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Thursday, April 28, 2022


Claims, Pricers, & Codes




Patient Eligibility Information for Additional Services — Now Available

You can now check eligibility (PDF) for these Medicare-covered services:

For these services, we return CPT or HCPCS codes and dates of service (DOS) or next eligible dates. When we return DOS, we also return NPIs so you can coordinate care.

If you need help, contact your eligibility service provider.


Physicians, Teaching Hospitals, Physician Assistants, & Advanced Practice Nurses: Open Payments Review & Dispute Ends May 15

You have until May 15 to review and dispute program year 2021 Open Payments data before CMS publishes it in June. Reviewing your data is voluntary, but strongly encouraged. Log into the Open Payments system to review your data. If you have a dispute, work directly with the reporting entity to resolve it; we don’t mediate or facilitate disputes.

Accessing Your Account:

  • If you don’t have an account, register in the Open Payments system
  • If you haven’t accessed your account in 60 days or more, unlock your account in the CMS Portal
  • If you haven’t accessed your account in 180 days or more, call the Open Payments Help Desk

More Information:


Are You on the Missing Digital Contact Information Report?

We updated the CMS National Plan and Provider Enumeration System (NPPES) Public Reporting of Missing Digital Contact Information report to include the names and NPIs of providers who didn’t update their digital contact information (endpoints) as of March 31. If you’re on the list, add your digital contact information to NPPES now (instructions begin on slide 29). Organizations can also upload new or updated data elements in bulk format through the Electronic File Interchange process.

If you add endpoint information after March 2022, we’ll remove you from the list in the next quarterly update planned for early July.

More Information:


Claims, Pricers, & Codes

HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals

CMS published the first quarter 2022 HCPCS Level II Application Summary and Coding Decisions for Drugs and Biologicals (PDF). For more information, visit the HCPCS Level II Coding Decisions webpage.


Corrections to Home Health Billing for Denial Notices and Calculation of 60-Day Gaps in Services

You don’t need to submit Notices of Admission before billing for home health denials. CMS will process home health claims without an election period on file if the following are present:

  • Type of bill 0320
  • Condition code 21
  • From date on or after January 1, 2022

We revised edit criteria to make sure Medicare systems calculate 60-day gaps in service consistently.

See the instruction to your Medicare Administrative Contractor (PDF).


Updates for Medical Severity Diagnosis Related Groups (MS-DRG) Subject to Inpatient Prospective Payment System (IPPS) Replaced Devices Offered Without Cost or With a Credit Policy Fiscal Years (FYs) 2021-2022

The following DRG changes are effective for discharges on or after October 1, 2020:

  • Add MS-DRGs 140,141,142, 521 & 522
  • Remove MS-DRGs 129 & 130

See the instruction to your Medicare Administrative Contractor (PDF).


Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

Effective July 1, 2022, the following codes replace A4397 — Irrigation supply sleeve on the home health (HH) consolidated billing non-routine supply code list:

  • A4436 — Irrigation supply; sleeve, reusable, per month
  • A4437 — Irrigation supply; sleeve, disposable, per month

No codes are added to the HH consolidated billing therapy code list.

See the instruction to your Medicare Administrative Contractor (PDF).



Inpatient Rehabilitation Facility & Long-Term Care Hospital Virtual Training Program — June 15–16

Wednesday, June 15 & Thursday, June 16 from 1–5 pm ET

CMS is standardizing patient assessment data elements to ensure more consistent reporting and evaluation across post-acute care settings. Learn about changes that go into effect on October 1, 2022, for:

  • Inpatient Rehabilitation Facility Patient Assessment Instrument 4.0
  • Long-Term Care Hospital Continuity Assessment Record and Evaluation Data Set 5.0

Register to get:

  • Videos to review before the live, virtual workshops
  • Coding practice during the workshops



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