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January 2023 Monthly Medicare Transmittals & Coverage Updates

Published on 

Wednesday, January 25, 2023

Medicare Transmittals & MLN Articles

Travel Allowance Fees for Specimen Collections: 2023 Updates
  • MLN Release Date: January 9, 2023
  • What You Need to Know: Make sure your billing staff knows about the specimen collection fees and travel allowances for 2023.
  • MLN MM13071: (link)

Revised Transmittals & MLN Articles

National Coverage Determination 110.24: Chimeric Antigen Receptor T-cell Therapy
  • MLN Release Date: December 1, 2022 – Revised January 5, 2023
  • What You Need to Know: This article was revised to clarify that providers should not bill more than 1 unit per HCPCS code.
  • MLN MM12928: (link)
Home Health Prospective Payment System: CY 2023 Update
  • MLN Release Date: November 10, 2022 – Revised January 5, 2023
  • What You Need to Know: This article was revised to show that the rural add-on is extended through CY 2023 as part of the Consolidated Appropriations Act of 2023.
  • MLN MM12957: (link)

Coverage Updates

Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting

In June 2022, the Multispecialty Carotid Alliance (MSCA) submitted a formal request for reconsideration of the National Coverage Determination (NCD) 20.7: PTA that provides coverage for carotid artery stenting (CAS). In their letter they indicated evidence supports the following changes to the NCD:

  1. Expand patient selection criteria to reflect the established data from research:
    1. Revise the patient selection criteria for PTA and CAS with embolic protection to cover the following:
      1. Patients who have asymptomatic carotid artery stenosis ≥ 70%, and
      2. Patients who have symptomatic carotid artery stenosis ≥ 50%.
    2. Eliminate the requirement that patients be at high risk for CEA:
  2. Eliminate the minimum standards for facility requirements; and
  3. Leave coverage for any CAS procedures not described by the NCD to the discretion of the local Medicare Administrative Contractors (MACs).

On January 12, 2023, CMS accepted the formal request, initiated a National Coverage Analysis (link) and are accepting public comments from January 12, 2023 through February 11, 2023. The expected due date for a proposed decision memo is July 12, 2023.

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.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.