Bobbi Buell's Newsletter

Roberta L. Buell is a Principal at onPoint Oncology Inc., specializing in oncology reimbursement. With over 23 years of experience in billing, coding, and drug therapy reimbursement, she's a nationally recognized expert and frequent speaker on regulatory and reimbursement issues. Bobbi has led more than 600 seminars since 1991 and currently serves as content director for focalPoint® and assistPoint®. Learn more about Bobbi here .

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September 2025

Hospital Outpatient Drug Changes Q4

As you are aware, the Hospital Outpatient Fee Schedule changes for a subset of drugs every quarter. For drugs administered on or after October 1, 2025, the changes to the drug listed in Transmittal 13425, Change Request 14223 , are provided below. New COVID Antibody Products and Antibodies Codes Effective August 27, 2025, CMS is retroactively changing the code’s status indicator from E1 (Not Paid) to L (Not paid under OPPS. Paid at reasonable code; not subject to deductible or coinsurance) in the October 2025 Integrated Outpatient Code Editor (I/OCE). M0237-M0238 are status indicator S, meaning not subject to multi-procedure reduction, effective 1/24/25. Q0237 — Injection, tocilizumab-anoh, for hospitalized adult patients with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg M0237 — Intravenous infusion, tocilizumab-anoh, for hospitalized adult…

September 2025

Older but not Wiser

In June, the Centers for Medicare & Medicaid Services (CMS) announced a new six-year Innovation Center model called the Wasteful and Inappropriate Service Reduction (WISeR) Model . The model establishes new prior authorization or post-payment review requirements for a subset of items and services in Traditional Medicare. Oh joy--this oughta be as much fun as the RACs!!! CMS will partner with companies that have "experience managing prior authorization processes, including utilization management contractors or Medicare Advantage (MA) plans, to apply for model participation". WISeR will run for six performance years from January 1, 2026, to December 31, 2031, in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The application period opened on June 27, 2025. WISeR will test the use of technologies, including artificial intelligence (AI), for reviews on the designated services, beginning on January 1, 2026. The proposed initiative represents a significant…

September 2025

Trump Talk: A Regulatory Update

While my friends out there know a little about my politics, this article is not a commentary. There are so many things going on right now, I decided to bundle them all into one article. You can also pick and choose which topics interest you the most and ignore the rest. Actually, most of these should be important to most of my readers. A lot is coming down the pike. Here are the highlights of what's currently happening. Shutdown We currently do not have any agreement on a Continuing Resolution. This means that the government could shut down at Midnight on October 1. Last Friday, the House proposed a short CR that would keep everything open until November 21 . The Senate summarily defeated it as negotiations rolled along. Democrats have put forward an alternative that would extend funding through October 31 and add more than $1 trillion to extend Obamacare ("ACA") subsidies that are set to expire at the end of the year and roll back Medicaid and other health program cuts that…