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Thursday, December 22, 2022


Claims, Pricers, & Codes

MLN Matters® Articles


From Our Federal Partners



HHS Proposes to Standardize Electronic Health Care Attachments Transactions and Electronic Signature Processes to Improve the Care Experience for Patients and Providers

CMS, on behalf of HHS, issued the proposed rule, Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P). If finalized, the proposed rule would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals and office or telemedicine visits. The modifications to the adopted Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The proposed rule estimates a savings of $454 million annually in administrative costs and is a part of HHS’ and CMS ongoing efforts to significantly reduce paperwork burdens and empower health care providers to focus on direct patient care and streamline the care experience for patients and providers.

More Information:


Long-Term Care Hospital Provider Preview Reports: Review by January 17

Review your data by January 17, and contact CMS if you have questions. We’ll publish the data on Care Compare and in the Provider Data Catalog in March.  

Visit Public Reporting for more information.


Inpatient Rehabilitation Facility Provider Preview Reports: Review by January 17

Review your data by January 17, and contact CMS if you have questions. We’ll publish the data on Care Compare and in the Provider Data Catalog in March.  

Visit Public Reporting for more information.


Hospital Ownership Data Release

CMS continues to improve data transparency by making Medicare-certified hospital ownership data publicly available starting December 20. For the first time, researchers, state licensing officials, state and federal law enforcement agencies, and the public can identify common owners across hospitals. They can link this information to other data sources to identify the performance of facilities under common ownership.


Clotting Factor: CY 2023 Furnishing Fee

The 2023 blood clotting factor furnishing fee is $0.250 per unit.

More Information:


Medicare Diabetes Prevention Program: CY 2023 Payment Rates

Get CY 2023 payment rates for the Medicare Diabetes Prevention Program.

See the instruction to your Medicare Administrative Contractor.


CMS Burden Reduction News & Insights

Read about the latest burden reduction news and insights:

  • Proposed rule to expand access to health information and improve the prior authorization process
  • Proposed modifications to the National Council for Prescription Drug Programs retail pharmacy standards and new pharmacy subrogation standard
  • Reminder: eliminating certificates of medical necessity and durable medical equipment information forms


Claims, Pricers, & Codes

Medicare Part B Drug Pricing Files & Revisions: January Update

Learn about quarterly updates to the following average sales price (ASP) and not otherwise classified (NOC) pricing files effective for dates of service:

  • January 1–March 31, 2023: January 2023 ASP and ASP NOC
  • October 1–December 31, 2022: October 2022 ASP and ASP NOC
  • July 1–September 30, 2022: July 2022 ASP and ASP NOC
  • April 1–June 30, 2022: April 2022 ASP and ASP NOC

See the instruction to your Medicare Administrative Contractor.


Integrated Outpatient Code Editor: Version 24.0

Learn about claims processing changes effective January 1, 2023, for:

  • Hospital outpatient departments
  • Community mental health centers
  • Non-outpatient prospective payment system (PPS) hospital providers
  • Limited services when provided in a home health (HH) agency that isn’t paid under the HH PPS
  • Hospice patients for non-terminal illness treatment

See the instruction to your Medicare Administrative Contractor.


DMEPOS: Revised 2023 Fee Schedule Public Use File

Get revised 2023 DMEPOS fee schedule public use files in Excel and CSV formats.


National Correct Coding Initiative: Annual Policy Manual Update & Information on Other Payers

Get updates to the Medicare National Correct Coding Initiative (NCCI) Policy Manual effective January 1, 2023.

See Billing & Coding Advice FAQs to learn what to do about other commercial payers who deny payment citing NCCI edits.


MLN Matters® Articles

Clinical Laboratory Fee Schedule: CY 2023 Annual Update

Learn about changes effective January 1, 2023:

  • Instructions
  • Mapping new clinical laboratory test codes
  • Updates for laboratory costs subject to the reasonable charge payment


Hospital Outpatient Prospective Payment System: January 2023 Update

Learn about payment system updates and new codes for:

  • COVID-19
  • Drugs, biologicals, and radiopharmaceuticals
  • Devices
  • Other items and services


Laboratory Edit Software Changes: April 2023

Learn about changes to the laboratory national coverage determination edit module.


New Medicare Part B Immunosuppressant Drug Benefit

Learn about the new benefit effective January 1, 2023:

  • Extension of Medicare coverage for immunosuppressant drugs beyond 36 months for certain patients with kidney transplants
  • Coverage of premiums and cost sharing for some of these patients


Extension of Changes to the Low-Volume Hospital Payment Adjustment and the Medicare Dependent Hospital Program — Revised

Medicare Administrative Contractors have 60 days to reprocess affected claims.



Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier

Learn about the requirement to include a modifier on claims for separately payable Part B drugs and biologicals acquired under the 340B Program.


Rural Emergency Hospitals

Learn about this new Medicare Part A provider type:

  • Becoming a provider
  • Billing and payment
  • Reporting quality data


Intravenous Immune Globulin Demonstration — Revised

Learn about the 2023 payment rate for Q2052.


Medicare Preventive Services — Revised

Learn about updates to Medicare preventive services, including:

  • Colorectal cancer screening:
    • Reduced coinsurance starting January 1, 2023, when a screening colorectal cancer procedure becomes diagnostic or therapeutic
    • Reduced age for colorectal cancer screening tests effective January 1, 2023
    • Include a follow-on screening colonoscopy if a non-invasive stool-based test returns a positive result effective January 1, 2023
  • Flu shot: removed CPT code 90685 effective August 1, 2022.
  • Sexually transmitted infection (STI) screening & high intensity behavioral counseling to prevent STIs: added CPT code 0353U for chlamydia DNA test effective October 1, 2022.


From Our Federal Partners

CDC Interim Guidance: Antiviral Treatment of Influenza

Seasonal influenza activity is high across the U.S. The CDC has received numerous anecdotal reports of availability issues for generic oseltamivir in some locations. This may continue to occur in some communities as influenza activity continues.

This Health Alert Network Health Advisory provides clinicians and public health officials with guidance for prioritizing oseltamivir for treatment and information on other influenza antivirals that are recommended for treating influenza in areas where oseltamivir is temporarily unavailable.


Important Updates from the CDC on COVID-19 Therapeutics for Treatment & Prevention

This CDC Health Alert Network Health Update supplements Health Advisories issued on April 25 and May 24 to emphasize that the majority of Omicron sublineages circulating in the United States have reduced susceptibility to the monoclonal antibody, bebtelovimab and the monoclonal antibody combination, cilgavimab and tixagevimab (EvusheldTM).

Antiviral therapeutics for the treatment of COVID-19ritonavir-boosted nirmatrelvir (Paxlovid™), remdesivir (Veklury®), and molnupiravir (Lagevrio™), retain activity against currently circulating Omicron sublineages. These medications can prevent severe disease, hospitalization, and death and are widely available but have been underused.

This Health Update provides health care professionals, public health officials, and the public with guidance on improving use of therapeutics for treatment of COVID-19 and strategies to prevent serious outcomes of COVID-19.

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