Thursday, November 14, 2024
News
- 2025 Medicare Parts A & B Premiums and Deductibles
- Medicare Participation for CY 2025
- Ambulance Fee Schedule: CY 2025 Final Policies
- Prior Authorization Review Timeframe Change
- Skilled Nursing Facilities: Revalidation Due Date Extension
- Home Health & Hospice Resources
- Help Your American Indian & Alaska Native Patients Achieve Optimal Health
Claims, Pricers, & Codes
MLN Matters® Articles
- ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2025 Update
- New Waived Tests
Publications
News
2025 Medicare Parts A & B Premiums and Deductibles
On November 8, 2024, CMS released the 2025 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs and the 2025 Medicare Part D income-related monthly adjustment amounts.
Medicare Part B
The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024.
Medicare Part A Inpatient Hospital
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,676 in 2025, an increase of $44 from $1,632 in 2024. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2025, beneficiaries must pay a coinsurance amount of:
- $419 per day for the 61st through 90th day of a hospitalization ($408 in 2024) in a benefit period
- $838 per day for lifetime reserve days ($816 in 2024)
Skilled Nursing Facility
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025 ($204.00 in 2024).
See the full fact sheet for more information.
Medicare Participation for CY 2025
Learn about the advantages of participating in Medicare and changes for CY 2025. Your Medicare Administrative Contractor sent you a postcard with a link to the announcement (PDF).
See Annual Medicare Participation Announcement for more information.
Ambulance Fee Schedule: CY 2025 Final Policies
CMS issued the CY 2025 Physician Fee Schedule final rule that announced policy changes for Medicare payments, including ambulance services. Visit Ambulances Services Center for details.
Prior Authorization Review Timeframe Change
Effective January 1, 2025, CMS will reduce the timeframe for Medicare Administrative Contractors to review Medicare Fee-for-Service standard prior authorization requests to no more than 7 calendar days.
More Information:
- Prior Authorization for Certain Hospital Outpatient Department Services
- Prior Authorization Process for Certain DMEPOS Items
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Skilled Nursing Facilities: Revalidation Due Date Extension
CMS is revalidating enrolled skilled nursing facilities (SNFs) to collect data on ownership, managerial, and related party information. Your Medicare Administrative Contractor will send you a revalidation notice. SNFs will have until May 1, 2025, to submit their revalidation. See Become a Medicare Provider or Supplier.
Home Health & Hospice Resources
Medicare covers a wide range of home health and hospice services. During Home Care & Hospice Month, get familiar with these Medicare Learning Network resources:
- Medicare Payment Systems:
- Medicare Provider Compliance Tips:
- Creating an Effective Hospice Plan of Care fact sheet
- Enhancing Registered Nurse Supervision of Hospice Aide Services (PDF) fact sheet
- Safeguards for Medicare Patients in Hospice Care (PDF) fact sheet
Information for Patients:
- Care Compare: Search for home health services or hospice care
- Home Health:
- Home health services webpage
- Medicare & Home Health Care booklet
- Hospice:
- Hospice care webpage
- Medicare Hospice Benefits booklet
- Medicare & Hospice Benefits: Getting Started brochure
Help Your American Indian & Alaska Native Patients Achieve Optimal Health
American Indians and Alaska Natives face unique health disparities. Social determinants of health, including lack of access to health care, contribute to health disparities (see HHS Office of Minority Health).
During Native American Heritage Month, help address disparities, and recommend preventive services.
Medicare pays for preventive services. Find out when your patient is eligible. If you need help, contact your eligibility service provider.
More Information:
- CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities (PDF)
- CDC Healthy Tribes webpage
Information for Your Patients:
- Preventive & Screening Services webpage
- Coverage to Care Roadmap to Better Care (Tribal Version) (PDF)
Claims, Pricers, & Codes
PrEP for HIV Pharmacy Claims: New HCPCS Code & FAQ Update
CMS added a new HCPCS code Q0521 for pharmacies billing for Pre-exposure Prophylaxis (PrEP) for HIV drugs, effective January 1, 2025:
- Short descriptor: Supply fee hiv prep fda appr
- Long descriptor: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
The new code replaces codes Q0516, Q0517, Q0518, Q0519, and Q0520. Read the updated PrEP for HIV & Related Preventive Services website for more information.
Medicare Administrative Contractors (MACs) publicly posted the payment allowances for the HCPCS codes for the PrEP for HIV drugs and supplying fees furnished through December 31, 2024. Check your MAC’s website.
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2025 Update
Learn about the updates. See MLN Matters Articles 13818 (PDF) and 13828 (PDF) for:
- New codes
- Recent coding changes
- National Coverage Determination coding information
Medicare Administrative Contractors will adjust claims processed in error that you bring to their attention.
New Waived Tests
Learn about billing for clinical laboratories (PDF):
- Requirements
- New waived test approved by the FDA:
- HCPCS code
- Effective date
- Description
Medicare Administrative Contractors will adjust claims you bring to their attention.
Publications
Checking Medicare Claim Status — Revised
CMS added additional information (PDF) for checking claim status.
Checking Medicare Eligibility — Revised
CMS will remove your ability to check patient eligibility (PDF) from the Interactive Voice Response System. Your Medicare Administrative Contractor will let you know their timeline for this change.
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