Thursday, June 12, 2025
News
- Final National Coverage Determination: Noninvasive Positive Pressure Ventilation in Home for Treatment of Chronic Respiratory Failure Consequent to COPD
- Skilled Nursing Facility Value-Based Purchasing Program: June 2025 Confidential Feedback Reports
Compliance
Claims, Pricers & Codes
MLN Matters® Articles
- Ambulatory Surgical Center Payment System: July 2025 Update
- ESRD Prospective Payment System: July 2025 Update
- ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2025 Update
News
Final National Coverage Determination: Noninvasive Positive Pressure Ventilation in Home for Treatment of Chronic Respiratory Failure Consequent to COPD
CMS released a final national coverage determination and decision memo to establish national Medicare coverage of respiratory assist devices and home mechanical ventilators.
Skilled Nursing Facility Value-Based Purchasing Program: June 2025 Confidential Feedback Reports
Download your June 2025 Quarterly Confidential Feedback Reports for the FY 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program from iQIES.
These reports include facility-level measure results for 4 quality measures during FY 2024, the FY 2026 SNF VBP Program performance period:
- SNF 30-Day All-Cause Readmission Measure
- Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization
- Total Nursing Staff Turnover
- Total Nurse Staffing Hours per Resident Day
We’ll use these results for the FY 2026 SNF VBP Program year scoring and incentive payment calculations taking effect October 1, 2025. We’ll include performance scores and incentive payment multipliers for the FY 2026 SNF VBP Program year in the August 2025 Performance Score Reports.
Submit corrections requests for FY 2024 measure results until July 9. See Confidential Feedback Reporting & Review and Corrections for more information.
Questions?
- Contact iqies@cms.hhs.gov about report access
- Contact SNFVBPquestions@cms.hhs.gov about the program
Compliance
Mechanical Ventilation: Bill Correctly for Inpatient Claims
In a report, the Office of the Inspector General found that hospitals didn’t fully comply with Medicare requirements for claims with certain Medicare Severity Diagnosis-Related Groups that required more than 96 consecutive hours of mechanical ventilation. This resulted in $79 million in improper payments.
On your claims for mechanical ventilation, use the right procedure and diagnosis codes, including codes for the correct number of hours. Review the Ventilators provider compliance tip for more information.
SNF Services: Prevent Claim Denials
In 2023, the improper payment rate for skilled nursing facility (SNF) inpatient claims was 14.9%, with a projected improper payment amount of $4.8 billion (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the SNF Services provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Case mix prospective payment
Claims, Pricers & Codes
ICD-10 Codes: FY 2026
Get FY 2026 ICD-10 codes effective for patient discharges and encounters on or after October 1, 2025:
- ICD-10-CM diagnosis codes
- ICD-10-PCS procedure codes
National Correct Coding Initiative: July Update
Get the National Correct Coding Initiative (NCCI) third quarter edit files effective July 1, 2025, on these Medicare NCCI webpages:
MLN Matters® Articles
Ambulatory Surgical Center Payment System: July 2025 Update
Learn about payment system updates (PDF) effective July 1, 2025:
- Payment indicator change and new CPT code pairs for HCPCS code C1739
- New CPT code pair for HCPCS code C1602
- New CPT category III codes
- Drugs, biologicals, and radiopharmaceuticals
Skin substitute products
ESRD Prospective Payment System: July 2025 Update
Learn about changes to the outlier services list (PDF) under the ESRD Prospective Payment System starting July 1, 2025:
- Adding and removing certain renal dialysis items and services
- Updating the average unit cost for renal dialysis drugs that are oral equivalents to injectable drugs
- Revising the average dispensing fee of the National Drug Codes (NDCs) qualifying for outlier payment to $0.56 per NDC per month
ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2025 Update
Learn about updates (PDF) effective October 1, 2025:
- New codes
- Recent coding changes
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