Medicare AdvantageBilling CodesHigh impact
Q4 2024 newsletter
Devoted Health·Nephrology, Endocrinology, Infectious Disease +2 more·Provider News
Effective date
Jan 1, 2025
We identified it
Aug 13, 2026
Summary
Devoted Health Q4 2024 newsletter announces multiple 2025 plan year changes affecting medication coverage, billing requirements, and prior authorization processes. Key changes include PrEP coverage moving from Part D to Part B (effective Sept 30, 2024), oral phosphate binders shifting to dialysis centers under Part B bundled payments (Jan 1, 2025), new NDC billing requirements for all claims, CGM claims requiring NDCs, and revised payment policies for modifiers and inpatient readmissions. Additionally, the C-SNP provider verification form must be submitted within 60 days of member enrollment to prevent benefit loss.
Action Required
REQUIREMENTS: By December 31, 2024: (1) Billing team must update all claims submission processes to require National Drug Codes (NDCs) on all medication claims, effective January 1, 2025. (2) Billing team must implement changes to Continuous Glucose Monitor (CGM) billing to include NDCs and verify device status (preferred vs. nonpreferred) before claim submission. (3) Providers must review and update documentation templates to ensure all chronic conditions include status and plan notation for risk adjustment revalidation; CPT 99499 may be used on additional claims to submit 13+ diagnosis codes. (4) Front desk and scheduling staff must implement C-SNP verification form tracking: when a C-SNP member verification form is received from Devoted Health, it must be routed to the appropriate provider (PCP or specialist) for completion and faxed to 1-877-264-3859 WITHIN 60 DAYS OF ENROLLMENT to prevent member loss of coverage. (5) Billing team must update modifier and inpatient readmission payment policies per the 2025 Provider Manual revisions and new Critical Access Hospital billing methodologies. (6) Billing staff should prepare for HEDIS Medical Record Review beginning February 2025; designate staff to respond to Datavant record requests. Data submission deadline for closing gaps is February 28, 2025. (7) Pharmacy operations must note that starting January 1, 2025, oral phosphate binders will be provided at dialysis centers under Part B bundled payments, not through pharmacy—coordinate with dialysis facilities to prevent duplicate billing. Consequences of inaction: Claims will be denied if NDCs are not included; C-SNP members will lose plan enrollment if verification forms are not submitted within 60 days; HEDIS gaps not closed by February 28, 2025 will negatively impact Star Ratings.