Manual Updates to Chapter 17 of the Medicare Claims Processing Manual and Chapter 15 of the Medicare Benefit Policy Manual to Reflect Policies Finalized in the Calendar Year (CY) 2025 Physician Fee Schedule Final Rule

The purpose of this Change Request (CR) is to update Chapter 17 of the Medicare Claims Processing Manual (100-04) and Chapter 15 of the Medicare Benefit Policy Manual (100-02) to reflect policies finalized in the CY 2025 Physician Fee Schedule final rule:

In Chapter 17 of the Medicare Claims Processing Manual:
In section 20.1.3 of the Medicare Claims Processing Manual, we are clarifying policy related to payment limits for pneumococcal, hepatitis B and COVID-19 vaccines.
In section 40, we are clarifying JW/JZ Modifier Policy requirements with regard to a billing supplier who does not administer the drug to conform with changes finalized in the CY 2025 PFS final rule.
In section 80, we are including reference to COVID-19 vaccines.
In section 80.3, we are revising payment policy regarding fills and refills for immunosuppressive drugs to conform to regulatory changes in Subsection (§) 414.1001.
In section 80.4.1, we are revising policy to conform with regulatory changes to the conditions in which a clotting factor furnishing fee may be paid in § 410.63.
In section 80.7, we are making typographical corrections.
In Chapter 15 of the Medicare Benefit Policy Manual:
In section 50.4.4.2, we are clarifying policies with regard to administration of the COVID-19 vaccine and adding new paragraph E. for an additional payment for in-home administration of Part B preventive vaccines.
In section 50.5.1, we are clarifying coverage policy for immunosuppressive drugs to conform with regulatory changes in §§ 410.30 and 414.1001.
In section 50.5.5, we are revising the text to conform with regulatory changes to the conditions in which a clotting factor furnishing fee may be paid in § 410.63.

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