The week in Medicare updates
APCs Insider, August 21, 2015
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CMS releases October 2015 quarterly update of HCPCS drug/biological code changes
On August 6, CMS released the quarterly update of the HCPCS code set. This instruction informs the contractors of updated specific drug/biological HCPCS codes. Beginning in October 2015, a temporary HCPCS code will be established for alemtuzumab (Lemtrada®).
Effective date: October 1, 2015
Implementation date: October 5, 2015
Implementation date: October 5, 2015
View Transmittal R3304CP.
CMS provides claims processing instructions for diagnostic digital breast tomosynthesis
On August 6, CMS released a change request providing claims processing instructions for HCPCS code G0279 (diagnostic digital breast tomosynthesis, unilateral or bilateral [list separately in addition to G0204 or G0206]).
Effective date: January 1, 2016
Implementation date: January 4, 2016
Implementation date: January 4, 2016
View Transmittal R3301CP.
CMS releases new and revised place of service codes for outpatient hospitals
On August 6, CMS released a change request revising the description of place of service (POS) code 22 to On Campus-Outpatient Hospital and creates a new POS code 19 for Off Campus-Outpatient Hospital.
Effective date: January 1, 2016
Implementation date: January 4, 2016
Implementation date: January 4, 2016
View Transmittal R3315CP.
CMS revises systems for applying therapy caps in Maryland hospitals
On August 6, CMS released a change request revising Original Medicare systems to ensure therapy services provided in Maryland hospitals are subject to the outpatient therapy per-beneficiary caps. The update also added several sections discussion therapy caps, including documentation and the -KX (requirements specified in the medical policy have been met) modifier.
Effective date: January 1, 2016
Implementation date: January 4, 2016
Implementation date: January 4, 2016
View Transmittal R3309CP.
OIG posts advisory opinion regarding free drugs
On August 12, the Office of Inspector General (OIG) responded to a request for an advisory opinion regarding a program to provide a drug for free for a limited time to patients who experience a delay in the insurance approval process.
View the opinion.
CMS posts information on 2-midnight rule updates in the OPPS proposed rule
On August 12, CMS updated its Inpatient Hospital Reviews website to reflect the updates proposed in the CY 2016 OPPS proposed rule to the 2-midnight rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. The proposed rule also notified the public of upcoming changes in education and enforcement strategies. These changes were also discussed in a related fact sheet.
View the website.
View the fact sheet.
CMS posts decision regarding Lexi-Drugs revision request
On August 12, CMS posted a decision regarding the formal addition of Lexi-Drugs® to the list of compendia used by the Medicare program in the determination of a "medically accepted indication" for off-label drugs and biologics used in an anticancer chemotherapeutic treatment regimen.
View the decision.
CMS releases article on redeterminations and reconsiderations of certain claims
On August 13, CMS released special edition MLN Matters article SE1521 to inform providers of the clarification CMS has given to the MACs and Qualified Independent Contractors (QIC) regarding the scope of review for redeterminations. This updated instruction applies to redetermination requests received by a MAC or QIC on or after August 1, 2015, and will not be applied retroactively.
CMS posts bundled payments initiative fact sheet
On August 13, CMS posted a fact sheet regarding the Bundled Payments for Care Improvement Initiative (BPCI). The BPCI is composed of four broadly defined care models that bundle payments for multiple services beneficiaries received during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for an entire episode. These models may lead to higher quality and more coordinated care for beneficiaries at a lower cost to Medicare.
View the fact sheet.
View the press release.
CMS announces next ICD-10 Coordination and Maintenance Committee meeting
CMS announced its ICD-10 Coordination and Maintenance Committee meeting will take place September 22 and 23. The first day of the meeting will be devoted to procedure code issues. The second day of the meeting will be devoted to diagnosis code topics.
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