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Thursday, March 7, 2024




Claims, Pricers, & Codes




HHS Statement Regarding the Cyberattack on Change Healthcare

HHS is aware that Change Healthcare – a unit of UnitedHealth Group – was impacted by a cybersecurity incident in late February. HHS recognizes the impact this attack has had on health care operations across the country. HHS’ first priority is to help coordinate efforts to avoid disruptions to care throughout the health care system.

On March 5, HHS announced immediate steps that CMS is taking to assist providers to continue to serve patients. CMS will continue to communicate with the health care community and assist, as appropriate. Providers should continue to work with all their payers for the latest updates on how to receive timely payments.

Read the full statement.


Final Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs

Continuing the ongoing implementation of President Biden’s prescription drug pricing law, the Inflation Reduction Act of 2022, CMS released the final part one guidance (PDF) for the new Medicare Prescription Payment Plan. This guidance helps ensure that Medicare Part D plan sponsors can successfully implement the Medicare Prescription Payment Plan and effectively build the necessary infrastructure to provide a seamless experience for people enrolled in a Medicare Part D prescription drug plan who elect to participate in this program. 

This guidance is accompanied by the release of an Information Collection Request for the Medicare Prescription Payment Plan, which includes model materials for Medicare Part D plan sponsors to use when communicating to Part D enrollees about the program. Comments must be received by April 29, 2024, to be considered. In addition, the draft part two guidance (PDF) for the program is open for comment until March 16, 2024.

More Information:

Current Status of Blood Tests for Organ Transplant Rejection 

Patients with transplanted hearts, lungs, or kidneys who meet Medicare’s local coverage criteria can continue to access blood tests used to monitor for organ transplantation when ordered by their doctors. In March 2023, CMS, through its local contractors (known as Medicare Administrative Contractors or MACs) issued revised billing instructions for these tests in response to improper billing and overutilization. On February 29, MACs updated these instructions to clarify that these tests remain available to patients when medically necessary and ordered by a physician. 

More information about MolDx: Molecular Testing for Solid Organ Allograft Rejection:

Opioid Use Disorder: Medicare Pays for Certain Treatment Services

Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners. If you diagnose your patient with OUD, we also pay for certain treatment services, including:

  • Evaluation and management visits for medication management: Use these visits to provide medication management to make sure patients take medications (like buprenorphine) properly as part of their recovery process. 
  • Office-based substance use disorder (SUD) treatment services: You can bill for a group of services for the treatment of SUDs in the office setting. Medicare pays for a monthly bundle of services (for patients who are prescribed buprenorphine or naltrexone in the office setting) for the treatment of OUD or other SUDs. 
  • Opioid Treatment Program (OTP): Provide medications for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, as well as a range of other services including individual and group therapy, substance use counseling, and toxicology testing, for patients diagnosed with OUD. Consider referring your patient to an OTP if this specific MOUD is helpful to their recovery. OTPs may also furnish Intensive Outpatient Program services to treat OUD. 

Visit Opioid Use Disorder Screenings & Treatment for more information, including coverage and coding. 


Skilled Nursing Facility Value-Based Purchasing Program: March Confidential Feedback Reports 

Download your March Quarterly Confidential Feedback Reports for the FY 2025 Skilled Nursing Facility Value-Based Purchasing Program from iQIES. Review data for upcoming measure and scoring calculations, including planned and unplanned readmissions.

This data isn’t eligible for the review and correction process because it isn’t final. We’ll include final data and measure results in your June report.


Marriage and Family Therapists & Mental Health Counselors: Manual Updates 

CMS updated manuals to reflect Medicare coverage and payment for marriage and family therapists and mental health counselors effective January 1, 2024:

Nutrition-Related Health Conditions: Recommend Medicare Preventive Services

During National Nutrition Month®, encourage your patients to develop healthy eating and physical activity habits. Medicare covers 8 preventive services for nutrition-related health conditions like diabetes, chronic kidney disease, cardiovascular disease, and obesity:

  1. Annual wellness visit: health risk assessment and personalized prevention plan to keep patients healthy
  2. Cardiovascular disease screening tests: blood tests for cholesterol, lipid, and triglyceride levels to help detect conditions that may lead to a heart attack or stroke
  3. Diabetes screening: blood glucose laboratory test screenings for patients at risk for developing diabetes
  4. Diabetes self-management training: tips to help patients manage their diabetes, including eating healthy and being active, monitoring blood glucose, taking prescription drugs, and reducing risks 
  5. Intensive behavioral therapy (IBT) for cardiovascular disease: blood pressure check, tips on eating well, and aspirin use to lower risk for cardiovascular disease
  6. IBT for obesity: initial screening for body mass index and behavioral therapy sessions, including dietary assessment and counseling to help patients lose weight by focusing on diet and exercise
  7. Medical nutrition therapy: nutrition and lifestyle assessment, individual or group nutritional therapy services, help managing lifestyle factors, and follow-up visits to help certain patients manage their diet
  8. Medicare Diabetes Prevention Program (PDF): specially trained coaches teach long-term behavior changes for diet and exercise and weight control strategies for eligible patients

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

More Information:



Comprehensive Outpatient Rehabilitation Facility Services: Prevent Claim Denials 

In 2022, the improper payment rate for comprehensive outpatient rehabilitation facility (CORF) services was 47.4%, and insufficient documentation accounted for 89.7% of improper payments (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices E and G). Learn how to bill correctly for these services. Review the CORF services provider compliance tip for more information, including:

  • Requirements for claim payment
  • Documentation requirements and example of improper payment
  • Resources


Claims, Pricers, & Codes

National Correct Coding Initiative: April Update

Get the National Correct Coding Initiative (NCCI) second quarter edit files, effective April 1, 2024, on these Medicare NCCI webpages:


RARCs, CARCs, Medicare Remit Easy Print, & PC Print: April Update

Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), and watch for software updates if you use Medicare Remit Easy Print or PC Print.

More Information:



Proper Use of Modifiers 59, XE, XP, XS, & XU — Revised

Learn what’s changed (PDF). CMS added information on the use of modifier 59 in Rural Health Clinic and Federally Qualified Health Center settings.


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