{ "story_id": "b0efd1b385bb026ea1bd1117349f6a84", "desk": "drm3", "revision": 1, "published_at": "2026-09-01T10:30:00.000Z", "content_hash": "1b56c45ad1d0d7459f690c9ba39654f38426bb0949dcda8e6f9254fbbd614a00", "hash_basis": "sha256 over `headline\\ndek\\nprose`, plus `\\n` + the canonical citations JSON when any source is placed, plus `\\n#blog` for blogs", "basis": { "headline": "CMS Establishes New HCPCS Codes for TOMAC RLS Therapy", "dek": "The Centers for Medicare & Medicaid Services created new HCPCS codes for the TOMAC wearable device to treat restless legs syndrome.", "prose": "The Centers for Medicare & Medicaid Services (CMS) established two dedicated Healthcare Common Procedure Coding System (HCPCS) codes for the TOMAC system effective October 1, 2024. [^1]\n\nCode E0743 is billed per unit, meaning two units are required for bilateral therapy, and staff must not assume the code descriptor covers both legs automatically. [^2]\n\nPayer policies commonly require documentation that the patient is refractory to medications or unable to tolerate them, such as gabapentin, dopamine agonists, or opioids. [^3]\n\nThe TOMAC system is classified as durable medical equipment (DME) and is priced as a capped rental rather than a one-time supply or implanted neurostimulator. [^4]\n\nAccording to CAQH, eligibility runs 96% electronically, but prior authorization is only 40% fully electronic, and attachments sit at 24% in medical spaces. [^5]\n\nCMS-0057-F requires payers to expose FHIR APIs, including for prior authorization, by January 1, 2027, which will convert execution from brittle screen-scraping into a clean engineering problem. [^6]\n\nHFMA reported that up to 65% of denied claims are never reworked because there are more defensible denials than biller-hours available to defend them. [^7]\n\nMost RCM AI tools function as coordination systems that recommend actions, score denials, and draft appeal letters, but they route the final task back to a person to log in and finish the work. [^8]", "cited": "[{\"statement\":\"The Centers for Medicare & Medicaid Services (CMS) established two dedicated Healthcare Common Procedure Coding System (HCPCS) codes for the TOMAC system effective October 1, 2024.\",\"source\":\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-08-31T21:11:20.000Z\",\"publisher_count\":1,\"sources\":[\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\"]},{\"statement\":\"Code E0743 is billed per unit, meaning two units are required for bilateral therapy, and staff must not assume the code descriptor covers both legs automatically.\",\"source\":\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-08-31T21:11:20.000Z\",\"publisher_count\":1,\"sources\":[\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\"]},{\"statement\":\"Payer policies commonly require documentation that the patient is refractory to medications or unable to tolerate them, such as gabapentin, dopamine agonists, or opioids.\",\"source\":\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-08-31T21:11:20.000Z\",\"publisher_count\":1,\"sources\":[\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\"]},{\"statement\":\"The TOMAC system is classified as durable medical equipment (DME) and is priced as a capped rental rather than a one-time supply or implanted neurostimulator.\",\"source\":\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-08-31T21:11:20.000Z\",\"publisher_count\":1,\"sources\":[\"American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers\"]},{\"statement\":\"According to CAQH, eligibility runs 96% electronically, but prior authorization is only 40% fully electronic, and attachments sit at 24% in medical spaces.\",\"source\":\"Forbes\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-09-01T10:30:00.000Z\",\"publisher_count\":1,\"sources\":[\"Forbes\"]},{\"statement\":\"CMS-0057-F requires payers to expose FHIR APIs, including for prior authorization, by January 1, 2027, which will convert execution from brittle screen-scraping into a clean engineering problem.\",\"source\":\"Forbes\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-09-01T10:30:00.000Z\",\"publisher_count\":1,\"sources\":[\"Forbes\"]},{\"statement\":\"HFMA reported that up to 65% of denied claims are never reworked because there are more defensible denials than biller-hours available to defend them.\",\"source\":\"Forbes\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-09-01T10:30:00.000Z\",\"publisher_count\":1,\"sources\":[\"Forbes\"]},{\"statement\":\"Most RCM AI tools function as coordination systems that recommend actions, score denials, and draft appeal letters, but they route the final task back to a person to log in and finish the work.\",\"source\":\"Forbes\",\"instrument\":\"News\",\"claim_key\":null,\"published_at\":\"2026-09-01T10:30:00.000Z\",\"publisher_count\":1,\"sources\":[\"Forbes\"]}]", "kind": "news" }, "receipt_verify": "Ed25519 over the dot-joined string `slice_hash.cursor_from.cursor_to.view.view_version.row_count`; 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