Spotlights
Physician Fee Schedule: CY 2025 Proposed Rule – Submit Comments by September 9
CMS issued the CY 2025 Physician Fee Schedule (PFS) proposed rule to propose updates for Medicare PFS:
- Payment policies and rates
- Medicare Prescription Drug Inflation Rebate Program
- Behavioral Health Services
- Dental and Oral Health Services
- Opioid Treatment Programs
- Telehealth Services
- Rural Health Clinics and Federally Qualified Health Centers
See a summary of proposed provisions. Comments are due by September 9, 2024; see the proposed rule for details on how to submit them.
PrEP for HIV: Prepare for Potential Medicare Part B Coverage
On July 12, 2023, CMS proposed to transition coverage of Preexposure Prophylaxis (PrEP) using FDA-approved antiretroviral drugs (oral or injectable) to prevent HIV to Medicare Part B. Currently, HIV PrEP drugs may be covered under Medicare Part D.
It’s critical that your patients have uninterrupted access to their HIV PrEP drugs. We expect to release a final National Coverage Decision (NCD) in late September 2024, and we expect the final NCD will be similar to the proposed NCD. We’re encouraging you to prepare your systems now so you’re able to immediately transition to Part B coverage if we release a final NCD.
Review our fact sheet (PDF) and frequently asked questions (PDF) to learn more about how you can prepare for the possible upcoming coverage change, including information about enrollment, billing, claims processing, and coding.
Average Sales Price Files
CMS posted the July 2024 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2024 ASP Drug Pricing Files webpage.
Appropriate use of place-of-service codes
Review the revised Skilled Nursing Facility 3-Day Rule Billing (PDF) fact sheet and the SNF PPS section of Medicare Payment Systems to learn more about place-of-service codes.
Physician Fee Schedule: Learn What's New for CY 2024
CMS issued the CY 2024 Physician Fee Schedule (PFS) final rule that announces policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See a summary of key provisions effective January 1, 2024.
States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now
Share the Renew Your Medicaid or CHIP Coverage flyer (PDF) with your Medicaid and Children’s Health Insurance Program (CHIP) patients.
Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.
Read about it in the MLN Connects® newsletter.
