Billing News Mar 2023
National Correct Coding Initiative: No April Update
CMS isn’t updating any National Correct Coding Initiative edit files this April. Continue using the January edit files until the July files are posted.
Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: Quarterly Update 4/1/2023
New Codes Effective April 1, 2023 Proprietary Laboratory Analysis (PLA) See the tab “New Codes” of the table attached to CR 13082. New codes added to the national HCPCS file with an effective date of April 1, 2023. These new codes are MACpriced (where applicable) until they’re nationally priced. MACs will only price PLA codes for...
Coding Update to NCD 210.1 Prostate Cancer Screening
IMPLEMENTATION DATE: March 3, 2023 - MAC local edits; July 3, 2023 NCD 210.1 Prostate Cancer Screening Contractors shall add CPT code 0359U as covered for this policy effective January 1, 2023. CR#13070.6
Update - Colorectal Cancer Screening Tests (NCD 210.3)
Colorectal Cancer Screening Tests -Added information about reduced coinsurance (starting January 1, 2023) when a screening colorectal cancer procedure becomes diagnostic or therapeutic -Effective January 1, 2023, reduced the minimum age for colorectal cancer screening tests from 50 to 45 -Effective January 1, 2023, colorectal cancer screening...
Pfizer gets FDA panel's backing in RSV vaccine race
A panel of outside advisers to the U.S. health regulator on Tuesday recommended Pfizer Inc's (PFE.N) respiratory syncytial virus (RSV) vaccine, bringing it closer to becoming one of the first approved RSV shots for older adults in the United States. The Food and Drug Administration's (FDA) advisory committee voted 7-4 in favor of the...
CMS Instructs some billing arbitration decisions to resume following court ordered pause
Following the issue of a court-ordered pause to out-of-network payment dispute arbitration, the Centers for Medicare & Medicaid Services is now instructing arbitrators to resume determinations for care that occurred prior to Oct. 25, 2022. The notice, published Friday, tells Independent Dispute Resolution (IDR) entities to refer to...
Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap
Based on current COVID-19 trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023. Coverage for COVID-19 testing for Americans will change. Medicare...
UnitedHealthcare Clamping Down on Expanded Carrier Screening, Genetic Counselors, Testing Firms Say
While some professional organizations and clinicians have moved of late to embrace expanded genetic carrier screening panels, securing payor coverage for these tests remains a challenge. This divide was recently put into sharp relief as a number of genetic counselors have voiced concerns about a perceived uptick in denials for expanded carrier...
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