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Thursday, February 9, 2023



Claims, Pricers, & Codes

MLN Matters® Articles



DMEPOS: Get Benefit Category Determinations

Get new benefit category determinations for DMEPOS items in Section 110.8 of the Medicare Benefit Policy Manual, Chapter 15.

See the instruction to your Medicare Administrative Contractor.


Nurse Practitioners & Clinical Nurse Specialists: Update to List of National Certifying Bodies

CMS added the Nurse Portfolio Credentialing Commission to the list of national certifying bodies for nurse practitioners and clinical nurse specialists.

More Information:


Help Address Heart Health Disparities

Black or African American patients have the highest prevalence of hypertension out of all racial and ethnic groups (see data snapshot). American Heart Month and Black History Month is the perfect time to learn about preventive services, and find out how to address health disparities.

Medicare covers cardiovascular disease screening tests and intensive behavioral therapy for cardiovascular disease. Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.

More Information:



What’s the Comprehensive Error Rate Testing Program?

CMS created the Comprehensive Error Rate Testing (CERT) Program to measure the Fee-for-Service payment error rate. This identifies payments that don’t meet Medicare requirements; it doesn’t indicate fraud.

How does the program work?

The CERT contractor reviews a sample of processed claims. If a claim doesn’t meet Medicare’s coverage, coding, and billing rules, or the provider fails to submit medical records, it’s counted as a total or partial improper payment. Medicare Administrative Contractors analyze error rates to reduce improper payments, update their internal processes, and educate providers.


Claims, Pricers, & Codes

Home Health: Revised Editing of Telehealth Claims

From January 1 – February 6, 2023, CMS incorrectly returned claims with telehealth services if they didn’t include an in-person visit with the same revenue code (reason code 31869).

If we returned your claim, re-submit it to your Medicare Administrative Contractor.


HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals

CMS published the Fourth Quarter 2022 HCPCS Application Summaries & Coding Recommendations for drugs and biologicals. See HCPCS Level II Coding Decisions for more information.


MLN Matters® Articles

Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: Quarterly Update

Learn about updates for laboratory billing:

  • Next Clinical Laboratory Fee Schedule data reporting period
  • General specimen collection fee increase
  • New and discontinued HCPCS codes


New Payment Adjustments for Domestic N95 Respirators

Learn about cost reporting period changes starting January 1, 2023:

  • New payment adjustments for domestic National Institute for Occupational Safety and Health-approved surgical N95 respirators
  • Biweekly interim lump-sum payments


Removal of a National Coverage Determination & Expansion of Coverage of Colorectal Cancer Screening

Learn about national coverage determination (NCD) 160.22 and colorectal cancer screening:

  • Removed NCD 160.22 – ambulatory electroencephalographic (EEG) monitoring
  • Lowered the minimum age for colorectal cancer screening (CRC) from age 50 to 45 for certain tests
  • Expanded the definition of CRC screening tests and new billing instructions for colonoscopies under certain scenarios
  • Updated 3 Medicare manuals


Rural Health Clinic & Federally Qualified Health Center Medicare Benefit Policy Manual Update

Learn about 2022 and 2023 updates and how CMS clarified existing policy.


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