Transmittals

Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32 Sections 90, 190.2 and 300.2 for Coding Revisions to the National Coverage Determinations (NCDs) - April 2025 (1 of 2) Change Request (CR) 13818

The Fiscal Year 2025 Updates for the CMS Internet Only Manual (IOM) Publication (Pub.) 100-06, Medicare Financial Management Manual, Chapter 7 - Internal Control Requirements

Revisions to State Operations Manual (SOM) Appendix Q – Core Guidelines for Determining Immediate Jeopardy

Revisions to the State Operations Manual (SOM) Appendix X, Transplant Program Interpretive Guidelines and Survey Procedures and Chapter 9 - Exhibits

Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2025.

April 2025 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

April 2025 Update to the Medicare Severity – Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 42.1

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) – April 2025

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 31.1, Effective April 1, 2025

Updates of Chapter 4 and Exhibits in Publication (Pub.) 100-08, Including the Unified Program Integrity Contractor (UPIC) and Medical Review Accuracy Contractor (MRAC) Coordination Process.

Revisions to State Operations Manual SOM, Chapter 2, section 2779A1 CCN for Medicare Providers

Combined Common Edits Enhancements Modules CCEM Code Set Update

National Coverage Determination NCD 210.15 Pre Exposure Prophylaxis PrEP for Human Immunodeficiency Virus HIV Prevention

National Coverage Determination NCD 210.15 Pre Exposure Prophylaxis PrEP for Human Immunodeficiency Virus HIV Prevention

Phase 4 Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10 Digits in Length $99,999,999.99

Phase 4 Implementation to Expand Monetary Amount Fields Related to Billing and Payment to Accommodate 10 Digits in Length $99,999,999.99

Making Care Primary (MCP) Informational Unsolicited Responses (IURs)

Quarterly Update to Home Health (HH) Grouper

Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE

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