Thursday, May 1, 2025
News
Compliance
- Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
- Wheelchair Seating: Prevent Claim Denials
Events
MLN Matters® Articles
- Ambulatory Surgical Center Payment System: April 2025 Update
- Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: July 2025 Update
- HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2025 Quarterly Update
News
Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by June 28
CMS published preliminary gapfill rates (ZIP) for the Clinical Laboratory Fee Schedule (CLFS). Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by June 28. Visit the CLFS Annual Public Meetings webpage for more information.
Compliance
Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
In a report, the Office of the Inspector General found that Medicare improperly paid acute-care hospitals for outpatient services provided to hospice enrollees. To avoid improper payments, request and analyze hospice election statement addendums for these enrollees.
Review the Acute Care Hospital Inpatient Prospective Payment System educational tool for more information:
- We don’t pay for services given to palliate or manage a terminal illness and related conditions. Services should be provided under arrangements with the hospice provider.
- We only pay for Part B outpatient services that are unrelated to the terminal illness and related conditions.
Wheelchair Seating: Prevent Claim Denials
In 2023, the improper payment rate for wheelchair seating was 29.2%, with a projected improper payment amount of $15.5 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices E and G). Learn how to bill correctly for these services. Review the Wheelchair Seating provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Example of improper payments due to insufficient documentation
- Resources
Events
Clinical Laboratory Fee Schedule Annual Public Meeting — June 27
Friday, June 27 from 10 am – 4 pm ET
Baltimore, MD or virtual
Register by May 29 to present or attend in person.
More Information:
- Public Meeting Regarding New and Reconsidered Clinical Diagnostic Laboratory Test Codes for the Clinical Laboratory Fee Schedule for CY 2026 notice
- CLFS Annual Public Meetings webpage
MLN Matters® Articles
Ambulatory Surgical Center Payment System: April 2025 Update
Learn about payment system updates effective April 1, 2025 (PDF), including:
- New HCPCS code for simulation angiogram for radioembolization of tumors
- Revised payment rates for CPT codes 0446T and 0448T
- Drug, biological, and radiopharmaceutical codes
Skin substitute products
Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: July 2025 Update
Learn about updates for laboratory billing effective July 1, 2025 (PDF):
- Next reporting period for clinical diagnostic laboratory tests
New and deleted CPT codes
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2025 Quarterly Update
Learn about updates effective July 1, 2025 (PDF), including coding changes for:
- Angiography, lymphatic, venous, and related procedures
- Chemotherapy
- Radioisotopes and their administration
- Certain blood clotting factors indicated for the treatment of hemophilia and other bleeding disorders
- Customized prosthetic devices
Medicare Administrative Contractors will reprocess claims you bring to their attention.
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