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Thursday, June 22, 2023


Claims, Pricers, & Codes


MLN Matters® Articles



CMS Roundup (June 16, 2023)

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

  • CMS Seeking Charter Members to New Air Ambulance Advisory Committee
  • CMS Issues Guidance on Hospital Discharges to Post-Acute Care Providers
  • New Web Pages to Help Consumers Understand their Rights and Protections Against Unexpected Medical Bills


Lower Endoscopy: Comparative Billing Report in June

This month, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for lower endoscopy. Use the data-driven report to compare your billing practices with those of peers in your specialty and across the nation.

Look for an email from cbrpepper.noreply@religroupinc.com to access your report.

More Information:


Medicare Physician Fee Schedule Database: July Update

See the attachment in the instruction to your Medicare Administrative Contractor to learn about the July quarterly changes to the Medicare Physician Fee Schedule Database:

  • New codes
  • Procedure status changes


Behavioral Health Integration Services: Get Information about the Codes

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 makes separate payment to physicians and non-physician practitioners for BHI services they supply to patients over a calendar month service period. Find out how to code for 2 types of BHI services:

  1. Psychiatric Collaborative Care Model (CoCM): 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

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:

  • New CPT and HCPCS codes
  • Threshold time and assumed practitioner time for each code
  • Full code descriptors

More Information:


Claims, Pricers, & Codes

ICD-10-CM Diagnosis Codes: FY 2024

Get FY 2024 ICD-10-CM procedure codes effective for discharges on or after October 1, 2023.

More Information:



Expanded Home Health Value-Based Purchasing Model: Overview of the Interim Performance Report Webcast — July 27

Thursday, July 27 from 2–3 pm ET

Register for this webcast.

Learn about the data and information available in the Interim Performance Report (IPR) to help you monitor your performance during the CY 2023 performance year. Only CMS certification numbers with a Medicare-certification date before January 1, 2022, will get a July 2023 IPR.

More Information:


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

Home Dialysis Payment Adjustment & Performance Payment Adjustment for ESRD Treatment Choices Model: Updated Process — Revised

CMS deleted references to condition codes 74 and 76.

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