Transmittals

Update to the National Correct Coding Initiative (NCCI) Procedure-to Procedure (PTP) Edits, version 31.2, Effective July 1, 2025

Transmittal 12965 issued November 14, 2024, is being rescinded and replaced by Transmittal 13112, dated March 21, 2025, to revise the effective and implementation dates to reflect analysis for April, and Implementation in July 2025. This correction also revises the date in business requirement 13739.3. All other information remains the same.

Transmittal 13016 issued December 23, 2024, is being rescinded and replaced by Transmittal 13070, dated March 20, 2025, to remove business requirements 13591.14 and 13591.14.1. All other information remains the same.

Transmittal 12976 issued November 21, 2024, is being rescinded and replaced by Transmittal 13101, dated March 20, 2025, to update the logic for including Pass-Through Amounts for Supply Chain Cost in the "Estimated Total Pass-Through Amounts" field of the online estimating tool when pricing MA (HMO=Y) claims, by revising business requirement 13816.2. All other information remains the same.

Transmittal 12878 issued October 11, 2024, is being rescinded and replaced by Transmittal 13095, dated March 20, 2025, to add business requirement 13775.1.1, instructing that "condition code ML and MN shall not be passed to the BCRC." All other information remains the same.

Transmittal 13054 issued January 16, 2025, is being rescinded and replaced by Transmittal 13132, dated March 20, 2025, to revise Business Requirements (BRs) 13932.1, 13932.4, 13932.4.1, 13932.4.2, and 13932.5. This correction also adds BRs 13932.4.3 and 13932.4.4. All other information remains the same.

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—July 2025

Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update

Transmittal 13052 issued January 16, 2025, is being rescinded and replaced by Transmittal 13128, dated March 14, 2025, to update business requirement 13787.2. All other information remains the same. Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Transmittal 13052 issued January 16, 2025, is being rescinded and replaced by Transmittal 13128, dated March 14, 2025, to update business requirement 13787.2. All other information remains the same. User Enhancement Change Request (UECR): ViPS Medicare System (VMS) - Create Error Message in the Beneficiary Information Tracking System (BITS) to Limit the Prior Authorization (PA) Healthcare Common Procedure Coding System (HCPCS) within a Unique Tracking Number (UTN)

Enhancing Compliance and Payment Accuracy for Physician Services in Skilled Nursing Facilities

Sixteenth General Update to Provider Enrollment Instructions in Chapter 10 of CMS Publication 100-08

July 2025 Healthcare Common Procedure Coding System (HCPCS) Quarterly Update Reminder

Indian Health Services (IHS) Hospital Payment Rates for Calendar Year 2025

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year (FY) 2023 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2025 Update

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

Update to Provider Enrollment Appeals and Rebuttals Processing Instructions and Model Letters

Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04 Chapter 3, Inpatient Hospital Billing, Section 20.2.1

Rejections in the Medicare Adjudication Portal (MAP)