News
- Resources & Flexibilities to Assist with the Public Health Emergency in Florida
- CMS Roundup (October 4, 2024)
- Clinical Laboratory Fee Schedule: Reporting Delayed Until 2026
- Respiratory Viruses: Vaccinate against Flu, COVID-19, & RSV
Compliance
Claims, Pricers, & Codes
- Outpatient Skin Substitute Claims: New Codes & Updates Effective October 1
- HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
Multimedia
From Our Federal Partners
- First Marburg Virus Disease Outbreak in the Republic of Rwanda
- Enroll in EFT to Get Paid for CHAMPVA Claims
Information for Patients
News
Resources & Flexibilities to Assist with the Public Health Emergency in Florida
On October 8, 2024, HHS Secretary Xavier Becerra determined that a public health emergency exists in Florida and has existed since October 5, 2024. CMS is working closely with the state and federal partners to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane.
More Information:
CMS Roundup (October 4, 2024)
You may be interested in these topics from the CMS Roundup:
- Case Study on How CMS Prevented Payment of Potentially Fraudulent Claims
- Final Rule Extends Efforts to Address Significant, Anomalous, and Highly Suspect Billing Activity with Accountable Care Organizations
- Grants Totaling $1.4 Million to Six Institutions in Support of Health Equity Research
- Blog Detailing Efforts to Expand Access to High-Quality Primary Care
- Study of the Acute Hospital Care at Home Initiative
Agency Policies Supporting CMS Strategic Pillars
Clinical Laboratory Fee Schedule: Reporting Delayed Until 2026
On September 26, 2024, the Continuing Appropriations and Extensions Act of 2025 delayed the Clinical Laboratory Fee Schedule private payor reporting requirement for clinical diagnostic laboratory tests that aren’t advanced diagnostic laboratory tests:
- Next data reporting period is January 1 – March 31, 2026
- Data reporting is based on the original collection period, January 1 – June 30, 2019
The Act also extended the phase-in of payment reductions resulting from private payor rate implementation:
- No payment reductions for CY 2025
- Payment won’t be reduced by more than 15% for CY 2026–2028 compared to the payment amount established for a test the preceding year
Respiratory Viruses: Vaccinate against Flu, COVID-19, & RSV
Respiratory viruses cause hundreds of thousands of hospitalizations and thousands of deaths during each year’s fall and winter virus season (see HHS). The ideal time to get vaccinated varies by vaccine. The best time to get a flu shot is September and October (see CDC).
Medicare Part B covers:
Find out when your patient is eligible for these vaccines. If you need help, contact your eligibility service provider.
Medicare drug coverage (Part D) covers the respiratory syncytial virus (RSV) shot; it’s not covered by Part A or Part B. See Medicare Part D Vaccines (PDF).
People can get vaccines for the flu, COVID-19, and RSV at the same time. When your patients get their annual flu vaccine, they can get the latest COVID-19 vaccine plus an RSV vaccine, if they’re eligible and have never been vaccinated against RSV.
Get resources for your patients from the Risk Less. Do More campaign, including fact sheets, digital banners, and social media messages.
More Information:
- CDC Respiratory Illnesses webpage
- Vaccines.gov website
- Annual Influenza Vaccination (PDF) and Chronic Condition Prevalence among Medicare Fee-for-Service Enrollees with COVID-19 (PDF) data snapshots: Learn about disparities in Medicare patients
- Flu Shots, Medicare & Coronavirus, and RSV Shots: Get information for your patients
Compliance
Allergy & Immunology Services: Prevent Claim Denials
In 2022, the improper payment rate for allergy and immunology services was 27%, with a projected improper payment amount of $29.3 million (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendix H). Learn how to bill correctly for these services. Review the Allergy & Immunology Services Medicare Provider Compliance Tip for more information, including:
- Codes
- Denial reasons and how to prevent them
- Antigens and how CMS pays for them
Claims, Pricers, & Codes
Outpatient Skin Substitute Claims: New Codes & Updates Effective October 1
CMS added skin substitute HCPCS codes, and we changed status indicators and a descriptor effective October 1, 2024. We’ll make these updates to the January 2025 Integrated Outpatient Code Editor (I/OCE) with an effective date of October 1, 2024:
New Codes
We added 3 new HCPCS codes assigned to the high-cost group and status indicator N:
- A2027: Matriderm, per square centimeter
- A2028: Micromatrix flex, per mg
- A2029: Mirotract wound matrix sheet, per cubic centimeter
Status Indicator Changes
We’re aware of incorrect status indicators in the October 2024 I/OCE. We retroactively changed the status indicators for 3 HCPCS codes:
- Q5131: Injection, adalimumab-aacf (idacio), biosimilar, 20 mg
- Incorrectly assigned E2
- Changed to K and assigned to ambulatory payment classification 0787
- J9059: Injection, bendamustine hydrochloride (baxter), 1 mg
- Incorrectly assigned K
- Changed to E1
- J9072: Injection, cyclophosphamide (dr. reddy's), 5 mg
- Incorrectly assigned G
- Changed to E2
Descriptor Change
We changed the descriptor for HCPCS code A2024 to:
- Long descriptor: Resolve matrix or xenopatch, per square centimeter
- Short descriptor: Resolve or xenopatch sq cm
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
CMS published the 2024 HCPCS Application Summary for Quarter 3, 2024 Drugs and Biologicals. See HCPCS Level II Coding Decisions for more information.
Multimedia
Hospice Quality Reporting Program: HOPE Tool Web-Based Training
Take the Introducing the Hospice Outcomes and Patient Evaluation (HOPE) Tool web-based training. Get an overview of the tool and learn how it relates to the Hospice Quality Reporting Program and FY 2025 final rule. Five sections include interactive exercises to help you understand and apply the content presented. This Train-the-Trainer program is the first in a series that will help you prepare to implement HOPE and collect data starting in FY 2026.
If you have questions about hospice resources and trainings, contact the PAC Training Mailbox. Submit content-related questions to the HospiceQualityQuestions@cms.hhs.gov.
From Our Federal Partners
First Marburg Virus Disease Outbreak in the Republic of Rwanda
The CDC issued this Health Alert Network Health Advisory to inform clinicians and health departments about the Republic of Rwanda’s first confirmed outbreak of Marburg virus disease (MVD) with 36 laboratory confirmed cases and 11 deaths reported as of October 2, 2024, including at least 19 cases in health care workers. No confirmed cases of MVD related to this outbreak have been reported in the U.S. or other countries outside of the Republic of Rwanda to date. Currently, the risk of MVD in the U.S. is low; however, clinicians should be aware of the potential for imported cases.
See the full Health Advisory for more information, including recommendations for clinicians.
Enroll in EFT to Get Paid for CHAMPVA Claims
If you see patients under Civilian Health and Medical Program of VA (CHAMPVA), you must enroll in direct deposit (electronic funds transfer (EFT)) to get your payments. Getting paid by EFT is a federal requirement.
Enrolling in EFT helps:
- Keep CHAMPVA claim payments secure, efficient, and compliant
- Protect Veterans’ family members’ access to benefits
2 steps to enroll in EFT:
- Visit the VA Financial Services Center Customer Engagement Portal
- Complete the Payment Account Setup webform to enroll:
- Review the Vendor Webform User Guide for step-by-step instructions
- Call 877-353-9791 if you need help with the webform
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows, and children. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
More Information:
Information for Patients
2025 Medicare & You Handbook
Share the 2025 Medicare & You Handbook with your patients and their caregivers. Encourage them to switch to electronic versions of the Handbook and Medicare Summary Notices.
New and important this year:
- Lowering prescription drug costs
- Managing mental health and wellbeing
- Supporting caregivers
- Changes to telehealth coverage
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