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Thursday, May 18, 2023



Claims, Pricers, & Codes



From Our Federal Partners





COVID-19: Public Health Emergency Ended May 11

The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.

View the COVID-19 Vaccine Provider Toolkit for more information.


End of COVID-19 Public Health Emergency FAQs

Learn about updates to the Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (questions 21-23 on page 9).

Following the end of the PHE, can hospitals bill for outpatient physical therapy (PT), occupational therapy (OT), speech language pathology (SLP) services, Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy (MNT) provided to beneficiaries in their homes through telecommunication technology by hospital-employed staff?

In context of the end of the PHE, we have received a number of inquiries from interested parties regarding the expiration of this policy. We have reviewed all of the relevant guidance, including applicable billing instructions and external feedback, and recognize the confusion around these policies. We also recognize that the therapists and many of the other practitioners who provide these services remain on the list of distant site practitioners for Medicare telehealth services.

However, for DSMT services, we understand that some other types of hospital clinical staff, beyond those identified as eligible distant site practitioners for Medicare telehealth, can provide these services in some cases. To allow these services to continue to be furnished to patients in their home through telecommunication technology through the end of CY 2023, we are exercising enforcement discretion in reviewing the telehealth practitioner status of the clinical staff personally providing any part of a remotely furnished DSMT service, so long as the practitioner is otherwise qualified to provide the service.

Through the end of CY 2023, PT, OT, SLP, DSMT, MNT providers should continue to bill for these services when furnished remotely in the same way they have been during the PHE.

After the end of the PHE, how often will Medicare provide payment for a subsequent nursing facility or subsequent inpatient visit when furnished via Medicare telehealth?

We have received a number of inquiries from interested parties regarding temporarily continuing our suspension of these frequency limitations beyond the end of the PHE, specifically our requirement that CPT codes 99231-99233 may only be furnished via Medicare telehealth once every 3 days, and our requirement that CPT codes 99307-99309 may only be furnished via Medicare telehealth once every 14 days. We are exercising enforcement discretion and will not consider these frequency limitations through December 31, 2023, as we anticipate considering our policy further through our rulemaking process.

Will teaching physicians be allowed to use virtual presence and bill for services involving residents in residency training sites outside of a MSA after the PHE ends?

CMS is exercising enforcement discretion to allow teaching physicians in all teaching settings to be present virtually, through audio/video real-time communications technology, for purposes of billing under the PFS for services they furnish involving resident physicians. We are exercising this enforcement discretion through December 31, 2023, as we anticipate considering our policy for services involving teaching physicians and residents further through our rulemaking process.


Advancing Health Equity Through The CMS Innovation Center: First Year Progress And What’s To Come

Health Affairs published a blog by the CMS Innovation Center, outlining its health equity strategy, progress made over the last year, and additional areas of focus in the future.

The Innovation Center launched a new health equity initiative in 2022, proposing to:

  • Develop new models and revise existing models to promote and incentivize equitable care
  • Increase participation of safety net providers
  • Increase collection and analysis of equity data
  • Monitor and evaluate models for health equity impact


Power Seat Elevation Equipment on Power Wheelchairs: Coverage, Coding, & Payment

CMS issued a national coverage decision that – for the first time – establishes power seat elevation for power wheelchairs as durable medical equipment, eligible for coverage by the Medicare program.

Learn about coverage, coding, and payment.


Medicare Shared Savings Program: Apply for January 1 Start Date by June 15

Accountable Care Organizations (ACOs): Apply for the Medicare Shared Savings Program through the ACO Management System by June 15 at noon ET. See the Application Toolkit to get resources for the upcoming application submission cycle. 

We’re offering a new Advance Investment Payments option to encourage providers in rural and underserved areas to join together as ACOs.

More Information: 


Inpatient Rehabilitation Facility Services: Review Choice Demonstration

Beginning August 21, 2023, CMS will implement the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services in Alabama. These IRF providers can choose either 100% pre-claim review or 100% postpayment review during the selection period, July 7 – August 6, 2023.

We plan to expand the demonstration to additional states and Medicare Administrative Contractor jurisdictions at a later date.


Women’s Health: Talk with Your Patients About Making their Health a Priority

During National Women’s Health Week and National Osteoporosis Month, recommend appropriate preventive services to help your patients improve their health. Medicare covers preventive services to help support a healthy lifestyle, including:

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 — Reminder

The COVID-19 public health emergency (PHE) ended on May 11, 2023. In general, providers should only report the CR modifier and DR condition code during a PHE when a formal waiver is in place. So, you shouldn’t use the CR modifier or DR condition code for most 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.

See Medicare Billing for COVID-19 Vaccine Shot Administration for more information.




Skilled Nursing Facility: Minimum Data Set Resident Assessment Instrument Training

Take this CMS virtual training program to learn about:

  • Skilled nursing facility (SNF) Minimum Data Set 3.0 Resident Assessment Instrument v1.18.11 Manual and Item Set
  • SNF Quality Reporting Program reporting requirements that will go into effect October 1, 2023
  • Standardized patient assessment data elements: We’ll implement across post-acute care settings for more consistent reporting and evaluation

The training program has 2 parts:

  • Part 1: Learn — View pre-recorded training webinars to learn about new or revised items and guidance before the live event. A capstone case study gives you additional coding practice.
  • Part 2: Practice — Register for live, virtual workshop sessions on June 21 between 12:30 – 5 pm ET.  Practice coding scenarios for select data elements covered in Part 1.

More Information:




Screening Pap Tests & Pelvic Exams — Revised

We added information on skilled nursing facility consolidated billing.


From Our Federal Partners


Potential Risk for New Mpox Cases

The CDC issued a Health Alert Network Health Update about the potential for new clusters or outbreaks of mpox (formerly monkeypox) cases and to provide resources on clinical evaluation, treatment, vaccination, and testing.



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