Transmittals

Updates to Current Inpatient Claim Edits

The purpose of this Change Request (CR) is to implement the following updates to the list of DRGs subject to the IPPS payment policy for the reimbursement of replaced devices offered without cost or with a credit, effective for discharges on or after 10/01/2020

System Limitation Update for Centralized Flu Billers (CFB), Pneumococcal and Covid-19 Vaccinations

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) -- July 2022

Quarterly Update for the Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - July 2022

Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759

July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20- valent Conjugate Vaccine Code 90677

Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022

Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

April 2022 Update of the Ambulatory Surgical Center (ASC) Payment System

April 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)

April 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.1

Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

Addition of new provider State Codes

April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

Correction to Processing When Osteoporosis Drugs Are Billed for Other Indications

April 2022 Update to the Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS)

Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants

File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) Descriptions