This week in Medicare—9/11/2024
Osteogenesis Stimulators: Prior Authorization Requirements Suspended
On September 2, CMS published a Note in MLN Connects to communicate the suspension of prior authorization requirements for HCPCS codes E0747, E0748, and E0760, which took effect on August 28.
CMS is aware that there may be confusion over whether some noninvasive osteogenesis stimulators comply with the durable medical equipment three-year expected life requirement. The agency plans to provide additional direction about this requirement in future notice and comment rulemaking.
Hospice Benefit: Expanding Prepayment Review in 4 States
On September 2, CMS published a Note in MLN Connects to announce it will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. Initial review volumes will be low and adjusted based on results.
August 2024 Livanta Claims Review Advisor
On September 5, Livanta published the August 2024 edition of the Livanta Claims Review Advisor. Based on coding errors it has encountered while performing higher-weighted diagnosis-related group reviews, Livanta detailed the correct reporting of hypertension on Medicare Part A claims.
This edition focuses on documentation considerations, codes ranges, clinical guidelines, and helpful resources.
Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18 Section 170.1 and Chapter 32 Section 190.2 for Coding Revisions to the National Coverage Determinations (NCDs)--April 2024 Change Request (CR) 13390
On September 5, CMS published Medicare Claims Processing Transmittal 12822 to revise Chapters 18 and 32 of the Medicare Claims Processing Manual to include updated billing requirements for NCDs 210.10 and 110.4.
Effective date: October 1, 2023
Implementation date: November 7, 2024
Update to Internet-Only Manual Publication (Pub.) 100-04, Chapters 12 and 23, to Update Place of Service (POS) Code Descriptions to Match the POS Descriptions Found in Pub. 100-04, Chapter 26
On September 5, CMS published Medicare Claims Processing Transmittal 12823 to align POS code descriptions across Chapters 12, 23, and 26 of the Medicare Claims Processing Manual.
Effective date: October 8, 2024
Implementation date: October 8, 2024
October 2024 Update of the Ambulatory Surgical Center [ASC] PPS
On September 5, CMs published Medicare Claims Processing Transmittal 12824 regarding the October 2024 updates to the ASC PPS. The updates include 10 new HCPCS codes for drugs and biologicals, 12 new HCPCS codes for skin substitutes, retroactive changes to HCPCS code J3424, and more.
Effective date: October 1, 2024
Implementation date: October 7, 2024
2025 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
On September 6, CMS published Medicare Claims Processing Transmittal 12827 regarding updates to the list of HCPCS codes used for SNF CB. The new code files are expected to be available by November 1.
Effective date: January 1, 2025
Implementation date: January 6, 2025
Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation
On September 6, CMS revised a Memorandum to state survey agency directors containing guidance on rural emergency hospitals (REH). CMS revised the document to elaborate on REH eligibility, adding information about the conversion process for eligible facilities and action plan submission.
The original memorandum outlines requirements on delivery of care, survey guidelines, and the Conditions of Participation that facilities must meet to participate in the Medicare program.