This section provides the latest and essential industry updates as they become available.
New Skin Substitute Policies-Effective September 17, 2023
On August 3, Novitas, First Coast Service Options, and CGS Part B Medicare Administrative Contractors (MAC) finalized skin substitute policies for the treatment of diabetic foot ulcers (DFC’s) and venous leg ulcers (VLU’s) that become effective September 17, 2023.
Empire BlueCross BlueShield Update-Use of Modifier 25 for Billing for Visits that Include Preventive and Problem Oriented E&M Services
On January 1, 2023, Empire BlueCross BlueShield HealthPlus
(Empire) stated that they would begin to implement additional steps to review claims for Evaluation & Management (E/M) services submitted by providers
Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process Under the No Surprises Act: Change in Administrative Fee
This guidance amends the previous “Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act” released on October 31, 2022
CMS Announces 6.4%-9.1% CPI-U Adjustments for DME in 2023-Significamt Increase in DMEPOS Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) released the 2023 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Medicare fee schedule with an increase of 8.7 percent.
2022 Medicare Open Enrollment October 15th thru December 7th
Medicare’s Open Enrollment period gives people with Medicare the opportunity to make changes to their health plan or prescription drug plan, pick a Medicare Advantage plan, or return to Original Medicare (also referred to as Medicare Part A and Part B).
Excellus Blue Choice and Orthotics Denials
Recently, there has been an issue with Excellus BC/BS with the coverage of orthotics (HCPCS L3000). The problem is specifically for patients enrolled in their Medicaid
Managed Care plan (known as the Blue Choice Option where the patient’s ID number starts with VYT).
Medicare-August and September 2022 LCD, Billing & Coding Article Updates
Under the Limitations section, the active care requirement for systemic conditions has been revised to remove “qualified non-physician practitioners” to conform with the Centers for Medicare & Medicaid Services (CMS) Internet -Only Manual (IOM) Publication 100-02