The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare Part B (CMS-1784-P) Proposed Rule, which includes proposals related to Medicare physician...
New HCPCS Codes:Due to the lack of claims data for newer HCPCS codes, CMS proposes applying the greater of 31 percent of the HCPCS code's payment or the APC-wide device offset percentage for new procedure HCPCS codes that include the implantation or insertion of a device. New Conditions ...
Additionally, in the 2020 Fee Schedule Final Rule, CMS established add-code GPC1X for office/outpatient E/M visit complexity with an effective date of CY 2021. Since the code was established, CMS has received stakeholder feedback that the code definition is ...
In the CY 2023 Medicare Physician Fee Schedule (MPFS) final rule, CMS codified the JW modifier for wasted or discarded units. Some stakeholders commented that requiring the use of the JZ modifier would cause confusion and increase overhead burden among providers and was unnecessary ...
The Centers for Medicare & Medicaid Services (CMS) issued its2025 Physician Fee Schedule (PFS) proposed ruleearlier this month. Alongside a2.8 percent payment cutfor physicians, the rule includes numerous proposals directed at virtual care, including brand new codes for certain digital th...
Exclusions such as the anomalous catheter spending in this proposed rule are part of a larger strategy from CMS to address SAHS billing activity within the Medicare Shared Savings Program, which the agency said it will detail in the forthcoming Physician Fee Schedule rule. ...
Services (CMS) posted proposed Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment rates for the PoNS Controller and Mouthpiece to be discussed at the bi-annual Healthcare Common Procedure Coding System (HCPCS) Public Meeting, scheduled for May 29,...
In its 2024 Medicare Physician Fee Schedule (MPFS)final rule, the Centers for Medicare & Medicaid Services (CMS) included asectiontitled “Clarifications for Remote Monitoring Services”, responding to comments received on the proposed rule relating to remote patient monitoring (RPM), remote therapeut...
Phase-In Reduction Cap of Cuts Over 10% Situation: The National Limitation Amount (NLA) for a lab test HCPCS code is based on a percentage of the median of all local fee schedule amounts, including $0. Medicare pays whichever is lowest among the billed amount, local fee schedule amount ...
CMS published this annual update in conjunction with its annual physician fee schedule updates. CMS advised that going forward, however, it planned to add codes or advise the public of Code List changes only via the Code List’sspecific website. It is unclear if CMS will be making updates ...