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AbbVie Oncology
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MSHO Featured Corporate Sponsor Assistance Programs

• AVEO ACE
• Kyowa Kirin Cares
• Takeda Oncology's Here 2 Assist

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WPS Oncology Related LCD Updates

• Revised Policies / Articles

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WPS Recent Oncology Related News

• Medicare Part A Place of Service
• Complex Non-Chemotherapeutic Drug Administration
• Expedited Prior Authorization Requests
• Medicare Hot Links
• And More

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WPS Educational Offerings

New training opportunities available

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CMS-Medicare

Recent Oncology Related Articles

• Part B - Hospital Outpatient Average Sales Price (ASP)
• MLN Matters

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Recent RAC Monitor Article

This edition includes articles on

Developing! Appeal Process for Certain Changes in Status for Medicare
• Why is the Hottest Topic Not Included in the No Surprises Act?
• Shaping the Future: AI and Innovation in Coding
• Important: Cancer Numbers on the Rise for Young Women

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BCBSM/BCN

Recent Oncology Related News

• Additional Fee Schedules Added to Provider Portal
• Additional Fee Change Schedules Added to Provider Portal
• Piasky and Tremfya to Have a Site-of-Care Requirement
• Step Therapy Requirement Added for Darzalex Faspro
• And More

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 2-18-25

Update! Procrit or Epoetin Class Drugs Maintenance
• BCBSM Below Cost Reimbursement

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Resolved Payer Issues

Last Reviewed/Updated 2-18-25

• 0885 Claims Denied With Reason Code 693
• Procrit or Epoetin Class Drugs Maintenance
• Procrit Denials (693)
• 505(b)(2) Oncology Products Being Impacted by Prior Auth

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Aetna

• February 2025 OfficeLink Update
• Correction: Reimbursement for Modifiers SA & SB

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Health Alliance Plan

• Payment of Observation Hospital Stays
• Update - Medical Record Review Projects
• Ordering Genetic Tests for HAP Members
• Multifactor Authentication (MFA) Coming Soon
• New HAP 2025 Medicare Advantage Plans

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Medicaid

• MMP Bulletins
• Biller "B" Aware Notice

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Priority Health Update

• We're Closing Fax Number
• NCQA's 2025 HEDIS Audit is Underway
• Medicaid Formulary Changes Effective Feb. 1, 2025
• Updated TurningPoint Provider Training Guide Available
• CPAP & BiPAP Rental Guidelines Reminder

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United Healthcare

• Medical Policy Updates
• Reimbursement Policy Updates
• Pharmacy and Clinical Updates
• GEHA Members Have New ID Cards 

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Recent Oncology Related FDA Approvals and Expanded Indications

AstraZenca & Daiichi Sanyko Enhertu (trastuzumab deruxtecan)
SpringWorks Therapeutics Gomekli™ (mirdametinib)
Pfizer Adcetris® (brentuximab vedotin)
Deciphera Romvimza™ (vimseltinib)

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ASK MSHO

February 2025 Frequently Asked Questions

• 96523 for a Routine Port Flush?
• Can an IVP be Coded Without a Recorded Stop Time
• Coding for IV Infusions That Begin Outside the Observation Unit
• Coding Phone Calls on a Medicare Beneficiary

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