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Thursday, May 4, 2023


Claims, Pricers, & Codes


MLN Matters® Articles





FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency

HHS is planning for the federal public health emergency for COVID-19 to expire at the end of the day on May 11, 2023. CMS issued FAQs for all CMS programs, including Medicare, Medicaid, the Children’s Health Insurance Program, and private insurance to help you prepare.

More Information:

Guidance for the Expiration of the COVID-19 Public Health Emergency

The public health emergency (PHE) is expected to end on May 11, 2023. Read the Quality, Safety, & Oversight Memorandum to learn about:

  • Expiration of emergency waivers related to minimum health and safety requirements for long-term care and acute and continuing care providers
  • Timelines for certain regulatory requirements issued during the PHE

COVID-19 Over-the-Counter Tests

Learn about Medicare coverage of over-the-counter (OTC) COVID-19 tests during and after the public health emergency (PHE), which is expected to end on May 11, 2023.

Before May 11, patients can get up to 8 free OTC COVID-19 tests per month with no out-of-pocket costs.

After May 11:

  • Patients will still have access to laboratory-conducted COVID-19 tests (like PCR tests). Eligible patients will continue to get these lab-conducted tests at no cost, and their annual deductible, coinsurance, and copayment won’t apply.
  • OTC tests will still be available, but there may be out-of-pocket costs. Coverage of OTC tests may vary based on your patient’s insurance type.

More Information:

Medicare Diabetes Prevention Program: Public Health Emergency Flexibilities Continue through December 31

CMS expects the COVID-19 public health emergency to end on May 11, 2023. But, Medicare Diabetes Prevention Program (MDPP) suppliers may continue to offer MDPP services virtually through December 31, 2023, as long as they maintain an in-person CDC organization code. This includes the ability to:

  • Collect weight measurements for Medicare patients either through virtual technology, self-reported weight measurements, or both
  • Provide all services virtually with no limit to virtual sessions provided

More Information:

Transplant Eco-System: Role of Data in CMS Oversight of The Organ Procurement Organizations

CMS and the Health Resources & Services Administration remain committed to increasing organ procurement organization (OPO) performance. CMS has taken another step toward improving the organ transplantation  system by providing the most recent data on OPO performance to drive improvement for all 56 OPOs to meet the growing need for lifesaving organs.

See the full blog.  

Expanded Home Health Value-Based Purchasing Model: April Newsletter & Performance Reports

Read the April Home Health Value-Based Purchasing (HHVBP) Newsletter for the latest information, tools, and insights about the Expanded HHVBP Model.

Download your April 2023 Pre-Implementation Performance Report from iQIES. See instructions for accessing reports.

Religious Nonmedical Health Care Institution Benefit & COVID-19 Vaccines

Section 4138 of the Consolidated Appropriations Act, 2023 includes COVID-19 vaccine services in the definition of excepted services under the Religious Nonmedical Health Care Institution (RNHCI) benefit. CMS will treat claims containing only COVID-19 vaccine services as excepted services if the claim overlaps an RNHCI election period. This change is effective for claims processed on or after October 1, 2023.

More Information:

Clinical Laboratory Fee Schedule 2024 Preliminary Gapfill Rates: Submit Comments by June 26

CMS published 2024 preliminary gapfill rates for the Clinical Laboratory Fee Schedule. Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by June 26, 2023.

Visit Annual Public Meetings for more information.

Mental Health: Recommend Medicare Preventive Services

20% of Americans experience mental illness each year (see CDC), and it disproportionately affects racial and ethnic minority groups (see CDC). During National Mental Health Month, recommend appropriate preventive services, including:

Medicare covers preventive services, and 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:

Claims, Pricers, & Codes


COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency Update

The end of the COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023.

There are 2 exceptions:

DMEPOS Suppliers

Continue to use the CR modifier and COVID-19 narrative on claims for supplies and accessories associated with certain DMEPOS items provided during the PHE.

Skilled Nursing Facility & Swing Bed Providers

For benefit period and qualifying stay waivers, submit condition code DR for inpatient claims with admission dates before May 12, 2023. For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38.

Claim Status Category & Claim Status Codes  

Learn about claims status category and code updates effective March 1, 2023:

See the instruction to your Medicare Administrative Contractor.



Medicare Shared Savings Program: Navigating the Application Webinar — May 8

Monday, May 8 from 1–2:30 pm ET

Accountable Care Organizations (ACOs): Learn how to use the application toolkit to prepare your application for the upcoming cycle. We’ll also discuss the new Advance Investment Payments option to encourage health care providers in rural and underserved areas to join together as ACOs.

Register for this webinar.

More Information:

HCPCS Public Meeting — May 30 – June 1

Tuesday, May 30 – Thursday, June 1 from 9 am – 5 pm ET

Attend a virtual public meeting for the first biannual 2023 HCPCS coding cycle.

Visit HCPCS Public Meetings for more information, including meeting materials and guidelines.

MLN Matters® Articles


New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI — Revised

Learn how we verify attending physician information on a claim.



Electronic Cell-Signaling Treatment

Learn what Medicare covers instead of electronic cell-signaling treatment, including:

  • Peripheral nerve blocks
  • Transcutaneous electrical nerve stimulation
  • Percutaneous electrical nerve stimulation

Medicare doesn’t cover electronic cell-signaling treatment:

  • For metabolic, peripheral, or multiple neuropathies
  • For neuropathies in patients with underlying systemic diseases
  • With vitamin injections


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