Friday, April 11, 2025
News
- Dr. Mehmet Oz Shares Vision for CMS
- Skilled Nursing Facility Value-Based Purchasing Program: March 2025 Confidential Feedback Reports
- Skilled Nursing Facilities: Revalidation Deadline is May 1
Compliance
Claims, Pricers & Codes
- Medicare Physician Fee Schedule Database: April Update
- Integrated Outpatient Code Editor Version 26.1
MLN Matters® Articles
- ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2025 Update
- DMEPOS Fee Schedule: April 2025 Quarterly Update
- Hospital Outpatient Prospective Payment System: April 2025 Update
News
Dr. Mehmet Oz Shares Vision for CMS
As Dr. Mehmet Oz completes his first week as the 17th Administrator of CMS, he is sharing his agenda and vision for the agency. A cardiothoracic surgeon and former host of an award-winning TV show, he now leads the largest agency under HHS, with a $1.7 trillion budget, tasked with delivering health outcomes for more than 160 million people.
See the full press release.
Skilled Nursing Facility Value-Based Purchasing Program: March 2025 Confidential Feedback Reports
Download your March 2025 Quarterly Confidential Feedback Reports for the FY 2026 Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) from iQIES.
These reports contain interim stay-level data for the SNF 30-Day All-Cause Readmission Measure for FY 2024 quarters 1–3, the FY 2026 SNF VBP Program performance period.
Questions?
- Contact iqies@cms.hhs.gov about report access
- Contact SNFVBP@rti.org about the program
Skilled Nursing Facilities: Revalidation Deadline is May 1
Enrolled skilled nursing facilities should collect data on ownership, managerial, and related party information and submit their revalidation by May 1. See Become a Medicare Provider or Supplier for more information.
Last fall, your Medicare Administrative Contractor sent you a revalidation notice.
Compliance
Pneumatic Compression Devices: Prevent Claim Denials
In 2023, the improper payment rate for pneumatic compression devices was 78.9%, with a projected improper payment amount of $41.6 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, and G). Learn how to bill correctly for these services. Review the Pneumatic Compression Devices & Accessories provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
Claims, Pricers & Codes
Medicare Physician Fee Schedule Database: April Update
See the instructions to your Medicare Administrative Contractor (MAC) (PDF) attachment to learn about the April quarterly updates to the Medicare Physician Fee Schedule Database, including:
- New codes
- Procedure status changes
- Code short descriptor revisions
- Payment policy indicator changes
Your MAC will give you 30-days notice before they implement these changes. After that, they’ll adjust claims that you bring to their attention.
For more information, see the Medicare Claims Processing Manual, Chapter 23 (PDF), section 30.1.
Integrated Outpatient Code Editor Version 26.1
CMS posted the April 2025 Integrated Outpatient Code Editor files. Learn about claims processing changes effective April 1, 2025.
See the instruction to your Medicare Administrative Contractor (PDF).
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2025 Update
Learn about updates effective July 1, 2025 (PDF):
- Newly available codes
- Recent coding changes
- National Coverage Determination (NCD) coding information
DMEPOS Fee Schedule: April 2025 Quarterly Update
Learn about updates effective April 1, 2025 (PDF):
- New HCPCS codes, including:
- DMEPOS repairs and service added to fee schedule
- Complex rehabilitative power wheelchair accessories
- Lymphedema compression treatment items
- New fee schedule amounts
Hospital Outpatient Prospective Payment System: April 2025 Update
Learn about updates effective April 1, 2025 (PDF), including coding and billing changes for:
- Certain laboratory tests, COVID-19 monoclonal antibody therapy products, and Hospital Outpatient Prospective Payment System device categories
- Ambulatory payment classifications
- Surgical and imaging procedures
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitute products
Medicare Administrative Contractors will adjust claims you bring to their attention.
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