Puerto Rico POE-AG minutes - March 19, 2025
Jurisdiction N
Medicare Part A and B
March 19, 2025
Welcome
Janice Mumma, Supervisor, welcomed the members and introduced herself to the advisory group. She shared the agenda and reviewed the advisory committee guidelines. The purpose of the POE AG is to assist the contractor in creating, implementing, and reviewing supplier educational events. We held this meeting to allow suppliers to provide feedback on training topics, supplier educational materials, and dates and times for supplier educational events.
Janice introduced Dr. Summers, who gave a presentation on Local Coverage Determinations (LCDs), the role of the contractor, and how LCDs are created. There were no questions.
Educational activities from previous quarter
The activities from the previous quarter, including those with the highest and lowest attendance, were reviewed, and feedback was requested. Lines for comments were opened, but no one offered suggestions on how to increase participation. Please send an email to Janice.mumma@novitas-solutions.com, if you wish to send comments or suggestions related to education.
Activities for next quarter
The activities and events for March 2025 were announced.
CMS activities
We shared CMS's page on “Education and Training”. This page offers information on the national training program, outreach resources, the Medicare Learning Network, open house forums, available topics, and a provider type finder.
Comprehensive Error Rate Testing (CERT)
We shared information about the CERT program located at the CERT Program Resource Center. We discussed the CERT post-payment audit process, shared the 2024 report publication showing the error rate, and provided training to the supplier on this topic.
Education Strategy 2025
We reviewed the education strategy for 2025. We mentioned the series of workshops. “Stay Connected” where we offer week-long webinars on specific topics and the "Medicare Navigator" series, which focuses on a specific theme developed throughout the year. In short, the strategy includes topics presented in a series of workshops, monthly, bimonthly, and quarterly events covering a variety of subjects, and the annual virtual symposium. Topics are selected from diverse sources, including provider feedback and surveys, CERT data, Medicare data, claims submission data and errors, and more. Check out our calendar of events to receive monthly updates.
Social Media
First Coast is active on social media. LinkedIn and YouTube are live. Subscribe today and promote these social media tools to your colleagues. They also announced where to find recorded events on their website: First Coast's Learning on Demand.
Medicare Deductible, Coinsurance, and Premiums: 2025 Update
The 2025 deductibles, coinsurance, and premiums have been published. The 2025 Part A deductible is $1,676 and the 2025 Part B deductible is $257, with 20% coinsurance. For more information, visit Change request (CR) 13796.
2025 Annual Update of Therapy Limits per Beneficiary
The combined limit for physical therapy (PT) and speech-language therapy (SLP) is now $2,410, and the limit for occupational therapy (OT) is also $2,410. The limits for medical history are as follows: combined physical therapy and speech-language therapy services remain at $3,000, and occupational therapy services remain at $3,000.
Note: These limits will remain in effect until calendar year 2028, at which time they will be updated based on the Medicare Economic Index (MEI) review. For more information, please see the CR 13826.
Pre-exposure prophylaxis (PrEP) with antiretroviral drugs for HIV prevention
Beginning September 30, 2024, Medicare covers PrEP for HIV prevention in people at higher risk of contracting HIV, with no cost-sharing. This medication can be billed by pharmacies, doctors, healthcare professionals, and institutional facilities.
Medicare will cover the following as an additional preventive service:
- Up to 8 individual counseling consultations every 12 months
- Up to 8 HIV screening tests every 12 months
- A single test to detect the hepatitis B virus
Effective January 1, 2025, CMS added a new HCPCS code, Q0521, for pharmacies billing PrEP for HIV medications. If a physician or other healthcare professional prescribes PrEP, at least one valid ICD-10 diagnosis code must be included to assist pharmacies in filing their claims. CMS has resources and references available at PrEP for HIV and related services.
Provider registration application fee: Calendar year 2025
Effective January 1, 2025, the application fee is $730 for institutional providers who:
- Initially enroll in Medicare or Medicaid programs or the Children's Health Insurance Program (CHIP);
- Renew their enrollment in Medicare, Medicaid, or CHIP;
- Add a new Medicare practice address
CMS has defined an "institutional provider" as any provider or supplier that submits a paper Medicare enrollment application using forms CMS-855A, CMS-855B (except physician and non-physician professional organizations), CMS-855S, or an associated internet-based PECOS enrollment application.
CMS requires this fee for any of these enrollment applications submitted between January 1 and December 31, 2025.
This information was included in the December 12, 2024 edition of the MLN Connects weekly newsletter, which contains a link to the Federal Register.
Summary of Medicare Final Rule 2025 Policies
CMS issued a rule finalizing changes to Medicare payments under the PFS and other Medicare Part B policies, effective January 1, 2025.
A summary of these Medicare policies includes:
- Telehealth
- Caregiver Training
- Therapy
- Cardiovascular Risk Evaluation and Management
- Evaluation and Management
- Behavioral Health
- Advanced Primary Care
- Comprehensive Surgery Coverage
- Dental and Oral Health
For more details, please refer to CR13887.
How to use the add-on code G2211 for the complexity of office and outpatient assessment and management visits
Effective January 1, 2025, CMS updated the code list and modifier usage for code G2211. Code G2211 is paid with E/M codes and modifier 25 when the service or other procedure meets the modifier 25 requirement. Method II Critical Access hospitals should use invoice type 85X (revenue codes 096x, 097x, or 098x). For more information, see CR 13705.
Primary care advance management
Effective January 1, 2025, CMS developed new codes for primary care advance management services. These codes are G0556, G0557, and G0558.
These codes offer patients a comprehensive range of services to meet their individual needs based on complexity, allow providers to bill for these services as a monthly package (instead of billing for each individual service or tracking minutes on a minute-by-minute basis), and help simplify billing and documentation requirements while ensuring that patients have access to high-quality primary care services. For more information about these new codes, please visit the CMS Primary Care Advance Management Services webpage.
Telehealth guidelines for 2025
The telehealth guidelines in effect for 2024 have been extended until March 31, 2025. The telehealth guidelines for calendar year 2025 will be published once CMS finalizes them.
New procedures for credit balance reports quarterly submission
Effective December 1, 2024, vendors are no longer required to submit quarterly credit balance reports (CMS-838). Vendors are still required to report any overpayments they identify, but credit balance reports should only be used when these occur. When there are no credits to report, zero-balance certifications are no longer required. For more information, see Quarterly credit balance reports are no longer required.
Open discussion and final comments
There were no questions or comments. Suggestions for topics and dates can be sent to Janice.Mumma@novitas-solutions.com.
Next meetings are scheduled for July 23 and November 12.