Thursday, June 26, 2025
News
- Alert: Medicare Fraud Scheme Involving Phishing Fax Requests
- Medicare Diabetes Prevention Program: CY 2025 Payment Rates
Compliance
Claims, Pricers & Codes
- Integrated Outpatient Code Editor Version 26.2
- Medical Education: Don’t Submit Claims for Programs of All-Inclusive Care for the Elderly
MLN Matters® Articles
Publications & Multimedia
News
Alert: Medicare Fraud Scheme Involving Phishing Fax Requests
CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.
Important: CMS doesn’t initiate audits by requesting medical records via fax. Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real.
Medicare Diabetes Prevention Program: CY 2025 Payment Rates
Get CY 2025 payment rates (PDF) for the Medicare Diabetes Prevention Program.
See the instruction to your Medicare Administrative Contractor (PDF).
Compliance
Commodes, Bed Pans & Urinals: Prevent Claim Denials
In 2023, the improper payment rate for commodes, bed pans, and urinals was 47.7%, with a projected improper payment amount of $4.4 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Commodes, Bed Pans & Urinals provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
Documentation requirements
Claims, Pricers & Codes
Integrated Outpatient Code Editor Version 26.2
CMS posted the July 2025 Integrated Outpatient Code Editor files. Learn about claims processing changes effective July 1, 2025.
See the instruction to your Medicare Administrative Contractor (PDF).
Medical Education: Don’t Submit Claims for Programs of All-Inclusive Care for the Elderly
Programs of All-Inclusive Care for the Elderly (PACE) is excluded from the Inpatient Prospective Payment System for direct graduate medical and nursing and allied health education for Medicare Advantage enrollees. See the Medicare Claims Processing Manual, Chapter 3 (PDF), section 20.8 to find out when medical education billing is appropriate.
MLN Matters® Articles
DMEPOS Fee Schedule: July 2025 Quarterly Update
Learn about updates (PDF) effective July 1, 2025:
- No added or deleted codes
- Corrections to the 2025 fee schedule amounts for certain items provided in non-contiguous areas
Rural ZIP codes
Publications & Multimedia
Medicare & Mental Health Coverage — Revised
Learn what’s changed (PDF):
- Added information on:
- Providing caregiver training, depression screening, and tobacco use cessation counseling services through telehealth
- Allowing the physician or non-physician practitioner written order or referral to substitute for the signature on the initial plan of care certification for certain physical, occupational, and speech-language pathology therapies
- Added coverage information for:
- Digital mental health treatment devices
- Safety planning intervention and post-discharge phone follow-up contacts intervention to reduce the risk of suicide
- Opioid treatment programs, including Brixadi® and Opvee®
- Updated:
- In-person telehealth requirements for Rural Health Clinics and Federally Qualified Health Centers
- Coverage requirements for marriage and family therapists and mental health counselors
- Commonly used HCPCS and CPT codes, including codes eligible for telehealth
Substance Use Screenings & Treatment — Revised
Learn what’s changed (PDF):
- Safety planning intervention for patients in crisis and post discharge phone follow-up contacts intervention
- Prescribing controlled medications like buprenorphine via telehealth through December 31, 2025
- Coverage and billing information for Opioid Use Disorder Treatment: Opioid Treatment Programs
- Payment for certain medications and services, including medication for opioid use disorder in the emergency department
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