with scores greater than or equal to 4.5 points under the IPSS-R criteria. Coverage for HSCT using bone marrow or peripheral blood stem cell products for these patients who do not meet this criteria would be determined by the MACs.
Comments are due by January 6, 2024.
Reminder of EMTALA Requirements and Guidance for Hospitals in a Disaster
On December 8, CMS published a Memorandum to state survey agency directors regarding EMTALA requirements and surge flexibilities in preparation for possible increases in demands for service during flu/COVID-19/RSV season this winter. The memo includes a fact sheet on previous guidance issued about how hospitals may utilize various options to increase surge capacity and what compliance under EMTALA would require. This includes information on alternative screening/testing sites.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.