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Medicare Reimbursement Policy Updates for January 1, 2024

Reimbursement Policy

Revision

Add On Codes

Labor epidural language added. Medical Director approved. Notification on 11/1/2023 for effective date 1/1/2024.

Drug and Biologicals

Added coding guidance to Reimbursement Guidelines for reimbursement of administration fees.  Medical Director approved. Notification on 11/1/2023 for effective date 1/1/2024.

Evaluation and Management

Removed language regarding codes 99381 – 99397.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024. 

Nonpayment for Serious Adverse Events

New policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.

Opioid Treatment Program ReimbursementNew policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.
Pricing and Adjudication Principles

Bullets added for CMS rationale for reimbursement and reimbursement for denied or non-covered codes. Medical Director Approved. Notification on 11/1/2023 for effective date 1/1/2024.

Reduced and Discontinued Services

New policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024. 

Supply and Equipment

Lymphedema Gradient Compression Garments added.  No change to policy intent.

Telehealth

Removed language regarding codes 99381-99397.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.