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Thursday, April 13, 2023



Claims, Pricers, & Codes


MLN Matters® Articles







COVID-19: End of Public Health Emergency

CMS is planning for the end of the COVID-19 public health emergency (PHE), which is expected to occur on May 11, 2023. We updated the COVID-19 Vaccine Provider Toolkit with information on what to do during and after the end of the PHE.

More Information:

CMS Roundup (Apr. 07, 2023)

You may be interested in these topics from the CMS Roundup:

  • CMS Strengthens Enforcement Against Infection Control Deficiencies in Nursing Homes
  • Health Care Facilities May Now Use Clean Energy as an Alternate Power Source

Medicare Shared Savings Program: Application Toolkit Materials

Accountable Care Organizations (ACOs): See the Medicare Shared Savings Program Application Toolkit to get resources for the upcoming application submission cycle.

CMS will accept applications starting May 18 through the ACO Management System. Apply no later than noon ET on June 15.

More Information:

Inpatient Rehabilitation Facility Interdisciplinary Team Meetings After the COVID-19 Public Health Emergency

On May 8, 2020, CMS announced that inpatient rehabilitation facilities (IRFs) could conduct interdisciplinary team meetings electronically during the COVID-19 public health emergency (PHE). The PHE is expected to end on May 11, 2023. After the PHE ends, we expect IRFs to hold in-person, weekly interdisciplinary team meetings. Rehabilitation physicians may lead these meetings remotely using video, telephone conferencing, or other technology.

Hospital Outpatient Departments: Prior Authorization for Facet Joint Interventions Starts July 1

Hospital outpatient departments (OPDs) must submit prior authorization requests for facet joint interventions starting on or after July 1, 2023, unless your OPD is currently exempt from this process.

More Information:

Opioid Treatment Program Webpage Updates

CMS streamlined Opioid Treatment Program content. Visit the revised webpages to learn more about:

  • Enrollment
  • Billing
  • G-codes frequency of use guidelines
  • Claims
  • 2023 payment rates

Claims, Pricers, & Codes


Home Health Original Claims: Don’t Include Cross-Reference Document Control Numbers

Effective April 1, 2023, Medicare Administrative Contractors will return original home health claims with cross-reference document control numbers. Only submit these numbers on adjustment claims.

More Information:

Outpatient Rehabilitation Claims with Reason Code W7072: You Might Need to Resubmit Claims

A system change caused CMS to return the following outpatient claims with reason code W7072:

  • Bill types 74X and 75X
  • CPT codes 98980 and 98981

We’re bypassing reason code W7072 for these claims until we correct the issue in the July 2023 Integrated Outpatient Code Editor update. Resubmit claims that we returned in error.



IRIS: XML Format & Duplicate Interns and Residents Full-Time Equivalents Review — May 3

Wednesday, May 3 from 1–3 pm ET

Register for this webinar.

Target audience: Medicare Part A teaching providers or organizations

Learn about updates to IRIS:

  • New fields in XML format
  • List of approved vendors
  • New duplicate review audit contractor, Myers and Stauffer, LC
  • Process for completing duplicate full-time equivalents audit process

You may send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “IRIS Webinar” in the subject line. We’ll answer your questions during the webinar, or use them to develop educational materials.

MLN Matters® Articles


New Waived Tests

Learn about billing for Clinical Laboratory Improvement Amendments waived laboratory tests:

  • Requirements
  • New tests approved by the FDA
  • Using modifier QW



Intravenous Immune Globulin Demonstration — Revised

Learn what’s changed:

  • Updated 2022 and 2023 payment rates for Q2052
  • Added claims adjustment language for updated payment rates

Medicare Modernization of Payment Software — Revised

Learn what’s changed:

  • Added information on the updated versions of the Home Health Prospective Payment System Grouper software, Medicare Code Editor, and Medicare Severity Diagnosis-Related Group Grouper
  • Added information on the completion of conversion of the Integrated Outpatient Code Editor
  • Updated the Java conversion schedule summary table



Expanded Home Health Value-Based Purchasing Model: Self-Assessment Tool Webinar Materials

CMS posted materials from the Strategies for Success Self-Assessment Tool webinar in March:

Visit Expanded Home Health Value-Based Purchasing Model for more information.


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