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Thursday, April 27, 2023



Claims, Pricers, & Codes


MLN Matters® Articles

Information for Patients




Hospital Price Transparency Enforcement Updates

CMS is committed to ensuring that consumers have the information they need to make fully informed decisions regarding their health care. CMS expects hospitals to comply with hospital price transparency requirements and is enforcing these rules to ensure that people are easily able to learn what a hospital charges for items and services. This fact sheet outlines process updates CMS is making to increase compliance with the hospital price transparency requirements. CMS continues to explore additional ways to ensure that hospitals fully comply with the hospital price transparency requirements, including whether to propose additional changes through rulemaking.

See the full fact sheet.

For the First Time, HHS Is Making Ownership Data for All Medicare-Certified Hospice and Home Health Agencies Publicly Available

The Biden-Harris Administration has made promoting competition and protecting consumers a top priority. In support of the President’s Executive Order on promoting competition and the Administration’s commitment to transparency, HHS released ownership data for all Medicare-certified hospice and home health agencies.

Transparent ownership data benefits the public by assisting patients, and their loved ones, in making more informed decisions about care. HHS plans to analyze these data to identify ways to inform policy approaches that can improve competition in health care.

See the full press release.

Behavioral Health Integration Services: Find Out What Medicare Covers & Who’s Eligible

Behavioral health integration (BHI), incorporating behavioral health care with primary care, is an effective strategy to improve mental, behavioral, or psychiatric health for many patients. Medicare covers 2 types of BHI services:

  1. Psychiatric Collaborative Care Model (CoCM) approach: Use CPT codes 99492–99494 and HCPCS code G2214 to bill
  2. General BHI services using models of care other than CoCM: Use CPT code 99484 and HCPCS code G0323 to bill

We make separate payment to physicians and non-physician practitioners for services they supply over a calendar month service period.

Eligibility is based on the clinical judgment of the billing practitioner. Eligible conditions include:

  • Mental health
  • Behavioral health, including substance use disorder
  • Psychiatric

Read Behavioral Health Integration Services to learn more, including:

  • Service components or parts
  • Requirements for an initiating visit, supervision, and advance consent

More Information:

Claims, Pricers, & Codes


HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals

CMS published the First Quarter 2023 HCPCS Application Summaries & Coding Recommendations for drugs and biologicals. See HCPCS Level II Coding Decisions for more information.



2023 Quality Conference — May 1–3

Building Resilient Communities: Having an Equitable Foundation for Quality Health Care

Monday, May 1 – Wednesday, May 3

Register for the conference.

This virtual conference convenes leaders across the health care spectrum to explore how patients, advocates, providers, researchers, and champions in health care quality improvement can develop and spread solutions to address America’s most pervasive health system challenges.

MLN Matters® Articles


Home Health Claims: Telehealth Reporting

Learn about:

  • Revised claim edits
  • In-person visit line item requirement reversal
  • Reporting instructions

Skilled Nursing Facility Prospective Payment System: Updates to Current Claims Editing

Learn about:

  • Improved editing for interrupted stays that span 2 months
  • Modified editing for occurrence span codes

Information for Patients


States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now

Share the Renew Your Medicaid or CHIP Coverage flyer with your Medicaid and Children’s Health Insurance Program (CHIP) patients.

Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.

Here are 3 things your patients with Medicaid or CHIP can do to prepare:

  1. Make sure their state has their current contact information
  2. Check the mail for a letter about their Medicaid or CHIP coverage
  3. Complete their renewal form right away (if they get one)

Related Resources:


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