Spotlights
PrEP for HIV: Prepare for Potential Medicare Part B Coverage
On July 12, 2023, CMS proposed to transition coverage of Preexposure Prophylaxis (PrEP) using FDA-approved antiretroviral drugs (oral or injectable) to prevent HIV to Medicare Part B. Currently, HIV PrEP drugs may be covered under Medicare Part D.
It’s critical that your patients have uninterrupted access to their HIV PrEP drugs. We’re encouraging you to prepare your systems now so you’re able to immediately transition to Part B coverage if we release a final National Coverage Decision (NCD).
Review our fact sheet (PDF) to learn more about how you can prepare for the possible upcoming coverage change, including information about enrollment, billing, claims processing, and coding.
Average Sales Price Files: January 2024
CMS posted the July 2024 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the ASP Drug Pricing Files webpage.
Appropriate use of place-of-service codes
Review the revised Skilled Nursing Facility 3-Day Rule Billing (PDF) fact sheet and the SNF PPS section of Medicare Payment Systems to learn more about place-of-service codes.
Physician Fee Schedule: Learn What's New for CY 2024
CMS issued the CY 2024 Physician Fee Schedule (PFS) final rule that announces policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See a summary of key provisions effective January 1, 2024.
