Notice2025-08753
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2025
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
May 16, 2025
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This quarterly notice lists Centers for Medicare & Medicaid Services (CMS) manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published in the 3-month period, relating to the Medicare and Medicaid programs and other programs administered by CMS.
Full Text
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<title>Federal Register, Volume 90 Issue 94 (Friday, May 16, 2025)</title>
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[Federal Register Volume 90, Number 94 (Friday, May 16, 2025)]
[Notices]
[Pages 21043-21049]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-08753]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9154-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances--January Through March 2025
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This quarterly notice lists Centers for Medicare & Medicaid
Services (CMS) manual instructions, substantive and interpretive
regulations, and other Federal Register notices that were published in
the 3-month period, relating to the Medicare and Medicaid programs and
other programs administered by CMS.
FOR FURTHER INFORMATION CONTACT: It is possible that an interested
party may need specific information and not be able to determine from
the listed information whether the issuance or regulation would fulfill
that need. Consequently, we are providing contact persons to answer
general questions concerning each of the addenda published in this
notice.
----------------------------------------------------------------------------------------------------------------
Addenda Contact Phone No.
----------------------------------------------------------------------------------------------------------------
I. CMS Manual Instructions................................ Ronda Allen-Bonner............... (410) 786-4657
II. Regulation Documents Published in the Federal Register Terri Plumb...................... (410) 786-4481
III. CMS Rulings.......................................... Tiffany Lafferty................. (410) 786-7548
IV. Medicare National Coverage Determinations............. Wanda Belle, MPA................. (410) 786-7491
V. FDA-Approved Category B IDEs........................... John Manlove..................... (410) 786-6877
VI. Collections of Information............................ William Parham................... (410) 786-4669
VII. Medicare--Approved Carotid Stent Facilities.......... Sarah Fulton, MHS................ (410) 786-2749
VIII. American College of Cardiology-National Sarah Fulton, MHS................ (410) 786-2749
Cardiovascular Data Registry Sites.
IX. Medicare's Active Coverage-Related Guidance Documents. Lori Ashby, MA................... (410) 786-6322
X. One-time Notices Regarding National Coverage Provisions JoAnna Baldwin, MS............... (410) 786-7205
XI. National Oncologic Positron Emission Tomography David Dolan, MBA................. (410) 786-3365
Registry Sites.
XII. Medicare-Approved Ventricular Assist Device David Dolan, MBA................. (410) 786-3365
(Destination Therapy) Facilities.
XIII. Medicare-Approved Lung Volume Reduction Surgery Sarah Fulton, MHS................ (410) 786-2749
Facilities.
XIV. Medicare-Approved Bariatric Surgery Facilities....... Sarah Fulton, MHS................ (410) 786-2749
XV. Fluorodeoxyglucose Positron Emission Tomography for David Dolan, MBA................. (410) 786-3365
Dementia Trials.
All Other Information..................................... Renee Swann...................... (410) 786-4492
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SUPPLEMENTARY INFORMATION:
I. Background
The Centers for Medicare & Medicaid Services (CMS) is responsible
for administering the Medicare and Medicaid programs and coordination
and oversight of private health insurance. Administration and oversight
of these programs involves the following: (1) furnishing information to
Medicare and Medicaid beneficiaries, health care providers, and the
public; and (2) maintaining effective communications with CMS regional
offices, state governments, state Medicaid agencies, state survey
agencies, various providers of health care, all Medicare contractors
that process claims and pay bills, National Association of Insurance
Commissioners (NAIC), health insurers, and other stakeholders. To
implement the various statutes on which the programs are based, we
issue regulations under the authority granted to the Secretary of the
Department of Health and Human Services under sections 1102, 1871,
1902, and related provisions of the Social Security Act (the Act) and
Public Health Service Act. We also issue various manuals, memoranda,
and statements necessary to administer and oversee the programs
efficiently.
Section 1871(c) of the Act requires that we publish a list of all
Medicare manual instructions, interpretive rules, statements of policy,
and guidelines of general applicability not issued as regulations at
least every 3 months in the Federal Register.
II. Format for the Quarterly Issuance Notices
This quarterly notice provides only the specific updates that have
occurred in the 3-month period along with a hyperlink to the full
listing that is
[[Page 21044]]
available on the CMS website or the appropriate data registries that
are used as our resources. This is the most current up-to-date
information and will be available earlier than we publish our quarterly
notice. We believe the website list provides more timely access for
beneficiaries, providers, and suppliers. We also believe the website
offers a more convenient tool for the public to find the full list of
qualified providers for these specific services and offers more
flexibility and ``real time'' accessibility. In addition, many of the
websites have listservs; that is, the public can subscribe and receive
immediate notification of any updates to the website. These listservs
avoid the need to check the website, as notification of updates is
automatic and sent to the subscriber as they occur. If assessing a
website proves to be difficult, the contact person listed can provide
information.
III. How To Use the Notice
This notice is organized into 15 addenda so that a reader may
access the subjects published during the quarter covered by the notice
to determine whether any are of particular interest. We expect this
notice to be used in concert with previously published notices. Those
unfamiliar with a description of our Medicare manuals should view the
manuals at <a href="http://www.cms.gov/manuals">http://www.cms.gov/manuals</a>.
The Director of the Office of Strategic Operations and Regulatory
Affairs of CMS, Kathleen Cantwell, having reviewed and approved this
document, authorizes Trenesha Fultz-Mimms, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Trenesha Fultz-Mimms,
Federal Register Liaison, Department of Health and Human Services.
Publication Dates for the Previous Four Quarterly Notices
We publish this notice at the end of each quarter reflecting
information released by CMS during the previous quarter. The
publication dates of the previous four Quarterly Listing of Program
Issuances notices are: April 29, 2024 (89 FR 33356), July 22, 2024
(89 FR 59104), November 7, 2024 (89 FR 88282) and February 19, 2025
(90 FR 9902). We are providing only the specific updates that have
occurred in the 3-month period along with a hyperlink to the website
to access this information and a contact person for questions or
additional information.
Addendum I: Medicare and Medicaid Manual Instructions (January Through
March 2025)
The CMS Manual System is used by CMS program components,
partners, providers, contractors, Medicare Advantage organizations,
and State Survey Agencies to administer CMS programs. It offers day-
to-day operating instructions, policies, and procedures based on
statutes and regulations, guidelines, models, and directives. In
2003, we transformed the CMS Program Manuals into a web user-
friendly presentation and renamed it the CMS Online Manual System.
How To Obtain Manuals
The Internet-only Manuals (IOMs) are a replica of the Agency's
official record copy. Paper-based manuals are CMS manuals that were
officially released in hardcopy. The majority of these manuals were
transferred into the internet-only manual (IOM) or retired. Pub 15-
1, Pub 15-2 and Pub 45 are exceptions to this rule and are still
active paper-based manuals. The remaining paper-based manuals are
for reference purposes only. If you notice policy contained in the
paper-based manuals that was not transferred to the IOM, send a
message via the CMS Feedback tool.
Those wishing to subscribe to old versions of CMS manuals should
contact the National Technical Information Service, Department of
Commerce, 5301 Shawnee Road, Alexandria, VA 22312 Telephone (703-
605-6050). You can download copies of the listed material free of
charge at: <a href="http://cms.gov/manuals">http://cms.gov/manuals</a>.
How To Review Transmittals or Program Memoranda
Those wishing to review transmittals and program memoranda can
access this information at a local Federal Depository Library (FDL).
Under the FDL program, government publications are sent to
approximately 1,400 designated libraries throughout the United
States. Some FDLs may have arrangements to transfer material to a
local library not designated as an FDL. Contact any library to
locate the nearest FDL. This information is available at <a href="http://www.gpo.gov/libraries/">http://www.gpo.gov/libraries/</a>.
In addition, individuals may contact regional depository
libraries that receive and retain at least one copy of most federal
government publications, either in printed or microfilm form, for
use by the general public. These libraries provide reference
services and interlibrary loans; however, they are not sales
outlets. Individuals may obtain information about the location of
the nearest regional depository library from any library. CMS
publication and transmittal numbers are shown in the listing
entitled Medicare and Medicaid Manual Instructions. To help FDLs
locate the materials, use the CMS publication and transmittal
numbers. For example, to find the manual Qualifications for Speech-
Language Pathologists Furnishing Outpatient Speech-Language
Pathology Services (CMS-Pub. 100-02) Transmittal No. 13051.
Addendum I lists a unique CMS transmittal number for each
instruction in our manuals or program memoranda and its subject
number. A transmittal may consist of a single or multiple
instruction(s). Often, it is necessary to use information in a
transmittal in conjunction with information currently in the manual.
Fee-For Service Transmittal Numbers
Please Note: Beginning Friday, March 20, 2020, there will be the
following change regarding the Advance Notice of Instructions due to
a CMS internal process change. Fee-For Service Transmittal Numbers
will no longer be determined by Publication. The Transmittal numbers
will be issued by a single numerical sequence beginning with
Transmittal Number 10000.
For the purposes of this quarterly notice, we list only the
specific updates to the list of manual instructions that have
occurred in the 3-month period. This information is available on our
website at <a href="http://www.cms.gov/Manuals">www.cms.gov/Manuals</a>.
These Change Request (CR) are being released on a limited
approved basis due to the moratorium.
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Transmittal No. Manual/subject/publication No.
------------------------------------------------------------------------
Medicare General Information (CMS-Pub. 100-01)
------------------------------------------------------------------------
13065................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13080................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
------------------------------------------------------------------------
Medicare Benefit Policy (CMS-Pub. 100-02)
------------------------------------------------------------------------
13051................... Qualifications for Speech-Language
Pathologists Furnishing Outpatient Speech-
Language Pathology Services.
13088................... Updates to Medicare Benefit Policy Manual and
Medicare Claims Processing Manual for Opioid
Treatment Programs (OTPs).
13121................... 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.
13133................... Rural Health Clinic (RHC) and Federally
Qualified Health Center (FQHC) Medicare
Benefit Policy Manual Chapter 13 Update.
13147................... Updates to Medicare Benefit Policy Manual and
Medicare Claims Processing Manual for Opioid
Treatment Programs (OTPs).
------------------------------------------------------------------------
[[Page 21045]]
Medicare National Coverage Determination (CMS-Pub. 100-03)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare Claims Processing (CMS-Pub. 100-04)
------------------------------------------------------------------------
12914................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
12982................... Quarterly Update to Home Health (HH) Grouper.
13013................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13032................... January 2025 Update of the Hospital Outpatient
Prospective Payment System (OPPS).
13037................... Clinical Laboratory Fee Schedule--Medicare
Travel Allowance Fees for Collection of
Specimens and New Updates for 2025.
13038................... April 2025 Quarterly Update to Healthcare
Common Procedure Coding System (HCPCS) Codes
Used for Skilled Nursing Facility (SNF)
Consolidated Billing (CB) Enforcement.
13039................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13040................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13042................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13044................... January 2025 Update of the Ambulatory Surgical
Center [ASC] Payment System.
13045................... Calendar Year (CY) 2025 Home Infusion Therapy
(HIT) Payment Rates and Instructions for
Retrieving the January 2025 Home Infusion
Therapy (HIT) Services Payment Rates Through
the CMS Mainframe Telecommunications System.
13050................... Internet Only Manual Update, Pub. 100-04,
Chapter 3 (Inpatient Hospital Billing),
Sections 20.1.2.7, 140.2.10, 150.28,
190.7.2.5, and Chapter 4 (Part B Hospital)
Section 10.7.2.4 Procedures for Medicare
Contractors to Perform and Record Outlier
Reconciliation Adjustments.
13055................... CR 13923, Payment for Part B Preventive
Vaccines and heir Administration on the Claim
for Rural Health Clinics (RHCs) and Federally
Qualified Health Centers (FQHCs).
13059................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13061................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13063................... Instructions for Retrieving the January 2025
Opioid Treatment Program (OTP) Payment Rates
Through the CMS Mainframe Telecommunications
System.
13067................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13068................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13072................... Instructions for Downloading the Medicare ZIP
Code File for April 2025 Files.
13073................... Enhancing Compliance and Payment Accuracy for
Physician Services in Skilled Nursing
Facilities.
13074................... Principal Diagnosis Code Reporting Update for
Hospice and Manual Updates to Sections 30.3,
40.2, and 50 of Chapter 11 of the Claims
Processing Manual: Processing Hospice Claims.
13078................... Roster Billing for Hepatitis B--July 2025
Release.
13079................... January 2025 Update of the Ambulatory Surgical
Center [ASC] Payment System.
13082................... File Conversions Related to the Spanish
Translation of the Healthcare Common
Procedure Coding System (HCPCS) Descriptions.
13084................... Update to the Internet Only Manual (IOM)
Publication (Pub.) 100-04 Chapter 3,
Inpatient Hospital Billing, Section 20.2.1.
13088................... Updates to Medicare Benefit Policy Manual and
Medicare Claims Processing Manual for Opioid
Treatment Programs (OTPs).
13089................... Manual Updates Regarding Home Health
Adjustments and Skilled Nursing Facility,
Home Health and Hospice Pricer Information.
13090................... April 2025 Coding Updates for the Inpatient
Psychiatric Facilities Prospective Payment
System (IPF PPS).
13091................... Roster Billing for Hepatitis B--July 2025
Release.
13101................... April 2025 Update to the Inpatient Prospective
Payment System (IPPS) For Correction to Total
Pass-Through Amounts Reported on the Provider
Specific File (PSF) to Include Allogeneic
Stem Cell Costs.
13102................... Healthcare Common Procedure Coding System
(HCPCS) Codes Subject to and Excluded from
Clinical Laboratory Improvement Amendments
(CLIA) Edits.
13103................... Quarterly Update to the Medicare Physician Fee
Schedule Database (MPFSDB)--April 2025
Update.
13104................... Quarterly Update for Clinical Laboratory Fee
Schedule (CLFS) and Laboratory Services
Subject to Reasonable Charge Payment.
13106................... Non-systems Internet Only Manual (IOM) Chapter
25 Changes.
13115................... Indian Health Services (IHS) Hospital Payment
Rates for Calendar Year 2025.
13116................... July 2025 Healthcare Common Procedure Coding
System (HCPCS) Quarterly Update Reminder.
13123................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13127................... Quarterly Update to the National Correct
Coding Initiative (NCCI) Procedure- to-
Procedure (PTP) Edits, version 31.2,
Effective July 1, 2025.
13135................... April 2025 Update of the Hospital Outpatient
Prospective Payment System (OPPS).
13147................... Updates to Medicare Benefit Policy Manual and
Medicare Claims Processing Manual for Opioid
Treatment Programs (OTPs).
13148................... Calendar Year (CY) 2025 Home Infusion Therapy
(HIT) Payment Rates and Instructions for
Retrieving the January 2025 Home Infusion
Therapy (HIT) Services Payment Rates Through
the CMS Mainframe Telecommunications System.
------------------------------------------------------------------------
Medicare Secondary Payer (CMS-Pub. 100-05)
------------------------------------------------------------------------
13046................... The Recovery and Adjustment of Medicare Claims
where the Department of Veteran Affairs (VA)
also Made Payment Using the Medicare
Duplicate Payment (DP) Process.
13070................... Updates to the Medicare Carrier System (MCS),
the Viable Information Processing Systems
Medicare Systems (VMS) and the Common Working
File (CWF) Processes to Capture and Further
Automate the Medicare Secondary Payer (MSP)
Processes.
------------------------------------------------------------------------
Medicare Financial Management (CMS-Pub. 100-06)
------------------------------------------------------------------------
13047................... Notice of New Interest Rate for Medicare
Overpayments and Underpayments--2nd Quarter
Notification for FY 2025.
13071................... Updates to the Internet Only Manual (IOM)
Publication100-06 Chapters 3 Overpayments and
4 Debt Collection.
------------------------------------------------------------------------
Medicare State Operations Manual (CMS-Pub. 100-07)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare Program Integrity (CMS-Pub. 100-08)
------------------------------------------------------------------------
13048................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13049................... Documentation for Claims for Replacement of
Essential Accessories for Beneficiary-Owned
Continuous Glucose Monitors (CGMs).
13060................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13062................... Sixteenth General Update to Provider
Enrollment Instructions in Chapter 10 of CMS
Publication 100-08.
13080................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13085................... Update to Provider Enrollment Appeals and
Rebuttals Processing Instructions and Model
Letters.
13139................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
------------------------------------------------------------------------
[[Page 21046]]
Medicare Contractor Beneficiary and Provider Communications (CMS-Pub.
100-09)
------------------------------------------------------------------------
13109................... The Supplemental Security Income (SSI)/
Medicare Beneficiary Data for Fiscal Year
(FY) 2023 for Inpatient Prospective Payment
System (IPPS) Hospitals, Inpatient
Rehabilitation Facilities (IRFs), and Long
Term Care Hospitals (LTCHs).
------------------------------------------------------------------------
Medicare Quality Improvement Organization (CMS-Pub. 100-10)
------------------------------------------------------------------------
13086................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
------------------------------------------------------------------------
Medicare Program of All-Inclusive Care for the Elderly (CMS-Pub. 100-11)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare End Stage Renal Disease Network Organizations (CMS Pub 100-14)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicaid Program Integrity Disease Network Organizations (CMS Pub 100-
15)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare Managed Care (CMS-Pub. 100-16)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare Business Partners Systems Security (CMS-Pub. 100-17)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Medicare Prescription Drug Benefit (CMS-Pub. 100-18)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Demonstrations (CMS-Pub. 100-19)
------------------------------------------------------------------------
13054................... Update--Federally Qualified Health Center
(FQHC) Participation in and Payment Under the
Maryland Primary Care Program (MDPCP) for
Healthcare Common Procedure Coding System
(HCPCS) Codes 99453 and 99454.
13064................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13114................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13132................... Update--Federally Qualified Health Center
(FQHC) Participation in and Payment Under the
Maryland Primary Care Program (MDPCP) for
Healthcare Common Procedure Coding System
(HCPCS) Codes 99453 and 99454.
13138................... Accountable Care Organization (ACO) Primary
Care Flex Model CO PC Flex Model).
------------------------------------------------------------------------
One Time Notification (CMS-Pub. 100-20)
------------------------------------------------------------------------
12770................... Updating Calendar Year (CY) 2025 Medicare
Diabetes Prevention Program (MDPP) Inflation
Payment Rates.
12958................... Updates to Billing for Care Coordination
Services for Rural Health Clinics (RHCs) and
Federally Qualified Health Centers (FQHCs).
13034................... Phase 4: Implementation to Expand Monetary
Amount Fields Related to Billing and Payment
to Accommodate 10-Digits in Length
($99,999,999.99).
13035................... Extensions of Certain Temporary Changes to the
Low-Volume Hospital Payment Adjustment and
the Medicare-Dependent Hospital (MDH) Program
under the Inpatient Prospective Payment
System (IPPS) provided by the American Relief
Act, 2025.
13036................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13041................... Editing for Duplicate Processing for
Practitioner Professional Services and
Critical Access Hospital (CAH) Professional
Services.
13043................... Fiscal Intermediary Shared System (FISS)
Changes to Automate the Application of
Condition Code ZC for Chimeric Antigen
Receptor (CAR) T-Cell and Other Immunotherapy
Cases Involving a Clinical Trial of a
Different Product.
13052................... CR 13787, User Enhancement Change Request
(UECR): ViPS Medicare System (VMS)--Create
Error Message in the Beneficiary Information
Tracking System (BITS) to Limit the Prior
Authorization (PA) Healthcare Common
Procedure Coding System (HCPCS) within a
Unique Tracking Number (UTN).
13053................... CR 13788, User Enhancement Change Request
(UECR): ViPS Medicare System (VMS)--Copy Over
Existing SuperOp Sequences (Active/Inactive/
Archived).
13054................... CR 13932, Update--Federally Qualified Health
Center (FQHC) Participation in and Payment
Under the Maryland Primary Care Program
(MDPCP) for Healthcare Common Procedure
Coding System (HCPCS) codes 99453 and 99454.
13056................... CR 13852, Fiscal Intermediary Shared System
(FISS) User Enhancement Change Request
(UECR)--Creation of New Reason Codes to
Validate the National Provider Identifier
(NPI) on Prior Authorization (PA) Unique
Tracking Numbers (UTNs) and Claims.
13057................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13058................... CR 13779, User Enhancement Change Request
(UECR): ViPS Medicare System (VMS)--Updates
to the Automated Paperless Exception System
(APEX) Request Screen (APEX/1).
13069................... Fiscal Intermediary Shared System (FISS) User
Enhancement Change Request (UECR)--Create a
New Additional Development Request (ADR)
Location Prior Authorization (PA) Claims.
13075................... Phase 5: Implementation to Expand Monetary
Amount Fields Related to Billing and Payment
to Accommodate 10-Digits in Length
($99,999,999.99).
13081................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13083................... Rejections in the Medicare Adjudication Portal
(MAP).
13087................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13092................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13095................... Reporting Identifiers for the Healthcare
Integrated General Ledger Accounting System
(HIGLAS) Payments Reported for Periodic
Interim Payment (PIP) Claims 13096
Utilization of KX Modifier Medicare Physician
Fee Schedule Payment for Dental Services
Inextricably Linked to Covered Medical
Services.
13096................... Implementation of the Award for the
Jurisdiction J (J-J) Part A and Part B
Medicare Administrative Contractor (JJ A/B
MAC).
13097................... International Classification of Diseases, 10th
Revision (ICD-10) and Other Coding Revisions
to National Coverage Determinations (NCDs)--
July 2025.
13098................... Remove Part B Batch Eligibility Process (HELG)
from the Common Working File (CWF).
13100................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
13112................... User Management in the Medicare Adjudication
Portal (MAP) for 837D Dental Claims.
13113................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
[[Page 21047]]
13128................... User Enhancement Change Request (UECR): ViPS
Medicare System (VMS)--Create Error Message
in the Beneficiary Information Tracking
System (BITS) to Limit the Prior
Authorization (PA) Healthcare Common
Procedure Coding System (HCPCS) within a
Unique Tracking Number (UTN).
13130................... Revision to the Cost Report Acceptability
Checklists--This CR Rescinds and Fully
Replaces CR 11644.
13146................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
------------------------------------------------------------------------
Medicare Quality Reporting Incentive Programs (CMS-Pub. 100-22)
------------------------------------------------------------------------
13076................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
------------------------------------------------------------------------
State Payment of Medicare Premiums (CMS-Pub.100-24)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
Information Security Acceptable Risk Safeguards (CMS-Pub. 100-25)
------------------------------------------------------------------------
None.
------------------------------------------------------------------------
For questions or additional information, contact Ronda Allen-
Bonner (410-786-4657).
Addendum II: Regulation Documents Published in the Federal Register
(January Through March 2025)
Regulations and Notices
Regulations and notices are published in the daily Federal
Register. To purchase individual copies or subscribe to the Federal
Register, contact GPO at <a href="http://www.gpo.gov/fdsys">www.gpo.gov/fdsys</a>. When ordering individual
copies, it is necessary to cite either the date of publication or
the volume number and page number.
The Federal Register is available as an online database through
GPO Access. The online database is updated by 6 a.m. each day the
Federal Register is published. The database includes both text and
graphics from Volume 59, Number 1 (January 2, 1994) through the
present date and can be accessed at <a href="http://www.gpoaccess.gov/fr/index.html">http://www.gpoaccess.gov/fr/index.html</a>. The following website <a href="http://www.archives.gov/federal-register/">http://www.archives.gov/federal-register/</a> provides information on how to access electronic editions,
printed editions, and reference copies.
For questions or additional information, contact Gittel Treitel
(410-786-4673).
Addendum III: CMS Rulings (January Through March 2025)
CMS Rulings are decisions of the Administrator that serve as
precedent final opinions and orders and statements of policy and
interpretation. They provide clarification and interpretation of
complex or ambiguous provisions of the law or regulations relating
to Medicare, Medicaid, Utilization and Quality Control Peer Review,
private health insurance, and related matters.
The rulings can be accessed at <a href="https://www.cms.gov/medicare/regulations-guidance/cms-rulemaking/rulings">https://www.cms.gov/medicare/regulations-guidance/cms-rulemaking/rulings</a>.
For questions or additional information, contact Tiffany
Lafferty (410-786-7548).
Addendum IV: Medicare National Coverage Determinations (January Through
March 2025)
Addendum IV includes completed national coverage determinations
(NCDs), or reconsiderations of completed NCDs, from the quarter
covered by this notice. Completed decisions are identified by the
section of the NCD Manual (NCDM) in which the decision appears, the
title, the date the publication was issued, and the effective date
of the decision. An NCD is a determination by the Secretary for
whether or not a particular item or service is covered nationally
under the Medicare Program (title XVIII of the Act), but does not
include a determination of the code, if any, that is assigned to a
particular covered item or service, or payment determination for a
particular covered item or service. The entries below include
information concerning completed decisions, as well as sections on
program and decision memoranda, which also announce decisions or, in
some cases, explain why it was not appropriate to issue an NCD.
Additional information on NCDs, including open NCDs and pending
NCDs, can be found on the NCD Dashboard, which is posted on the CMS
website at <a href="https://www.cms.gov/medicare/coverage/determination-process">https://www.cms.gov/medicare/coverage/determination-process</a>.
For the purposes of this quarterly notice, we are providing only
the specific updates to national coverage determinations (NCDs), or
reconsiderations of completed NCDs published in the 3-month period.
For questions or additional information, contact Wanda Belle,
MPA (410-786-7491).
----------------------------------------------------------------------------------------------------------------
Title NCDM section Transmittal No. Issue date Effective date
----------------------------------------------------------------------------------------------------------------
N/A N/A N/A N/A N/A
----------------------------------------------------------------------------------------------------------------
Addendum V: FDA-Approved Category B Investigational Device Exemptions
(IDEs) (January Through March 2025)
(Inclusion of this addenda is under discussion internally.)
Addendum VI: Approval Numbers for Collections of Information (January
Through March 2025)
All approval numbers are available to the public at <a href="http://Reginfo.gov">Reginfo.gov</a>.
Under the review process, approved information collection requests
are assigned OMB control numbers. A single control number may apply
to several related information collections. This information is
available at <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>.
For questions or additional information, contact William Parham
(410-786-4669).
Addendum VII: Medicare-Approved Carotid Stent Facilities (January
Through March 2025)
Addendum VII includes listings of Medicare-approved carotid
stent facilities. All facilities listed meet CMS standards for
performing carotid artery stenting for high-risk patients. On March
17, 2005, we issued our decision memorandum on carotid artery
stenting. We determined that carotid artery stenting with embolic
protection is reasonable and necessary only if performed in
facilities that have been determined to be competent in performing
the evaluation, procedure, and follow-up necessary to ensure optimal
patient outcomes. We have created a list of minimum standards for
facilities modeled in part on professional society statements on
competency. All facilities must at least meet our standards in order
to receive coverage for carotid artery stenting for high risk
patients. For the purposes of this quarterly notice, we are
providing only the specific updates that have occurred in the 3-
month period. There were no additions, deletions, or editorial
changes to the listing for Medicare-approved carotid stent
facilities for this 3-month period. This information is available
at: <a href="http://www.cms.gov/MedicareApprovedFacilitie/CASF/list.asp#TopOfPage">http://www.cms.gov/MedicareApprovedFacilitie/CASF/list.asp#TopOfPage</a>.
For questions or additional information, contact Sarah Fulton,
MHS (410-786-2749).
Addendum VIII: American College of Cardiology's National Cardiovascular
Data Registry Sites (January Through March 2025)
The initial data collection requirement through the American
College of Cardiology's National Cardiovascular Data Registry (ACC-
NCDR) has served to develop and improve the evidence base for the
use of ICDs in
[[Page 21048]]
certain Medicare beneficiaries. The data collection requirement
ended with the posting of the final decision memo for Implantable
Cardioverter Defibrillators on February 15, 2018.
For questions or additional information, contact Sarah Fulton,
MHS (410-786-2749).
Addendum IX: Active CMS Coverage-Related Guidance Documents (January
Through March 2025)
CMS published three final guidance documents on August 7, 2024,
to provide a framework for more predictable and transparent evidence
development and encourage innovation and accelerate beneficiary
access to new items and services. The documents are available at:
Coverage with Evidence Development: <a href="https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=38">https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=38</a>.
CMS National Coverage Analysis Evidence Review: <a href="https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=37">https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=37</a>.
Clinical Endpoints Guidance: Knee Osteoarthritis: <a href="https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=36">https://www.cms.gov/medicare-coverage-database/view/medicare-coverage-document.aspx?mcdid=36</a>.
For questions or additional information, contact Lori Ashby, MA
(410 786 6322).
Addendum X: List of Special One-Time Notices Regarding National
Coverage Provisions (January Through March 2025)
There were no special one-time notices regarding national
coverage provisions published in the 3-month period. This
information is available at <a href="http://www.cms.gov">http://www.cms.gov</a>.
For questions or additional information, contact JoAnna Baldwin,
MS (410-786 7205).
Addendum XI: National Oncologic PET Registry (NOPR) (January Through
March 2025)
Addendum XI includes a listing of National Oncologic Positron
Emission Tomography Registry (NOPR) sites. We cover positron
emission tomography (PET) scans for particular oncologic indications
when they are performed in a facility that participates in the NOPR.
In January 2005, we issued our decision memorandum on positron
emission tomography (PET) scans, which stated that CMS would cover
PET scans for particular oncologic indications, as long as they were
performed in the context of a clinical study. We have since
recognized the National Oncologic PET Registry as one of these
clinical studies. Therefore, in order for a beneficiary to receive a
Medicare-covered PET scan, the beneficiary must receive the scan in
a facility that participates in the registry. There were no
additions, deletions, or editorial changes to the listing of
National Oncologic Positron Emission Tomography Registry (NOPR) in
the 3-month period. This information is available at <a href="http://www.cms.gov/MedicareApprovedFacilitie/NOPR/list.asp#TopOfPage">http://www.cms.gov/MedicareApprovedFacilitie/NOPR/list.asp#TopOfPage</a>.
For questions or additional information, contact David Dolan,
MBA (410-786-3365).
Addendum XII: Medicare-Approved Ventricular Assist Device (Destination
Therapy) Facilities (January Through March 2025)
Addendum XII includes a listing of Medicare-approved facilities
that receive coverage for ventricular assist devices (VADs) used as
destination therapy. All facilities were required to meet our
standards in order to receive coverage for VADs implanted as
destination therapy. On October 1, 2003, we issued our decision
memorandum on VADs for the clinical indication of destination
therapy. We determined that VADs used as destination therapy are
reasonable and necessary only if performed in facilities that have
been determined to have the experience and infrastructure to ensure
optimal patient outcomes. We established facility standards and an
application process. All facilities were required to meet our
standards in order to receive coverage for VADs implanted as
destination therapy.
For the purposes of this quarterly notice, we are providing only
the specific updates to the list of Medicare-approved facilities
that meet our standards that have occurred in the 3-month period.
This information is available at <a href="http://www.cms.gov/MedicareApprovedFacilitie/VAD/list.asp#TopOfPage">http://www.cms.gov/MedicareApprovedFacilitie/VAD/list.asp#TopOfPage</a>.
For questions or additional information, contact David Dolan,
MBA, (410-786-3365).
----------------------------------------------------------------------------------------------------------------
Provider Date of initial Date of re-
Facility No. certification certification State
----------------------------------------------------------------------------------------------------------------
The following are new facilities
----------------------------------------------------------------------------------------------------------------
HonorHealth Scottsdale Shea, Medical 030087 03/04/2025 n/a AZ
Center, 9003 E. Shea Blvd.,Scottsdale, AZ
85260; Other information: DNV ID #:
C691982; Previous Re-certification Dates:
n/a.
Medical City Fort Worth, 900 Eighth Avenue, 450672 03/05/2025 n/a TX
Fort Worth, TX 76104; Other information:
DNV ID #: C750130; Previous Re-
certification Dates: n/a.
----------------------------------------------------------------------------------------------------------------
The following facilities have editorial changes (in bold).
----------------------------------------------------------------------------------------------------------------
Christ Hospital, 2139 Auburn Avenue, 360163 02/17/2012 10/23/2024 OH
Cincinnati, OH 45219; Other information:
Joint Commission ID #6987; Previous Re-
certification Dates: 02/17/2012; 02/20/
2014; 04/05/2016; 03/20/2018; 2/26/21; 07/
09/2022.
Medical University of South Carolina 420004 09/23/2010 09/21/2024 SC
Medical Center, 169 Ashley Avenue,
Charleston, SC 29425; Other information:
Joint Commission ID #6584; Previous Re-
certification Dates: 09/23/2010; 09/07/
2012; 08/05/2014; 09/13/2016; 09/26/2018;
03/24/2021; 07/21/2022.
Ascension Saint Thomas Hospital, 4220 440082 06/22/2010 10/19/2024 TN
Harding Pike, Nashville, TN 37205; Other
information: Joint Commission ID #7891;
Previous Re-certification Dates: 06/22/
2010; 06/22/2012; 05/20/2014; 07/13/2016;
01/14/2021; 09/03/2022.
Penn State Milton S. Hershey Medical 390256 10/29/2003 10/09/2024 PA
Center, 500 University Drive, Hershey, PA
17033; Other information: Joint Commission
ID #6075; Previous Re-certification Dates:
04/01/2008; 03/24/2010; 03/16/2012; 04/08/
2014; 06/07/2016; 05/22/2018; 9/11/2020;
06/30/2022.
The University of Kansas Hospital 170040 03/08/2016 10/23/2024 KS
Authority, 4000 Cambridge Street, Kansas
City, KS 66160-7200; Other information:
Joint Commission ID #: 8567; Previous Re-
certification Dates: 03/08/2016; 03/06/
2018; 07/20/2022.
Abington Memorial Hospital, 1200 Old York 390231 07/10/2012 10/30/2024 PA
Road, Abington, PA 19001; Other
information: Joint Commission ID #: 6013;
Previous Re-certification Dates: 06/28/
2012; 06/03/2014; 06/28/2016; 05/22/2018;
07/16/2022.
Bethesda North Hospital, 10500 Montgomery 360179 12/16/2021 12/13/2024 OH
Road, Cincinnati, OH 45242; Other
information: DNV ID #: C755357; Previous
Re-certification Dates: 12/16/2021.
Deborah Heart and Lung Center, 200 Trenton 310031 02/05/2019 01/09/2025 NJ
Road, Browns Mills, NJ 08051; Other
information: DNV ID #: C522707; Previous
Re-certification Dates: 02/05/2019; 02/10/
2022.
Medical City Dallas, 7777 Forest Lane, 450647 09/09/2008 12/04/2024 TX
Dallas, TX 75230; Other information: Joint
Commission ID #9008; Previous Re-
certification Dates: 09/09/2008; 08/10/
2010; 07/17/2012; 06/27/2014; 07/12/2016;
4/3/2021; 10/20/2022.
Lutheran Hospital of Indiana, 7950 West 150017 09/14/2010 12/11/2024 IN
Jefferson Boulevard, Fort Wayne, IN 46804;
Other information: Joint Commission ID
#7157; Previous Re-certification Dates: 09/
14/2010; 10/24/2012; 10/21/2014; 11/01/
2016; 05/05/2021; 09/22/2022.
Froedtert Memorial Lutheran Hospital, Inc, 520177 07/31/2012 12/11/2024 WI
9200 West Wisconsin Avenue, Milwaukee, WI
53226; Other information: Joint Commission
ID #: 7718; Previous Re-certification
Dates: 07/31/2012; 07/08/2014; 08/09/2016;
2021-01-07; 09/14/2022.
[[Page 21049]]
Memorial Regional Hospital, 3501 Johnson 100038 08/20/2014 12/04/2024 FL
Street, Hollywood, FL 33021; Other
information: Joint Commission ID #: 6811;
Previous Re-certification Dates: 08/20/
2014; 08/11/2016; 03/27/2021; 10/19/2022.
Loma Linda University Medical Center, 11234 050327 11/23/2012 12/14/2024 CA
Anderson Street, Loma Linda, CA 92354;
Other information: Joint Commission #:
9898; Previous Re-certification Dates: 02/
07/2012; 01/23/2014; 02/23/2016; 04/10/
2018; 05/15/2021; 11/23/2012.
California Pacific Medical Center-Van Ness 050047 10/20/2009 12/11/2024 CA
Campus, 1101 Van Ness Avenue, San
Francisco, CA 94109; Other information:
Joint Commission ID #5152; Previous Re-
certification Dates: 12/08/2009; 11/11/
2011; 01/07/2014; 02/09/2016; 03/20/2018;
02/20/2021; 11/09/2022.
Mayo Clinic Hospital--Rochester, 1216 240010 02/26/2008 12/18/2024 MN
Second Street SW, Rochester, MN 55902-
1906; Other information: Joint Commission
ID #: 8181; Previous Re-certification
Dates: 02/26/2008; 02/09/2010; 02/21/2012;
02/21/2014; 04/05/2016; 03/23/2018; 03/20/
2021; 11/03/2022.
Barnes-Jewish Hospital, 1 Barnes Jewish 260032 08/21/2008 12/11/2024 MO
Plaza, Saint Louis, MO 63110; Other
information: Joint Commission ID #: 8387;
Previous Re-certification Dates: 08/21/
2008; 07/27/2010; 07/17/2012; 08/05/2014;
09/13/2016; 11/10/2017; 10-22-2020; 10/05/
2022.
Indiana University Health, Inc., 1701 North 150056 08/12/2008 02/22/2025 IN
Senate Boulevard, Indianapolis, IN 46202;
Other information: Joint Commission ID #:
188549; Previous Re-certification Dates:
08/12/2008; 08/17/2010; 08/17/2012; 08/19/
2014; 10/04/2016; 05/29/21; 01/20/2023.
Adventist Health System/Sunbelt Inc. dba 100007 10/24/2012 05/20/2023 FL
AdventHealth, 601 East Rollins Street,
Orlando, FL 32803; Other information:
Joint Commission ID #6873; Previous Re-
certification Dates: 10/24/2012; 10/07/
2014; 11/15/2016; 01/30/2019; 06/12/2021.
Bon Secours St. Mary's Hospital, 5801 Bremo 490059 12/15/2011 03/04/2023 VA
Road, Richmond, VA 23226; Other
information: Joint Commission ID #: 6387;
Previous Re-certification Dates: 12/15/
2011; 12/17/2013; 01/26/2016; 02/21/2018;
06/11/2021.
North Shore University Hospital, 300 330106 09/27/2016 03/29/2023 NY
Community Drive, Manhasset, NY 11030;
Other information: Joint Commission ID #:
2091; Previous Re-certification Dates: 09/
27/2016; 9/19/2018; 06/26/2021.
University of Iowa Hospitals and Clinics, 160058 06/22/2010 11/16/2024 IA
200 Hawkins Drive, Iowa City, IA 52242;
Other information: Joint Commission ID #:
8266; Previous Re-certification Dates: 06/
22/2010; 07/26/2012; 07/29/2014; 08/02/
2016; 7/11/2018; 4/8/2021; 10/14/2022.
----------------------------------------------------------------------------------------------------------------
Addendum XIII: Lung Volume Reduction Surgery (LVRS) (January Through
March 2025)
Addendum XIII includes a listing of Medicare-approved facilities
that are eligible to receive coverage for lung volume reduction
surgery. Until May 17, 2007, facilities that participated in the
National Emphysema Treatment Trial were also eligible to receive
coverage. The following three types of facilities are eligible for
reimbursement for Lung Volume Reduction Surgery (LVRS):
<bullet> National Emphysema Treatment Trial (NETT) approved
(Beginning 05/07/2007, these will no longer automatically qualify
and can qualify only with the other programs);
<bullet> Credentialed by the Joint Commission (formerly, the
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)) under their Disease Specific Certification Program for
LVRS; and
<bullet> Medicare approved for lung transplants.
Only the first two types are in the list. For the purposes of
this quarterly notice, there are no additions and deletions to a
listing of Medicare-approved facilities that are eligible to receive
coverage for lung volume reduction surgery. This information is
available at <a href="http://www.cms.gov/MedicareApprovedFacilitie/LVRS/list.asp#TopOfPage">www.cms.gov/MedicareApprovedFacilitie/LVRS/list.asp#TopOfPage</a>.
For questions or additional information, contact Sarah Fulton,
MHS (410-786-2749).
Addendum XIV: Medicare-Approved Bariatric Surgery Facilities (January
Through March 2025)
Addendum XIV includes a listing of Medicare-approved facilities
that meet minimum standards for facilities modeled in part on
professional society statements on competency. All facilities must
meet our standards in order to receive coverage for bariatric
surgery procedures. On February 21, 2006, we issued our decision
memorandum on bariatric surgery procedures. We determined that
bariatric surgical procedures are reasonable and necessary for
Medicare beneficiaries who have a body-mass index (BMI) greater than
or equal to 35, have at least one co-morbidity related to obesity
and have been previously unsuccessful with medical treatment for
obesity. This decision also stipulated that covered bariatric
surgery procedures are reasonable and necessary only when performed
at facilities that are: (1) certified by the American College of
Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program
standards and requirements in effect on February 15, 2006); or (2)
certified by the American Society for Bariatric Surgery (ASBS) as a
Bariatric Surgery Center of Excellence (BSCOE) (program standards
and requirements in effect on February 15, 2006).
There were no additions, deletions, or editorial changes to
Medicare-approved facilities that meet CMS' minimum facility
standards for bariatric surgery that have been certified by ACS and/
or ASMBS in the 3-month period. This information is available at
<a href="http://www.cms.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage">www.cms.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage</a>.
For questions or additional information, contact Sarah Fulton,
MHS (410-786-2749).
Addendum XV: FDG-PET for Dementia and Neurodegenerative Diseases
Clinical Trials (January Through March 2025)
There were no FDG-PET for Dementia and Neurodegenerative
Diseases Clinical Trials published in the 3-month period.
This information is available on our website at <a href="http://www.cms.gov/MedicareApprovedFacilitie/PETDT/list.asp#TopOfPage">www.cms.gov/MedicareApprovedFacilitie/PETDT/list.asp#TopOfPage</a>.
For questions or additional information, contact David Dolan,
MBA (410-786-3365).
[FR Doc. 2025-08753 Filed 5-15-25; 8:45 am]
BILLING CODE 4120-01-P
</pre></body>
</html>Indexed from Federal Register on May 16, 2025.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.