June 2022 Medicare Transmittals and Coverage Updates
Published on
Wednesday, June 22, 2022
Medicare MLN Articles & Transmittals
July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
- MLN Release Date: May 31, 2022
- What You Need to Know: This article includes information about new COVID-19 CPT vaccine and administration codes. You will also find details about new CPT proprietary laboratory analyses (PLA) coding changes and new CPT Category III codes effective July 1, 2022.
- MLN MM127961: (link)
Update to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) Services
- MLN Release Date: May 31, 2022
- What You Need to Know: This article provides information about a new HCPCS drug code for payment beginning July 1, 2022, and updates to the list of home infusion drugs.
- MLN MM12667: (link)
July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
- MLN Release Date: June 9, 2022
- What You Need to Know: Effective July 1, 2022, there is a new CPT Category III Code, newly established HCPCS codes for drugs, biologicals and radiopharmaceuticals and new skin substitute products and low-cost/high-cost group assignment.
- MLN MM12773: (link)
Revised Medicare MLN Articles & Transmittals
July 2022 Updates to the Hospital Outpatient Prospective Payment System (OPPS)
- Article Release Date: May 31, 2022 – Revised June 16, 2022
- What You Need to Know: This article was revised due to CMS rescinding Transmittal 11435 and replacing it with Transmittal 11457 to correct Table 1 in the attachment A, because it was missing some codes.
- MLN MM12761: (link)
Coverage Updates
Surgical Dressings: Medicare Requirements
Excerpt from May 26, 2022 edition of MLN Connects ((link)
“Medicare covers primary or secondary surgical dressings:
- When used to protect or treat a wound
- If needed after you debride a wound
You must:
- Include clinical information in patients’ medical records that demonstrates a reasonable and necessary need for the type and quantity of surgical dressings
- Evaluate the wound monthly and update the record, unless you document why you can't do a monthly evaluation and how you're monitoring the patient's ongoing use of dressings
For more information, see the Surgical Dressings – Policy Article.”
Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease Tracking Sheet
On June 16, CMS posted a Tracking Sheet (link) regarding National Coverage Determination (NCD) 220.6.20 Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease. CMS generated this NCD analysis based on stakeholder feedback during the finalization of the NCD for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease. The purpose of the NCD reconsideration is to determine if the current policy of one PET scan per patient per lifetime should be revised.
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.
