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CY 2025 Identification and Review of Potentially Misvalued Services In the CY 2012 PFS final rule with comment period (76 FR 73058), we finalized a process for the public to nominate potentially misvalued codes

By self-infusing, individuals can avoid waiting for care at a medical facility. Most notably, for purposes of understanding the Medicare clotting factor payment inadequacy that was addressed by Congress by adding the furnishing fee, the report states [t]he method of delivery of clotting factor has implications for Medicare payment

N Engl J Med

In such instances, CMS proposes to calculate the average total allowed charges per individual per year for the drug using allowed charges and the number of individuals who used the drug or biological product based on claims for the previously grouped billing and payment code during the year

2018 Sep