Thursday, March 27, 2025
News
- Extension of Medicare Provisions
- Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement
- Nutrition-Related Health Conditions: Recommend Medicare Preventive Services
Claims, Pricers, & Codes
MLN Matters® Articles
- Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: April 2025 Quarterly Update
- HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2025
- Improving Payment Accuracy for Physician Services in Skilled Nursing Facilities
- Processing Hospice Claims – Principal Diagnosis Code Reporting Update: Medicare Claims Processing Manual, Chapter 11, Sections 30.3, 40.2 & 50
- Roster Billing for Hepatitis B: July 2025 Release — Revised
Publications & Multimedia
- Hospital Price Transparency
- 2025 Medicare Part C and Part D Reporting Requirements and Data Validation — Revised
News
Extension of Medicare Provisions
The Full-Year Continuing Appropriations and Extensions Act, 2025 extended certain Medicare provisions through September 30, 2025 including but not limited to:
- Increased inpatient hospital payment adjustment for certain low-volume hospitals
- Medicare-dependent hospital program
- Certain telehealth flexibilities
See the complete list of provision extensions in the Act.
Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement
CMS released a final national coverage determination and decision memo to establish coverage policies for transcatheter tricuspid valve replacement for the treatment of symptomatic tricuspid regurgitation.
Nutrition-Related Health Conditions: Recommend Medicare Preventive Services
During National Nutrition Month®, encourage your patients to develop healthy eating and physical activity habits. Medicare covers 8 preventive services for nutrition-related health conditions like diabetes, chronic kidney disease, cardiovascular disease, and obesity:
- Annual wellness visit
- Cardiovascular disease screening tests
- Diabetes screening
- Diabetes self-management training
- Intensive behavioral therapy (IBT) for cardiovascular disease
- IBT for obesity
- Medical nutrition therapy
- Medicare Diabetes Prevention Program
Find out when your patient is eligible for these services (PDF). If you need help, contact your eligibility service provider.
Information for Your Patients:
Claims, Pricers & Codes
Discarded Drugs & Biologicals: Deleted HCPCS Code
CMS deleted the following HCPCS code and descriptor from the Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy HCPCS Codes (PDF) list: J0739 — Injection, cabotegravir, 1 mg, FDA-approved prescription, only for use as HIV pre-exposure prophylaxis (not for use as treatment for HIV).
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: April 2025 Quarterly Update
Learn about updates for laboratory billing (PDF) effective April 1, 2025:
- Next reporting period for clinical diagnostic laboratory tests
New and deleted CPT codes
HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2025
Learn about updates (PDF) effective April 1, 2025:
- New and discontinued codes
Codes subject to, and excluded from, Clinical Laboratory Improvement Amendments edits
Improving Payment Accuracy for Physician Services in Skilled Nursing Facilities
Learn to use the correct place of service (POS) codes (PDF):
- Use POS 31 for services provided during a patient’s Medicare Part A stay
Use POS 32 for services provided in nursing facilities and for those provided in skilled nursing facilities when patients have exhausted their Part A coverage
Processing Hospice Claims – Principal Diagnosis Code Reporting Update: Medicare Claims Processing Manual, Chapter 11, Sections 30.3, 40.2 & 50
Learn about updates for claims (PDF) received on or after April 1, 2025:
- Updated guidance on non-reportable principal diagnosis codes
- Clarified liability for claim denials during a hospice election
Added related conditions to the Medicare Claims Processing Manual, Chapter 11 (PDF), section 50
Roster Billing for Hepatitis B: July 2025 Release — Revised
Find out when mass immunizers may bill (PDF) for hepatitis B claims using Place of Service code 60 (Mass Immunization Centers) and specialty code 73 (Roster Billers).
Publications & Multimedia
Hospital Price Transparency
Price transparency helps lower costs and gives consumers the information they need to make financial decisions about their health care. Learn more about hospital price transparency (PDF):
- What pricing information hospitals must provide
- What formats hospitals must use
- Resources to help hospitals meet accessibility and file requirements
- Information patients need to know
- Where to get more information
2025 Medicare Part C and Part D Reporting Requirements and Data Validation — Revised
CMS updated this web-based training course, including:
- Reporting sections that require evaluation
- Compliance requirements for each reporting section of the special needs plan
Grievance reporting standards
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