Thursday, May 2, 2024
- CMS Statement on Proposed Local Coverage Determination for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
- Quality in Motion: Acting on the CMS National Quality Strategy
- ESRD: Oral-Only Renal Dialysis Service Drugs & Biological Products
News
CMS Statement on Proposed Local Coverage Determination for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers
CMS is aware that on April 25, 2024, the Medicare Administrative Contractors (MACs) released a proposed Local Coverage Determination (LCD) to provide appropriate coverage for skin substitute grafts used for chronic non-healing diabetic foot and venous leg ulcers. The MACs issued the collaborative proposed Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers LCD to make sure that Medicare covers, and people with Medicare have access to, skin substitute products that are supported by evidence that shows that they are reasonable and necessary for the treatment of diabetic foot and venous leg ulcers in the Medicare population and that coverage aligns with professional guidelines for appropriately managing these wounds.
CMS strongly encourages interested parties to take advantage of the opportunity under the LCD process to provide comments to the MACs during the public comment period, which is open until June 8, 2024. As part of the LCD process, each of the MACs will be holding public listening sessions in May to provide additional engagement opportunities on this proposed coverage policy.
See the press release for more information.
Quality in Motion: Acting on the CMS National Quality Strategy
CMS wants to improve the quality and safety of your health care. Learn how we’re making progress through our new action plan, Quality in Motion: Acting on the CMS National Quality Strategy (PDF).
ESRD: Oral-Only Renal Dialysis Service Drugs & Biological Products
Starting January 1, 2025, CMS will pay for oral-only ESRD renal dialysis service drugs and biological products, including phosphate binders, under the ESRD PPS Consolidated Billing. We’ll use the same methodology we used to pay for calcimimetics (PDF) in CY 2018. See Including Oral-Only Drugs in the ESRD PPS Bundled Payment (PDF) to learn about:
- Transitional Drug Add-on Payment Adjustment
- Pricing
- Discarded drugs
- HCPCS codes for generic phosphate binders
- Average sales price data
Claims, Pricers, & Codes
Clinical Laboratory Improvement Amendments: Adjusting Claims
CMS corrected an error to Clinical Laboratory Improvement Amendments certification data affecting claims from December 13, 2023 – April 20, 2024. Contact your Medicare Administrative Contractor to adjust your claims if needed.
Events
CMS National Provider Enrollment Conference in San Diego — August 28 & 29
Wednesday, August 28 & Thursday, August 29 from 8 am – 5 pm PT
Register for the CMS National Provider Enrollment Conference at the San Diego Convention Center. Take advantage of this opportunity to meet with CMS and Medicare Administrative Contractor provider enrollment experts.
Publications
Skilled Nursing Facility Place of Service Codes: Updated Resources
CMS updated Medicare Learning Network resources to clarify the place of service codes you should use for inpatient services outside of a facility:
- Skilled Nursing Facility Billing Reference
- Medicare Payment Systems: Skilled Nursing Facility Prospective Payment System
- Skilled Nursing Facility 3-Day Rule Billing
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