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Thursday, December 21, 2023



Claims, Pricers, & Codes

MLN Matters® Articles


From Our Federal Partners




CMS Roundup (Dec 15, 2023)

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

  • 2023 Measures Under Consideration for Adoption Through Medicare Rulemaking
  • Fact Sheet Highlighting Accomplishments to Improve Safety and Quality of Life in Long-Term Care Settings
  • Date for the 2024 CMS Health Equity Conference
  • Public Comment on Proposed NCD for Allogeneic Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndromes
  • Ownership Data for Rural Health Clinics & Federally Qualified Health Centers


Opioid Use Disorder Screenings & Treatment: Medicare Pays for Services

Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners:

If you diagnose your patient with OUD, we pay for certain treatment services. Visit Opioid Use Disorder Screenings & Treatment for coverage and coding information. Bookmark this webpage for the latest updates.


Opioid Treatment Programs: New Information for 2024

Visit Opioid Treatment Programs (OTP) for CY 2024 updates, including:

  • Physician Fee Schedule final rule extends the flexibility through the end of CY 2024 to provide periodic assessments via audio-only when video isn’t available, when authorized by SAMHSA and DEA
  • Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule establishes a weekly payment adjustment for an Intensive Outpatient Program (IOP) provided by an OTP for opioid use disorder treatment; the IOP service:
    • Must be medically reasonable and necessary 
    • Can’t duplicate any service paid for under any bundled payments billed for an episode of care in a given week


Skilled Nursing Facility Consolidated Billing: Are You Following the Requirements?

Skilled nursing facility (SNF) consolidated billing eliminates the potential for duplicate billings for the same service and allows SNFs to oversee and coordinate the total package of care. Learn about consolidated billing requirements, including recent updates to excluded and physician incident to services.

More Information:



Global Surgery: Bill Correctly

In a report, the Office of the Inspector General found that providers didn’t always comply with federal requirements when they bill for surgical services, including missing co-surgery and assistant-at-surgery modifiers. Review the revised Global Surgery (PDF) booklet, and learn about: 

  • Coding 
  • Billing
  • Payment


Claims, Pricers, & Codes

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

For all dates of service starting January 1, 2023, and 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 reopened all claims submitted for C1827 with dates of services starting January 1, 2023, reprocessed them if needed. If your physician claim in an ambulatory surgical center was incorrectly denied, let your Medicare Administrative Contractor know, and they’ll correct it.

More Information:


MLN Matters® Articles

DMEPOS Fee Schedule: CY 2024 Update

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

  • Fee schedule amounts for new and existing codes
  • Payment policy changes



Medicare Diabetes Prevention Program Orientation Video

Watch this video (6:31), and find out how to become a Medicare Diabetes Prevention Program supplier, including:

  • Enrolling
  • Providing services
  • Getting payments from Medicare


From Our Federal Partners

Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV & Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023–2024 Winter Season

The CDC issued a Health Alert Network Health Advisory to alert health care providers to low vaccination rates against influenza, COVID-19, and respiratory syncytial virus (RSV). Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased health care capacity strain in the coming weeks.

Health care providers should:

  • Administer influenza, COVID-19, and RSV immunizations now to patients, if recommended
  • Recommend antiviral medications for influenza and COVID-19 for all eligible patients, especially patients at high-risk of progression to severe disease, such as older adults and people with certain underlying medical conditions

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