2022-12-15-MLNC

Revises pricing methodology for drug component of methadone weekly bundle and add-on code for take-home methadone supplies
Modifies payment rate for individual therapy in non-drug component of the bundled payments for episodes of care
Allows OTP intake add-on code to initiate treatment with buprenorphine provided via 2-way audio-video communications technology or audio-only technology when audio-video technology isn’t available and all requirements are met
Extends the flexibility through the end of CY 2023 to provide periodic assessments via audio-only when video isn’t available, when authorized by SAMHSA and DEA
Clarifies OTPs can bill for medically reasonable and necessary services provided via mobile units

We updated the OTP webpages with this and other new information.

Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility

Starting January 1, 2023, Medicare will offer a new benefit that helps continue to pay for immunosuppressive drugs. The Part B immunosuppressive drug (Part B-ID) benefit is for patients who will lose ESRD Medicare coverage 36 months after a kidney transplant and who don’t have, and don’t expect to have, certain other types of health care coverage. The new benefit only covers immunosuppressive drugs and no other items or services.

When you check patient eligibility for this benefit, the response may indicate:

Part B-ID coverage effective as early as January 1, 2023, with enrollment reason code “P-Part B Immunosuppressive Drug Benefit”
Noncoverage for all items and services except immunosuppressive drugs
Qualified Medicare Beneficiary (QMB) program periods (only when a patient is enrolled in QMB)

If you need help, contact your eligibility service provider.

You can’t bill QMB patients for Medicare cost-sharing, including deductibles, coinsurance, and copayments.

Home Health Quality Reporting Program: Get Final OASIS-E Instrument

Get the final Outcome and Assessment Information Set Version E (OASIS-E) instrument effective January 1, 2023.

More Information:

Compliance

Bill Correctly: Power Mobility Devices

The following clarifies messaging from December 8.

The Power Mobility Devices booklet explains how to properly document and bill for power mobility devices (PMDs). Follow these steps to bill for PMDs:

Obtain the Standard Written Order (SWO)
Make a prior authorization request
Complete a home assessment
Keep the following documents: SWO, face-to-face visit supporting documents, written home assessment report, and proof of delivery
Review all information to avoid improper payments

An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs. To properly bill for PMD repairs:

Show repairs are reasonable, necessary, or meet the requirements
Document labor time adequately
Show that DMEPOS suppliers must provide repair warrantees
Specify that wheelchair repair costs can’t exceed a certain amount over a device’s 5-year lifetime

More Information:

42 CFR 414.210
Section 110.2 Medicare Benefit Policy Manual, Chapter 15
Section 510.1 Medicare Program Integrity Manual, Chapter 5

Claims, Pricers, & Codes

Intravenous Immune Globulin Treatment in the Home: ICD-10 Code Update

CMS added a new ICD-10-CM diagnosis code for coverage of intravenous immune globulin treatment of primary immune deficiency diseases in the home:

D81.82: Activated Phosphoinositide 3-kinase Delta Syndrome
Effective October 1, 2022

More Information:

MLN Matters® Articles

DMEPOS Fee Schedule: CY 2023 Update

Learn about this annual update:

Fee schedule amounts for new and existing codes
Payment policy changes

HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2023

Learn about new and discontinued HCPCS codes.

Home or Residence Services: Billing Instructions

Learn about billing for the new evaluation and management visit family:

Codes
Care settings

National Coverage Determination 200.3: Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease

Learn about coverage for:

FDA-approved monoclonal antibodies for the treatment of Alzheimer’s Disease
CMS-approved studies

Publications

Post-Acute Care Quality Reporting Program: Patient Health Questionnaire Cue Card

During patient mood interviews, help patients select how often they have symptoms by showing them the new PHQ-2 to 9 cue card.

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