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Thursday, April 4, 2024


Proposed Payment Rules



Claims, Pricers, & Codes

MLN Matters® Articles

From Our Federal Partners


Proposed Payment Rules

FY 2025 Skilled Nursing Facility Prospective Payment System Proposed Rule

Learn about the FY 2025 Skilled Nursing Facility Prospective Payment System proposed rule. See the rule and related files for more information.


FY 2025 Inpatient Psychiatric Facilities Prospective Payment System & Quality Reporting Updates Proposed Rule

Learn about the FY 2025 Inpatient Psychiatric Facilities Prospective Payment System proposed rule. See the rule for more information.


FY 2025 Hospice Payment Rate Update Proposed Rule

Learn about the FY 2025 Hospice Payment Rate Update proposed rule. See the rule and related file and the Hospice Center for more information.


ESRD Claims: Manual Update to Revise Section Title & Correct Condition Codes 

CMS updated the Medicare Claims Processing Manual, Chapter 8 (PDF):

  • Section 50: Revised the title
  • Section 50.3: Inserted existing condition codes 74 and 80 related to home dialysis that we previously removed in error

See the instruction to your Medicare Administrative Contractor (PDF).



Surgical Dressings: Prevent Claim Denials 

In 2022, the improper payment rate for surgical dressings was 41.8%, and insufficient documentation accounted for 70.6% of improper payments (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, and G). Learn how to bill correctly for these services and prevent denials. Review the surgical dressings provider compliance tip for more information, including:

  • HCPCS & CPT Codes
  • Documentation requirements and example of improper payment
  • Resources


Claims, Pricers, & Codes


Medicare Part B Drug Pricing Files & Revisions: April Update

Learn about quarterly updates to the following average sales price and not otherwise classified pricing files:

  • April 2024 
  • January 2024 
  • October 2023
  • July 2023
  • April 2023

See the instruction to your Medicare Administrative Contractor (PDF).


DMEPOS: Provider Level Adjustment Codes on Remittance Advice

Learn about system changes to report DMEPOS provider level adjustment codes on the remittance advice. See the instruction to your Medicare Administrative Contractor (PDF).


MLN Matters® Articles

Hospital Outpatient Prospective Payment System: April 2024 Update

Learn about payment system updates effective April 1, 2024 (PDF):

  • New codes
  • Covered devices for pass-through payments
  • Level 6 intraocular procedures ambulatory payment classification: Modify your claim if CMS returns it 
  • iDose TR (travoprost intracameral implant) for glaucoma treatment
  • Cardiovascular remote interrogation device evaluation: clarification on the status indicator
  • Intensive cardiac rehabilitation services in a hospital off-campus, non-excepted provider-based department: additional payment amount effective January 1, 2024; we’ll retroactively adjust claims you submitted with the PN modifier from January to April
  • Drugs, biologicals, and radiopharmaceuticals
  • Skin substitutes

From Our Federal Partners

Providers Accepting CHAMPVA: Enroll in Direct Deposit Now

Attention health care providers who accept Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA): The VA is moving towards 100% direct deposit (electronic funds transfer (EFT)) for CHAMPVA claim payments. Visit the VA Financial Services Center Customer Engagement Portaland complete the Payment Account Setup web form to enroll. Payments will be deposited into a bank account. 

By transitioning to EFT, providers help ensure CHAMPVA payments are secure, efficient, and compliant with federal mandates, while safeguarding Veterans’ family members’ access to benefits.  

Getting paid by EFT isn’t optional; it’s a federal requirement. Make the move today.  

For assistance with the webform, call 877-353-9791. 


CHAMPVA is a health care program for spouses, widows(ers), and children of eligible Veterans. Through CHAMPVA, the VA shares the cost of certain health care services and supplies with eligible beneficiaries. 

More Information:

Increase in Invasive Serogroup Y Meningococcal Disease in the U.S.

The CDC issued a Health Alert Network Health Advisory to notify health care providers about an increase in invasive meningococcal disease, mainly attributable to Neisseria meningitidis serogroup Y.


  • Maintain a heightened suspicion for invasive meningococcal disease and start immediate antibiotic treatment for persons with suspected meningococcal disease 
  • Recognize that invasive meningococcal disease may affect people of any age or demographic group
  • Be aware that patients with invasive meningococcal disease may present with bloodstream infection or septic arthritis and without symptoms typical of meningitis
  • Ensure that all people recommended for meningococcal vaccination are up to date for meningococcal vaccines
  • Immediately notify state, tribal, local, or territorial health departments about any suspected or confirmed cases of invasive meningococcal disease
  • Consult with your state or local health department for any questions about meningococcal disease treatment or contact prophylaxis, including any changes based on local meningococcal resistance patterns


Health Care Preparedness Resources

The Administration for Strategic Preparedness and Response's Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) released new health care preparedness resources, which could help you comply with some of the CMS emergency preparedness requirements: 

More Information:

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