2023-12-07-MLNC

Date
2023-12-07
Title
Weekly Edition

MLN Connects logo

Thursday, December 7, 2023

 

News

Claims, Pricers, & Codes

MLN Matters® Articles

 

News 

Citrix Bleed Vulnerability: Act Now 

In response to active exploitation of a cybersecurity vulnerability, HHS’ Health Sector Cybersecurity Coordination Center released a notice (PDF) strongly encouraging organizations to upgrade their devices and prevent further damage to the health sector. Make sure your IT department reads the information and takes necessary action. We also encourage you to share this message with your network clearinghouses and vendors.

 

Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now 

CMS will implement 2 new provider types on January 1:

  1. Marriage and family therapist 
  2. Mental health counselor

Enroll in Medicare now. Starting for dates of service January 1, you can bill independently for services furnished for the diagnosis and treatment of mental illnesses. Find out how to become a Medicare provider, and take these steps to enroll:

Sign up to get national or local program news.

More Information:

Health Professional Shortage Area: CY 2024 Bonus Payments 

See ZIP Codes designated as Health Professional Shortage Areas in 2024 that are eligible for a Medicare Physician Bonus:

See the instruction to your Medicare Administrative Contractor (PDF).

 

Skilled Nursing Facility Value-Based Purchasing Program: December Confidential Feedback Reports

Download your December Quarterly Confidential Feedback Reports for the Skilled Nursing Facility Value-Based Purchasing Program from iQIES, including the incentive payment multiplier CMS will apply to your Part A claims in FY 2024.

Submit corrections until December 31. See Confidential Feedback Reporting & Review and Corrections for more information.

Questions?

Flu Shots: There’s Still Time to Protect Your Patients

The CDC recommends annual flu shots for everyone 6 months and older, including people with chronic medical conditions who have a higher risk of serious complications. Vaccination rates for Medicare Fee-for-Service patients vary by race, ethnicity, and geographic area (see data snapshot (PDF). During National Influenza Vaccination Week, encourage your patients to get flu shots, and find out how you can help reduce vaccination disparities.

Consider giving a preferred vaccine to your patients 65 years and older. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines: 

  1. Fluzone High-Dose Quadrivalent vaccine
  2. Flublok Quadrivalent recombinant flu vaccine
  3. Fluad Quadrivalent adjuvanted flu vaccine

If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead. 

Medicare Part B pays for the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

Find out when your patients are eligible for the flu shot. We give information for dates of service in the last 18 months:

  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

If you need help, contact your eligibility service provider.

More Information:

 

Claims, Pricers, & Codes

Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration 

We updated this message on February 1.

CMS retroactively added 2 new CPT codes for respiratory syncytial virus (RSV) vaccine administration to the Medicare Physician Fee Schedule files effective for dates of service on and after October 6, 2023: 

  • 96380 – Short descriptor: Admn rsv monoc antb im cnsl
  • 96381 – Short descriptor: Admn rsv monoc antb im njx

Get RSV shot information for your patients.

 

Discarded Drugs & Biologicals: JZ Modifier Use for Pharmacies 

Report the JZ modifier when you submit claims for single-dose container drugs that you dispensed but didn’t administer. See the updated answer to question 6 of the FAQs (PDF).

 

National Correct Coding Initiative: Annual Policy Manual Update

Get updates to the Medicare National Correct Coding Initiative (NCCI) Policy Manual effective January 1, 2024.

 

ICD-10: New Procedure Codes Effective April 1

CMS is implementing 41 new procedure codes (PDF) into ICD-10-PCS effective April 1, 2024. We’ll update the grouper software, code tables, index, and related files by February 1.

More Information:

 

 

MLN Matters® Articles

Edits to Prevent Payment of G2211 with Office/Outpatient Evaluation and Management Visit and Modifier 25 

Learn about complexity add-on code G2211 (PDF):

  • Medicare pays separately starting January 1, 2024
  • We don’t pay when you report an associated office or outpatient evaluation and management visit with modifier 25

  • We don’t pay Method II Critical Access Hospitals on the same encounter for type of bill 85X

     

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.

 

Update for Blood Clotting Factor Add-on Payments — Revised 

Learn what’s changed (PDF). CMS updated the list of HCPCS J codes:

  • Deleted J7191 and J7199
  • Added J7177, J7178, and J7214

Your Medicare Administrative Contractor will adjust claims for discharges as of October 1, 2022, by June 1, 2024. You don’t need to take any action.

 

 

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