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Thursday, March 14, 2024


Claims, Pricers, & Codes

MLN Matters® Articles





CMS Roundup (Mar 8, 2024)

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

  • Eighth Annual Evaluation Report of the Independence at Home Demonstration 
  • Second Annual Evaluation Report for the Primary Care First Model
  • 2024 National Impact Assessment Quality Measures Reports
  • National Plan and Provider Enumeration System to Include Additional Gender Options and P.O. Boxes Instead of Home Addresses
  • National Coverage Determination for Allogeneic Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndromes 
  • CMS Accomplishments for 2023


Marriage and Family Therapists & Mental Health Counselors: Updated Enrollment FAQs

See updated enrollment FAQs (PDF) for marriage and family therapists and mental health counselors (MHCs). CMS clarified:

  • Supervision requirements; see questions 2–3
  • Mental health professionals who can enroll as MHCs; see question 13
  • Reassignment arrangements; see question 25
  • Telehealth enrollment process; see question 34 
  • Opt-out requirements; see questions 40–42

We also added additional resources; see question 4. 


Skilled Nursing Facilities: Billing Medicare for Respiratory Vaccines

Medicare pays for vaccines administered during a patient’s stay in a nursing home. Vaccine payment depends on the type of vaccine and whether the patient is using their Skilled Nursing Facility Part A benefit. Learn how to bill (PDF) for these vaccines:

  • Respiratory syncytial virus
  • Flu
  • Pneumococcal 
  • COVID-19 


Colorectal Cancer: Screening Saves Lives

Colorectal cancer affects men and women of all racial and ethnic groups, and risk increases with age (see CDC). During Colorectal Cancer Awareness Month, encourage screening to help find this cancer early when treatment is most effective.

Medicare covers colorectal cancer screening. Find out when your patient is eligible for screening. If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes


Web Pricer: Send Us Your Feedback by April 15

CMS is interested in your experience with the Web Pricer application. You can submit feedback 1 of 2 ways:


ICD-10 Medicare Severity Diagnosis-Related Group Version 41.1 — Updated

CMS re-released the ICD-10 Medicare Severity Diagnosis-Related Group (MS-DRG) definitions manual file and grouper software effective April 1, 2024. Visit MS-DRG Classifications and Software for more information.


MLN Matters® Articles


New Waived Tests

Learn about billing for Clinical Laboratory Improvement Amendments waived laboratory tests (PDF):

  • Requirements
  • New tests approved by the FDA
  • Using modifier QW

Medicare Administrative Contractors won’t search their files to either take back payment or retroactively pay affected claims. They’ll adjust claims you bring to their attention.


Stay of Enrollment

Learn about this new enrollment status (PDF). CMS may implement a stay if:

  1. You’re not compliant with at least 1 Medicare enrollment requirement 
  2. You can become compliant by submitting the applicable Form CMS-855, CMS-20134, or CMS-588




Federally Qualified Health Center — Revised

Learn what’s changed (PDF):

  • Added information about:
    • Marriage and family therapists and mental health counselors
    • Services and codes
    • Vaccine billing instructions
  • Updated mental health in-person visit rules 

Update your link if you previously bookmarked it.

Information for Rural Health Clinics — Revised

Learn what’s changed (PDF). CMS added information about:

  • Marriage and family therapists and mental health counselors
  • Remote physiologic monitoring, remote therapeutic monitoring, community health integration, and principal illness navigation 
  • Intensive outpatient program services
  • CY 2024 All-Inclusive Rate
  • Social determinants of health
  • General care management services codes
  • Rural health reports and publications


Medicare & Mental Health Coverage — Revised

Learn what’s changed (PDF):

  • Added: 
    • Social determinants of health risk assessment as an optional annual wellness visit element
    • Community health integration and principal illness navigation when covered as mental health services
    • Marriage and family therapists and mental health counselors as eligible practitioners
    • 2 new HCPCS codes for psychotherapy for crisis services
    • 2025 in-person visit requirements for mental health services provided by telehealth
  • Added information about:
    • Annual wellness visit being a community health integration initiating visit
    • Caregiver training services
    • Intensive outpatient program services
    • Exception to the direct supervision requirement for “incident to” services and supplies
    • HCPCS code G0136
    • Marriage and family therapists and mental health counselors providing telehealth services
    • Frequency for partial hospitalization program plan of care certification
  • Updated payment rates:
    • Telehealth non-facility
    • Clinical social workers


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