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Thursday, November 2, 2023



Claims, Pricers, & Codes





CY 2024 Home Health Prospective Payment System Final Rule

On November 1, CMS issued the CY 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for Home Health Agencies (HHAs). This rule includes routine updates to the Medicare Home Health PPS payment rates for CY 2024 in accordance with existing statutory and regulatory requirements. CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023.

More Information:

CY 2024 End-Stage Renal Disease Prospective Payment System Final Rule 

On October 27, CMS issued a final rule that updates payment rates and policies under the end-stage renal disease (ESRD) prospective payment system (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. This rule also updates the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for CY 2024. In addition, the rule updates requirements for the ESRD Quality Incentive Program.

For CY 2024, CMS is increasing the ESRD PPS base rate to $271.02, increasing total payments to ESRD facilities by approximately 2.1%.

More Information:

Behavioral Health: Medicare Pays for 3 Services

Find out about 3 behavioral health services Medicare pays for that may improve patient outcomes:

  1. Behavioral Health Integration (BHI) Services (PDF): BHI is a model of care that incorporates behavioral health care into other care, like primary care, to improve mental, behavioral, or psychiatric health for many patients. We cover 2 types of BHI services.
  2. Psychotherapy for Crisis: These services are appropriate for patients in high distress with life-threatening, complex problems that require immediate attention. These services can help reduce a patient’s mental health crisis (including substance use disorder).
  3. Opioid Use Disorder (OUD) Screening & Treatment: We pay for OUD screenings performed by physicians and non-physician practitioners. If you diagnose your patient with OUD, we also pay for certain treatment services.

In October, we mailed a letter (PDF) to physicians and non-physician practitioners about these services. We encourage all providers to learn more, and help improve your patients’ behavioral health.

Lymphedema Compression: Medicare Pays for Treatment Items

Starting January 1, 2024, Medicare will pay for lymphedema compression treatment items for Part B patients. Learn more:

  • What’s covered and how often?
  • Who’s eligible?
  • Can I furnish these items?
  • What are my responsibilities?
  • How can I bill?
  • Where can I get more information?

Diabetes: Recommend Preventive Services 

In 2019, 27.5% of Medicare Fee-for-Service patients had a diagnosis of diabetes (see data snapshot (PDF)). During National Diabetes Month, talk with your patients about their risk factors, and recommend preventive services to prevent, detect, and treat diabetes.

Medicare pays for:

Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.

More Information:

Flu Shots Can Take Flu from Wild to Mild 

People 65 years and older are at higher risk of developing serious flu complications compared with young, healthy adults. The CDC recommends annual flu shots for everyone 6 months and older. Talk with your patients about getting a flu shot to reduce their risk, and take flu from wild to mild.

Consider giving a preferred vaccine to your patients 65 years and older. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines: 

  1. Fluzone High-Dose Quadrivalent vaccine
  2. Flublok Quadrivalent recombinant flu vaccine
  3. Fluad Quadrivalent adjuvanted flu vaccine

If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead. 

Medicare Part B pays for the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

Find out when your patients are eligible for the flu shot. We give information for dates of service in the last 18 months:

  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes

Vagus Nerve Stimulators: Transitional Pass-through Status for HCPCS Code C1827

Starting January 1, 2023, when used in combination with CPT code 64568, CMS granted transitional pass-through payment status for HCPCS code C1827 (Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller). 

CMS will reopen all claims submitted for C1827 starting January 1, 2023, and reprocess them if needed. You don’t need to take any action.

More Information:



Interns & Residents Duplicate FTEs Audit Reviews

Do you submit IRIS data for the Direct Graduate Medical Education and Indirect Medical Education reimbursement programs? Many teaching providers report full time equivalents that duplicate what’s reported by another provider. Learn what to expect from a CMS audit (PDF).

Expanded Home Health Value-Based Purchasing Model: October Newsletter 

Read the October Home Health Value-Based Purchasing (HHVBP) Newsletter (PDF) for the latest information, tools, and insights about the Expanded HHVBP Model.

Medicare Payment Systems — Revised

Learn what’s changedincluding FY 2024 updates for the following payment systems:

  • Acute Care Hospital Inpatient            
  • Hospice
  • Inpatient Psychiatric Facility 
  • Inpatient Rehabilitation Facility 
  • Long-Term Care Hospital
  • Skilled Nursing Facility

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