All Fee-For-Service Providers

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.