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Thursday, September 15, 2022


Claims, Pricers, & Codes

MLN Matters® Articles



Make Your Voice Heard Request for Information Seeks Public Comment to Promote Efficiency, Reduce Burden, & Advance Equity within CMS Programs

CMS released a request for information (RFI) seeking public input on accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 public health emergency.

CMS encourages comments from all interested stakeholders, in particular, patients and their families, providers, clinicians, consumer advocates, and health care professional associations. We also encourage comments from individuals serving and located in underserved communities and from all CMS stakeholders serving populations facing disparities in health and health care. Comments must be received by November 4, 2022 to be considered.

More Information:


Enhancing Oncology Model to Improve Cancer Care: Apply by September 30

The new Enhancing Oncology Model (EOM) aims to improve cancer care for Medicare patients and lower health care costs. The EOM strives to:

  • Promote high-quality, patient-centered, equitable cancer care
  • Encourage providers to reduce use of unnecessary services, like emergency department visits and hospitalizations, and prescribe higher-value drugs
  • Deliver cancer care in a way that generates the best possible patient outcomes
  • Support and learn from cancer patients and caregivers

If your oncology practice wants to participate, register and apply by September 30.

More Information:


Revision to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) to Align to 1834(a)(5)(E) of the Social Security Act

The initial coverage period for patients who use home oxygen under Section D of NCD 240.2 didn’t change; this resolves a technical issue from a previous NCD update. Effective September 27, 2021, it’s either:

  • 90 days
  • Number of days in the practitioner prescription (if shorter)

For information about the NCD change, see the instruction to your Medicare Administrative Contractor.


Claims, Pricers, & Codes

Billing for Hospital Part B Inpatient Services

Hospitals: Review instructions to bill Medicare Part B for inpatient services to prevent claim denials, including new information on allowed revenue codes. We aren’t changing policy.

More Information:


National Correct Coding Initiative: October Quarterly Update

Get the National Correct Coding Initiative (NCCI) fourth quarter edit files, effective October 1, 2022, on these Medicare NCCI webpages:


MLN Matters® Articles

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2023

Learn about coding updates (PDF) for 22 NCDs.


Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment — Revised

Because code 0340U is both a Proprietary Laboratory Analysis and an Advanced Diagnostic Laboratory Test, it has an indicator of N and a payment amount on the fee schedule. Learn more about the quarterly update (PDF).

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