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Wednesday, November 22, 2023



MLN Matters® Articles



CMS Roundup (Nov 17, 2023)

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

  • Learnings from the Acute Hospital Care at Home Waiver  
  • Medicare Care Choices Model Improved Quality of Life and Care for Medicare Hospice Enrollees While Reducing Costs and Acute Care Service Use
  • Request for Applications for the Guiding an Improved Dementia Experience Model
  • Improper Payment Data & Corrective Actions in FY 2023 Financial Report
  • CMS Awards Round Two of New Medicare-Funded Graduate Medical Education Residency Slots

Provider Enrollment Application Fee: CY 2024

Effective January 1, the application fee is $709 for institutional providers who are:

  • Initially enrolling in the Medicare or Medicaid programs or the Children's Health Insurance Program (CHIP)
  • Revalidating their Medicare, Medicaid, or CHIP enrollment
  • Adding a new Medicare practice location

CMS requires this fee with any of these enrollment applications submitted from January 1 – December 31, 2024. See the notice for more information.


Clinical Laboratory Fee Schedule: CY 2024 Final Payment Determinations & Reporting Delay 

See the Clinical Laboratory Fee Schedule (CLFS) CY 2024 final payment determinations (ZIP). Visit CLFS Annual Public Meetings to learn more about the process. You may request a reconsideration of a code until January 20, and CMS will discuss it at next year’s meeting.

On November 16, the Further Continuing Appropriations and Other Extensions Act of 2024 delayed the CLFS private payor reporting requirement for clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests: 

  • Next data reporting period is January 1 – March 31, 2025 
  • Reporting is based on the original data collection period, January 1 – June 30, 2019

The Act also extended the phase-in of payment reductions resulting from private payor rate implementation:

  • No payment reductions for CY 2024
  • Payment won’t be reduced by more than 15% for CY 2025 – 2027 compared to the payment amount established for a test the preceding year


Medicare Ground Ambulance Data Collection System: 5 Top Tips

CMS posted 5 top tips on the Medicare Ground Ambulance Data Collection System for:


Respiratory Virus Season: Protect Your Patients

The CDC recommends the seasonal 2023–2024 flu vaccine and updated 2023–2024 COVID-19 vaccine for everyone 6 months and older. Talk with your patients about these vaccines. They’re the most effective way to protect them from the worst outcomes this respiratory virus season.

Medicare pays for:

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

More Information:


Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar—November 29

Wednesday, November 29 from 1:30–2:30 pm ET

Register for this webinar. 

During this webinar, CMS will:

  • Review Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) coverage requirements from pre-admission to discharge
  • Provide a refresher on existing payment requirements and answer common IRF PPS Helpdesk questions

After the webinar, we’ll post a recording on the IRF PPS webpage. 


Ambulance Open Door Forum — November 30

Thursday, November 30 from 2–3 pm ET

Attend the Ambulance Open Door Forum for an overview of the changes finalized in the CY 2024 Physician Fee Schedule final rule on the Medicare Ground Ambulance Data Collection System. CMS will also announce the CY 2024 Ambulance Inflation Factor and Productivity Adjustment.

More Information:

MLN Matters® Articles

Lymphedema Compression Treatment Items: Implementation

Learn about the new Medicare DMEPOS benefit category (PDF) starting January 1, 2024, including:

  • Codes
  • Payment
  • Billing

ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2024 Update — Revised

Learn what’s changed (PDF). CMS added information about CPT codes 0359U, 81455, and 81479.


New Ownership Reporting Requirements for Providers Using the Form CMS-855A

Learn how Medicare defines a private equity company and real estate investment trust (PDF) so you can report ownership information on the revised enrollment form.

More Information:

Intravenous Immune Globulin Demonstration — Revised

Learn what’s new (PDF), including information on:

  • Section 4134 of the Consolidated Appropriations Act, 2023 
  • Address for overnight mailings
  • 2024 payment rate for Q2052
  • Billing and coding 

Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model — Revised

Learn what’s changed (PDF):

  • Clarified repetitive ambulance services criteria 
  • Added language on HCPCS codes subject to prior authorization

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