Dynamic List Information
Dynamic List Data
Weekly Edition
MLN Connects logo

Thursday, May 23, 2024



Claims, Pricers, & Codes

MLN Matters® Articles

From Our Federal Partners



Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date

The Medicare Shared Savings Program is now accepting applications through the Accountable Care Organization (ACO) Management System. Apply no later than noon ET on June 17, 2024.

ACOs interested in Advance Investment Payments (PDF) or the ACO Primary Care Flex Model must first apply to the Shared Savings Program.

To learn more about the process, register for the upcoming June 5, 2024 webinar on Completing Phase 1 of the Application and Avoiding Common Deficiencies.

More information: 

Medicare Providers: Deadlines for Joining an Accountable Care Organization

To participate in an Accountable Care Organization (ACO) for performance year 2025, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:

Participant taxpayer identification numbers can only appear on one ACO participant list. Resolve any overlaps by September 5.

More Information:

Institutional Providers: Medicare Enrollment & Certification Roadmap

Read the Provider Enrollment & Certification Roadmap (PDF) to learn about each step of the process, including timeframes and points of contact.

More Information:

Improve Your Search Results for CMS Content

If you’re using a search engine to find information on CMS.gov, include “CMS” in your search term to get optimal results.


Medical Services Authorized by the Veterans Health Administration: Avoid Duplicate Payments

In a report, the Office of the Inspector General found that Medicare paid providers for medical services authorized and paid for by the Department of Veterans Affairs’ community care programs, resulting in duplicate payments of up to $128 million. We don’t pay for services authorized under Veterans Health Administration benefits. 

More information to bill correctly:


Claims, Pricers, & Codes

Pass-Through Device: Correct Returned Claims

Learn how to correct pass-through device claims that CMS returned with Reason Code W7098, “Claim with pass-through device lacks required procedure (RTP).”

For claims with a pass-through device code, include the corresponding procedure code from the device offset code pairs list. If the procedure and pass-through device codes aren’t paired on the list, resubmit the claim with HCPCS C1889 in place of the pass-through device code so your Medicare Administrative Contractor (MAC) can reprocess your claim.

For example: You billed HCPCS code 92920 for the procedure, but it’s not a corresponding procedure for the pass-through device HCPCS C1761. If your MAC returns the claim with Reason Code W7098, resubmit it using HCPCS code 92920 with HCPCS C1889 instead of C1761.


MLN Matters® Articles

ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2024 Update

Learn about revisions effective October 1, 2024 (PDF):

  • New codes
  • Recent coding changes 

National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation 

Learn about expanded coverage for allogeneic hematopoietic stem cell transplantation (HSCT) effective March 6, 2024 (PDF):

  • HSCT using bone marrow, peripheral blood or umbilical cord blood stem cell products
  • Other indications for stem cell transplantation not otherwise specified

Your Medicare Administrative Contractor will adjust claims that you bring to their attention.

Hospice Claims Edits for Certifying Physicians — Revised 

CMS added coding information for the referring provider name (PDF) for claims you submit on or after October 7, 2024, with dates of service June 3, 2024 or later.

From Our Federal Partners

Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia: Ensure Travelers are Current on Meningococcal Vaccination

The CDC issued a Health Alert Network Health Advisory to alert clinicians to cases of meningococcal disease linked to travel to the Kingdom of Saudi Arabia (KSA). Since April 2024, 12 cases of meningococcal disease linked to KSA travel: United States (5 cases), France (4 cases), and the United Kingdom (3 cases). 

Recommendations for Healthcare Providers

  • Recommend vaccination with MenACWY conjugate vaccine for people considering travel to KSA to perform Hajj or Umrah (pilgrims) in addition to routine meningococcal vaccination for adolescents and other people at increased meningococcal disease risk
  • Maintain a heightened index of suspicion for meningococcal disease among symptomatic people who have recently been in KSA and among close contacts of people who have recently been in KSA, regardless of vaccination status
  • Immediately notify state, tribal, local, or territorial health departments about any suspected or confirmed cases of meningococcal disease in the United States
  • Preferentially consider using rifampin, ceftriaxone, or azithromycin instead of ciprofloxacin as prophylaxis for close contacts in the United States of meningococcal disease cases associated with travel in KSA


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).