Friday, February 14, 2025
News
Claims, Pricers & Codes
- Ambulance Fee Schedule: CY 2025 Inflation Factor
- Integrated Outpatient Code Editor Version 26.0
- New Place of Service Code for Facilities Providing Programs of All-Inclusive Care for the Elderly: Not Applicable to Medicare
- Home Health Consolidated Billing: CY 2025 HCPCS Code Update
MLN Matters® Articles
- Ambulatory Surgical Center Payment Update – January 2025
- HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2025 Quarterly Update
- Hospital Outpatient Prospective Payment System: January 2025 Update
- Payment for Medicare Part B Preventive Vaccines & Their Administration for Rural Health Clinics & Federally Qualified Health Centers
- Travel Allowance Fees for Specimen Collection – 2025 Updates
News
Complex Non-Chemotherapeutic Drug Administration: Determining Payment for Services
CMS updated information on complex non-chemotherapeutic drug administration services in the Medicare Claims Processing Manual Chapter 12 (PDF), section 30.5, including the details and complexity we use to determine payment.
More Information:
- CY 2025 Physician Fee Schedule final rule
- Instruction to your Medicare Administrative Contractor (PDF)
Claims, Pricers & Codes
Ambulance Fee Schedule: CY 2025 Inflation Factor
The CY 2025 Ambulance Inflation Factor is 2.4%.
More Information:
- Medicare Claims Processing Manual, Chapter 15 (PDF), section 20.4
- Instruction to your Medicare Administrative Contractor (PDF)
Integrated Outpatient Code Editor Version 26.0
CMS posted the January 2025 Integrated Outpatient Code Editor files. Learn about claims processing changes effective January 1, 2025.
See the instruction to your Medicare Administrative Contractor (PDF).
New Place of Service Code for Facilities Providing Programs of All-Inclusive Care for the Elderly: Not Applicable to Medicare
CMS created place of service (POS) code 66 for a facility or location providing comprehensive medical and social services as part of the Programs of All-Inclusive Care for the Elderly. POS code 66 is for Medicaid claims. It isn’t applicable for adjudication of Medicare claims. Medicare claims containing POS 66 will be denied.
More Information:
- Medicare Claims Processing Manual, Chapter 26 (PDF), section 10.5
- Instruction to your Medicare Administrative Contractor (PDF)
Home Health Consolidated Billing: CY 2025 HCPCS Code Update
See the revised instruction to your Medicare Administrative Contractor (PDF) to learn about CY 2025 changes to HCPCS codes used for home health consolidated billing. CMS updated the non-routine supply code list to:
- Add 5 new codes
- Update the description for 3 codes from the previous list
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – January 2025
Learn about payment system updates effective January 1, 2025 (PDF):
- New device categories, CPT, and HCPCS codes
- Drugs and biologicals
- Skin substitutes
- Non-opioid treatments for pain relief
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2025 Quarterly Update
Learn about changes effective April 1, 2025 (PDF):
- Updates to the lists of HCPCS codes that are subject to the consolidated billing provision of the Skilled Nursing Facility (SNF) Prospective Payment System
- New, deleted, and revised codes from Part A and Part B SNF files for:
- Radiation therapy
- ESRD-related service
- Chemotherapy
- Blood clotting factor
- Remote therapeutic monitoring
- Colorectal screening
Hospital Outpatient Prospective Payment System: January 2025 Update
Learn about payment system updates effective January 1, 2025 (PDF):
- Coding
- Device pass-through status
- Comprehensive Ambulatory Payment Classification
- Drugs, biologicals, and pharmaceuticals
- Pricer logic
Payment for Medicare Part B Preventive Vaccines & Their Administration for Rural Health Clinics & Federally Qualified Health Centers
Learn about vaccine payment policies (PDF) for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs):
- Hepatitis B vaccines are paid like other Part B preventive vaccines effective January 1, 2025.
- New claim-based payments for Part B preventive vaccines and their administration are effective July 1, 2025. RHCs and FQHCs will need to annually reconcile payments with the facilities’ actual vaccine and vaccine administration costs on their cost reports.
Travel Allowance Fees for Specimen Collection – 2025 Updates
Learn about CY 2025 updates effective January 1, 2025 (PDF):
- Specimen collection fees and determining eligibility
- Travel allowance policies and mileage rate
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