Spotlight
Spotlights
Average Sales Price: January 2023
CMS posted the January 2023 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2023 ASP Drug Pricing Files webpage.
Learn What’s New for CY 2023
CMS issued a CY 2023 Medicare Physician Fee Schedule (PFS) final rule to expand access to behavioral health care, cancer screening coverage, and dental care. See the press release, PFS fact sheet, Quality Payment Program fact sheets, and Medicare Shared Savings Program fact sheet for provisions effective January 1, 2023.
Inflation Reduction Act
As directed by the Inflation Reduction Act, CMS implemented a temporary increase in payment for qualifying biosimilars. The new law allows for a temporary increase in the add-on payment for 15 qualifying biosimilars whose Average Sales Price (ASP) is less than the price of the associated reference biological. The October 2022 ASP Pricing File on the Medicare Part B Average Sales Price webpage reflects the temporary increase amount for the qualifying biosimilars. Review our FAQs (PDF), which might also help you respond to your patient’s questions.
Flu Shots
Get payment, coverage, billing, & coding information for the 2022-2023 season. You can now check eligibility (PDF) for the flu shot. We give information from claims billed in the last 18 months:
CPT or HCPCS codes
- Dates of service
- NPIs who administered the shots
If you need help, contact your eligibility service provider.
Important Links
Educational Resources
Medicare Fee-for-Service (FFS) Payment
- Fee Schedules - General Information
- Prospective Payment Systems - General Information
- Acute Inpatient PPS
- Ambulance Fee Schedule
- Ambulatory Surgical Center (ASC) Payment
- Clinical Laboratory Fee Schedule
- DMEPOS Competitive Bidding
- Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule
- Home Health PPS
- Hospice
- Hospital-Acquired Conditions (Present on Admission Indicator)
- Hospital Outpatient PPS
- Inpatient Psychiatric Facility PPS
- Inpatient Rehabilitation Facility PPS
- Long-Term Care Hospital PPS
- PC Pricer
- Physician Fee Schedule
- Skilled Nursing Facility PPS
Medicare Fee-for-Service Part B Drugs
How To Stay Informed
- Subscribe now to get the weekly MLN Connects® newsletter for the latest Fee-for-Service program information, event announcements, claims and pricer information, and MLN educational resources.
Provider/Supplier Resources
- Medicare Coverage - General Information
- Council for Technology & Innovation
- Clarification about Part B versus Part D Drug Coverage (PDF)
- End Stage Renal Disease (ESRD) Center
- ICD-10
- Medicare Provider-Supplier Enrollment
- National Provider Identifier Standard (NPI)
- Medicare National Correct Coding Initiative (NCCI) Edits
- SNF Consolidated Billing
- Sustainable Growth Rates & Conversion Factors
- Versions 5010 and D.0 & 3.0