2025-06-26-MLNC

by  CMS - MLNConnects
Jul 7th, 2025

News

Alert: Medicare Fraud Scheme Involving Phishing Fax Requests

CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.

Important: CMS doesn’t initiate audits by requesting medical records via fax. Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real.

Medicare Diabetes Prevention Program: CY 2025 Payment Rates

Get CY 2025 payment rates (PDF) for the Medicare Diabetes Prevention Program. 

See the instruction to your Medicare Administrative Contractor (PDF).

Compliance

Commodes, Bed Pans & Urinals: Prevent Claim Denials

In 2023, the improper payment rate for commodes, bed pans, and urinals was 47.7%, with a projected improper payment amount of $4.4 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Commodes, Bed Pans & Urinals provider compliance tip for more information, including:

• Billing codes
• Denial reasons and how to prevent them
• Documentation requirements

Claims, Pricers & Codes

Medical Education: Don’t Submit Claims for Programs of All-Inclusive Care for the Elderly

Programs of All-Inclusive Care for the Elderly (PACE) is excluded from the Inpatient Prospective Payment System for direct graduate medical and nursing and allied health education for Medicare Advantage enrollees. See the Medicare Claims Processing Manual, Chapter 3 (PDF), section 20.8 to find out when medical education billing is appropriate.

Publications & Multimedia

Medicare & Mental Health Coverage — Revised

Learn what’s changed (PDF):

• Added information on:
  • Providing caregiver training, depression screening, and tobacco use cessation counseling services through telehealth
  • Allowing the physician or non-physician practitioner written order or referral to substitute for the signature on the initial plan of care certification for certain physical, occupational, and speech-language pathology therapies
• Added coverage information for:
  • Digital mental health treatment devices
  • Safety planning intervention and post-discharge phone follow-up contacts intervention to reduce the risk of suicide
  • Opioid treatment programs, including Brixadi® and Opvee®
• Updated:
  • In-person telehealth requirements for Rural Health Clinics and Federally Qualified Health Centers
  • Coverage requirements for marriage and family therapists and mental health counselors
  • Commonly used HCPCS and CPT codes, including codes eligible for telehealth 

Substance Use Screenings & Treatment — Revised

Learn what’s changed (PDF):

• Safety planning intervention for patients in crisis and post discharge phone follow-up contacts intervention
• Prescribing controlled medications like buprenorphine via telehealth through December 31, 2025
• Coverage and billing information for Opioid Use Disorder Treatment: Opioid Treatment Programs
• Payment for certain medications and services, including medication for opioid use disorder in the emergency department

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