by CMS - MLNConnects
Jun 21st, 2022
- Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023
- Men’s Health: Talk to Your Patients About Preventive Services
- ICD-10-CM Diagnosis Codes: Fiscal Year 2023
- July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
- Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised
News
Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023
CMS reduced the number of claims in the Comprehensive Error Rate Testing program report for reporting year 2023. We’ll send you a letter if your claims are impacted by this reduction.
Men’s Health: Talk to Your Patients About Preventive Services
During Men’s Health Week, encourage your male patients to make their health a priority. Medicare covers preventive services, including:
- Alcohol misuse screening & counseling
- Cancer screening: colorectal & prostate
- Cardiovascular disease: screening tests & intensive behavioral therapy (IBT)
- Counseling to prevent tobacco use
- IBT for obesity
Your patients pay nothing if you accept assignment. Learn how to check eligibility (PDF) for preventive services. If you need help, contact your eligibility service provider.
More Information:
- Medicare Preventive Services educational tool
- Coverage to Care Prevention Resources: See flyer for men in 8 languages
- Preventive & Screening Services webpage: Get information for your patients
Compliance
Implanted Spinal Neurostimulators: Document Medical Records
In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.
Learn what you need to include in patient medical records:
- Prior Authorization and Pre-Claim Review Initiatives webpage
- Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
- Section 6.3.2.2 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
- 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
Claims, Pricers, & Codes
ICD-10-CM Diagnosis Codes: Fiscal Year 2023
Fiscal year 2023 ICD-10-CM diagnosis code files and guidelines are available on the 2023 ICD-10-CM webpage. These codes are effective for discharges and patient encounters on or after October 1, 2022.
July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Learn about quarterly updates to the following pricing files effective for dates of service:
- July 1–September 30, 2022: July 2022 ASP and ASP not otherwise classified (NOC)
- April 1–June 30, 2022: April 2022 ASP and ASP NOC
- January 1–March 31, 2022: January 2022 ASP and ASP NOC
- October 1–December 31, 2021: October 2021 ASP and ASP NOC
- July 1–September 30, 2021: July 2021 ASP and ASP NOC
See the instruction to your Medicare Administrative Contractor (PDF).
MLN Matters® Articles
July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
Learn about new codes and changes effective July 1, 2022 (PDF):
- CPT Category III code
- HCPCS codes for drugs, biologicals, and radiopharmaceuticals
- Skin substitute products and group assignment
Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised
Learn about delayed in-person visit requirements (PDF) after the end of the COVID-19 public health emergency.
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