MLN Product (Revised); Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance
This revised Product comprises Subregulatory Guidance for billing insulin with new limits under Medicare Part B benefit for DME, and its content is based on publically available content within at https://www.congress.gov/117/plaws/publ169/PLAW-117publ169.pdf#page=88. CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates DME suppliers and pharmacies on coinsurance and deductible, payments, spilt billing and modifiers. Starting July 1, 2023, the Part B coinsurance for a month’s supply of insulin used in an insulin pump covered under the DME benefit can’t exceed $35. In addition, the Part B deductible won’t apply for the insulin starting July 1, 2023.
Revisions to this Product include following content updates:
• Added HCPCS codes J1811 and J1813 to the Insulin Modifiers table (page 2).
The previous version of this product is available to the public and currently posted on the CMS website at https://www.cms.gov/files/document/mln4443820-billing-medicare-part-b-insulin-new-limits-patient-monthly-coinsurance.pdf
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 03, 2023
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.