Consistent with the policy established in section 50.12 of the revised Medicare Part B Drug Inflation Rebate Guidance, a manufacturer may receive only one extension of the rebate reduction per Part B rebatable biosimilar biological product per CMS determination of a severe supply chain disruption, as proposed in 427.402(c)(5)
More information on our coding and payment policies for COVID-19 monoclonal antibodies is available at
For instance, if a demanded overpayment determination was for a payment amount on a claim with a HCPCS or CPT code identified as having significant, anomalous, and highly suspect billing activity, and therefore the payment amount was excluded from certain financial calculations used in determining the ACO's financial performance under the proposed adjustment discussed in section III.G.7.d of this proposed rule, we would not include this amount as part of a reopening for the same performance year
While chewing tobacco may not be quite as deadly as smoking cigarettes, it is far from safe
As we stated in the CY 2024 PFS final rule, we believe that because E/M visit codes are intended to be used very broadly, the complexity of services required to provide this type of care is not fully incorporated as part of the valuation of the work RVUs when the E/M code itself is used as the primary way to report the work of the professional (88 FR 78972)
We believe updating the payment amount for intake activities with an addition of HCPCS code G0136 would serve as a reasonable proxy to reflect the value and resources required by new SAMHSA standards for initial assessment service activities at 8.12(f)(4)(i) that OTPs are required to provide, including an assessment to identify a patient's unmet HRSNs or the need for harm reduction intervention and recovery support services that are critical to the treatment of an OUD
