Thursday, April 17, 2025
News
- Clotting Factors: Medicare Part B Pays for Alhemo & Qfitlia
- Skilled Nursing Facilities: Revalidation Deadline Extended to August 1
- Raise Awareness & Understanding of Alcohol Use and Misuse
News
Clotting Factors: Medicare Part B Pays for Alhemo & Qfitlia
Medicare Part B pays for Alhemo (concizumab-mtci) and Qfitlia (fitusiran) as clotting factors for which the furnishing fee applies.
FDA approvals:
- Alhemo on December 20, 2024: indicated for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients 12 years of age and older with hemophilia A (congenital factor VIII deficiency) with factor VIII inhibitors or hemophilia B (congenital factor IX deficiency) with factor IX inhibitors
- Qfitlia on March 28, 2025: indicated for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients 12 years of age and older with hemophilia A or B, with or without factor VIII or IX inhibitors
CMS hasn’t assigned HCPCS codes to Alhemo and Qfitlia yet, so use a Not Otherwise Classified code. Your Medicare Administrative Contractor will determine the payment amount for the clotting factor and furnishing fee.
More Information:
- 2025 Physician Fee Schedule final rule
- Medicare Claims Processing Manual, Chapter 17 (PDF), section 80.4.1
Skilled Nursing Facilities: Revalidation Deadline Extended to August 1
Enrolled skilled nursing facilities should collect data on ownership, managerial, and related party information and submit their revalidation. CMS extended the deadline to August 1, 2025. See the Become a Medicare Provider or Supplier webpage for more information.
Raise Awareness & Understanding of Alcohol Use and Misuse
Excessive alcohol use is a leading preventable cause of death in the U.S. During Alcohol Awareness Month, talk with your patients who drink alcohol about potential risks.
Medicare pays for alcohol misuse screening and counseling for Medicare Part B patients who qualify.
Encourage your patients who are at risk to get an annual screening. Find out when your patient is eligible for these screenings and counseling. If you need help, contact your eligibility service provider.
More Information:
- Substance Use Screenings & Treatment (PDF) booklet
- For your patients:
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