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Thursday, January 12, 2023



Claims, Pricers, & Codes

MLN Matters® Articles





Key Dates for First Year of Inflation Reduction Act’s Medicare Drug Price Negotiation Program

On January 11, HHS announced key dates for the first year of the Medicare Drug Price Negotiation Program under the Inflation Reduction Act, which will lower drug costs for millions of Americans. For the first time in history, because of the Inflation Reduction Act, Medicare will have the ability to negotiate prescription drug prices. That process begins in 2023, and the first negotiated prices will go into effect in 2026.

Learn more, including major provisions of the Act already in effect in the press release.


Cognitive Assessment: CY 2023 Updates

Do you have a patient with a cognitive impairment? Medicare covers a separate visit for a cognitive assessment so you can more thoroughly evaluate cognitive function and help with care planning. Get the latest cognitive assessment and care plan services updates for CY 2023.


Care Compare: Telehealth Indicator for Doctors & Clinicians

CMS added a new telehealth indicator to clinician profile pages in Medicare Care Compare and in the Provider Data Catalog to help patients and caregivers find clinicians who provide telehealth services. See the Telehealth Indicator on Medicare Care Compare fact sheet for more information.


Clinical Laboratory Fee Schedule: CY 2023 Payment File

Get the CY 2023 payment file for clinical diagnostic laboratory tests.


Clinical Laboratories: PAMA Reporting & Payment Reductions Delayed

The Consolidated Appropriations Act, 2023, extended the statutory phase-in of payment reductions resulting from private payor rates through CY 2026:

  • CY 2021–2023: No reduction
  • CY 2024–2026: 15% limit on reductions

It also delayed reporting for clinical diagnostic laboratory tests that aren’t advanced diagnostic laboratory tests. The new reporting period, January 1, 2024 – March 31, 2024, will be based on the original data collection period of January 1, 2019 – June 30, 2019. 

For more information see PAMA Regulations.


Medicare Wellness Visits: Get Your Patients Off to a Healthy Start

The New Year is the perfect time to get your patients off to a healthy start by recommending Medicare wellness visits. We cover 2 types of exams:

  • Annual wellness visit or yearly “Wellness” visit focuses on preventive health and is covered every 12 months. Develop or update a personalized prevention plan and perform a health risk assessment.
  • Initial preventive physical exam or “Welcome to Medicare” preventive visit is a one-time visit for new Medicare patients within the first 12 months they have Part B. Review medical and social health history and discuss preventive services.

Your patients pay nothing for these visits if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.

Get information for your patients on the yearly “Wellness” visit and “Welcome to Medicare” preventive visit.


Claims, Pricers, & Codes


Drugs & Biologicals in Single-Use Containers: Using JW & JZ Modifiers

Read new FAQs about using the JW and JZ modifiers for Medicare Part B discarded drugs and biologicals from single-dose containers or single-use packages.

If you:

  • Didn’t discard any of the drug: Report the JZ modifier on the claim starting no later than July 1, 2023
  • Discarded any of the drug, continue to:
    • Report the JW modifier on the claim
    • Document the discarded amount in the patient’s medical record

We’ll use the JW and JZ modifiers to calculate discarded drug refunds.   


MLN Matters® Articles


Travel Allowance Fees for Specimen Collection: 2023 Updates

Learn about specimen collection fees and travel allowances, including policy updates and reminders.


ESRD & Acute Kidney Injury Dialysis: CY 2023 Updates — Revised

Learn what’s changed: Added J0889 to the consolidated billing list.


Home Health Prospective Payment System: CY 2023 Update — Revised

Learn what’s changed: We extended the rural add-on through CY 2023.


National Coverage Determination 110.24: Chimeric Antigen Receptor T-cell Therapy — Revised

Learn what’s changed: Don’t bill more than 1 unit per HCPCS code.



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