Dynamic List Information
Dynamic List Data
Weekly Edition
MLN Connects logo

Thursday, November 30, 2023


Claims, Pricers, & Codes

MLN Matters® Articles

Information for Patients



Quality Payment Program: Preview Your Performance Information by December 12

Doctors and clinicians: Now through December 12 at 8 p.m. ET, preview your 2022 performance information before it appears on the Medicare.gov compare tool and in the Provider Data Catalog. Learn more about the 2022 Preview Period and public reporting at Care Compare: Doctors and Clinicians Initiative.

HIV: Screening is Knowledge

The CDC estimates that 1.2 million people in the U.S. had HIV in 2021, and about 13% didn’t know they had it (see CDC). Screening is the only way to know for sure if they have HIV. Knowing their status helps them choose options to stay healthy. On World AIDS Day, talk with your patients about HIV prevention and screening.

Medicare pays for HIV screening, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for this screening and learn about screening frequency. If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes

Resubmit Telehealth Claims with Modifier CS

The following Rural Health Clinic (71X) and Federally Qualified Health Clinic (77X) telehealth claims were incorrectly returned to provider with edit W7123:

  • Preventive services that have cost sharing waived 
  • HCPCS code G2025 billed with modifier CS

CMS addressed this issue. Resubmit these claims with modifier CS to your Medicare Administrative Contractor.


Federally Qualified Health Center Prospective Payment System: CY 2024 Pricer

Based on data through June 2023, the CY 2024 Federally Qualified Health Center (FQHC) Prospective Payment System base payment rate is $195.99, which is 4.7% higher than 2023. Find your geographic adjustment factor (ZIP).

More Information:


Rural Health Clinic CY 2024 All-Inclusive Rate

CMS updated the rural health clinic (RHC) all-inclusive rate for CY 2024:

Independent & Provider-Based RHCs in Hospital with 50 or More Beds

The payment limit per visit is $139.00.

Specified (Grandfathered) Provider-Based RHCs with April 1, 2021, Established Payment Limit

For RHCs that continue to meet the qualifications in section 1833(f)(3)(B) of the Act, the payment limit per visit is the greater of these amounts:

  1. Your payment limit per visit starting January 1, 2023, increased by 4.6%
  2. The national statutory CY 2024 payment limit per visit of $139.00

More Information:


MLN Matters® Articles

Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease

CMS removed NCD 220.6.20 (PDF) from the Medicare National Coverage Determination Manual, effective October 13, 2023. Your Medicare Administrative Contractor will make coverage determinations.


ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates

Learn about changes effective January 1, 2024 (PDF):

  • Rate updates and policies for the ESRD Prospective Payment System
  • Payment for renal dialysis services provided to patients with acute kidney injury in ESRD facilities


Medicare Physician Fee Schedule Final Rule Summary: CY 2024

Learn about changes to (PDF):

  • Telehealth services
  • Evaluation and management visits
  • Behavioral health services
  • Dental and oral health services
  • Therapy services
  • Diabetes self-management training services
  • Community health integration services
  • Principal illness navigation services
  • Social determinants of health
  • Caregiver training


Information for Patients

Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings

CMS released a new toolkit to help you share information about Medicaid and Children’s Health Insurance Program (CHIP) renewals with patients. There’s also information on how to help patients transition to other health coverage options if they’re no longer eligible for Medicaid or CHIP. This toolkit includes ready-to-use resources like:

  • FAQs
  • Recorded phone and hold messages
  • No reply text messages and push notifications for patient portals
  • E-newsletter and patient portal messages

We encourage you to use these resources at your office’s front desk and in lobby or waiting areas, the billing department, patient portals, and other places. For more materials on Unwinding and Returning to Regular Operations after COVID-19, see outreach and educational resources.

Subscribe to the MLN Connects® newsletter, or read past editions.

View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure.

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).