[Federal Register Volume 89, Number 70 (Wednesday, April 10, 2024)]
[Rules and Regulations]
[Pages 25144-25147]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-07522]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 411, 413, 488, and 489

[CMS-1779-F2]
RIN 0938-AV02


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Updates to the Quality 
Reporting Program and Value-Based Purchasing Program for Federal Fiscal 
Year 2024; Corrections

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors in the final rule that 
appeared in the August 7, 2023 Federal Register, entitled ``Medicare 
Program; Prospective Payment System and Consolidated Billing for 
Skilled Nursing Facilities; Updates to the Quality Reporting Program 
and Value-Based Purchasing Program for Federal Fiscal Year 2024''. The 
effective date was October 1, 2023.

DATES: This correcting document is effective April 10, 2024, and is 
applicable beginning October 1, 2023.

FOR FURTHER INFORMATION CONTACT: John Kane, (410) 786-0557, for 
information related to the SNF PPS.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2023-16249 of August 7, 2023 (88 FR 53200), there were 
technical errors that are identified and corrected in this correcting 
document. These corrections are applicable as if they had been included 
in the final rule entitled ``Medicare Program; Prospective Payment 
System and Consolidated Billing for Skilled Nursing Facilities; Updates 
to the Quality Reporting Program and Value-Based Purchasing Program for 
Federal Fiscal Year 2024'' (hereinafter referred to as the FY 2024 SNF 
PPS final rule), which was effective October 1, 2023.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 53221 of the FY 2024 SNF PPS final rule (88 FR 53200), we 
discussed our proposal to add the surgical option that allows a subset 
of subcategory 42.2--codes for displaced fractures to be eligible for 
one of two orthopedic surgery categories. Additionally, we stated that 
we would add this surgical option to the subcategory of M84.5--codes 
for pathological fractures to certain weight bearing bones to be 
eligible for one of two orthopedic surgery categories. In the final 
rule, we inadvertently stated that this proposal applied to 45 of the 
codes within the subcategory S42.2 codes and to 46 of the codes within 
the subcategory M84.5 codes. However, these numbers were inadvertently 
swapped, meaning that the proposal applied to 46 of the codes within 
the subcategory S42.2 codes and to 45 of the codes within the 
subcategory M84.5 codes. We are correcting these errors.

B. Summary and Corrections of Errors to Tables Posted on the CMS 
Website for the PDPM ICD-10 Mappings

    We are correcting the following errors to the FY 2024 Patient 
Driven Payment Model (PDPM) ICD-10-CM mappings (hereinafter referred to 
as PDPM ICD-10 code mappings) that were made available on the CMS 
website at https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/pdpm in conjunction with the release of the FY 2024 SNF 
PPS final rule, as corrected by the correction notification that 
appeared in the October 4, 2023 Federal Register, entitled ``Medicare 
Program; Prospective

[[Page 25145]]

Payment System and Consolidated Billing for Skilled Nursing Facilities; 
Updates to the Quality Reporting Program and Value-Based Purchasing 
Program for Federal Fiscal Year 2024; Correction'' (88 FR 68486). The 
FY 2024 PDPM ICD-10 code mappings file may be accessed from the list of 
items under the ``PDPM Resources'' section of the website with an 
effective date of ``10-01-2023''.
    The first table in the FY 2024 PDPM ICD-10 code mappings file 
displays the list of ICD-10 codes that are recorded in Item I0020B ICD 
Code of the Minimum Data Set (MDS) assessment to determine a patient's 
clinical category assignment under PDPM. First, we are correcting 
errors in the clinical category assignment of 2 codes, B99.8 (Other 
infectious disease) and B99.9 (Unspecified infectious disease) (lines 
1071 and 1072 of the Excel spreadsheet) to reinstate their prior year's 
assignments from the FY 2023 SNF PPS final rule, as we proposed no 
changes in clinical categories in this code range in the FY 2024 SNF 
PPS proposed rule nor finalized them in the FY 2024 SNF PPS final rule. 
As such, the clinical category mapping for these two codes will be 
corrected to be ``Medical Management''.
    Second, we are correcting errors in the clinical category 
assignments of codes within the S42.2 subcategory of ICD-10 codes 
(lines 32154 et seq.) and the M84.5 subcategory of ICD-10 codes (lines 
17229 et seq.). As discussed in the FY 2024 SNF PPS final rule (88 FR 
53221), we had proposed to add the surgical option that allows a subset 
of subcategory 42.2--codes for displaced fractures to be eligible for 
one of two orthopedic surgery categories. Additionally, we stated that 
we would add this surgical option to the subcategory of M84.5--codes 
for pathological fractures to certain weight bearing bones to be 
eligible for one of two orthopedic surgery categories. However, when 
updating the PDPM ICD-10 mapping for FY 2024 to reflect these changes, 
we inadvertently added the surgical option to a selection of ICD-10 
codes for which we did not propose any changes. Further, we 
inadvertently did not add the surgical option for a selection of ICD-10 
codes for which we did propose to do so.
    Table 1 displays the list of affected ICD-10 codes for which we are 
correcting the clinical category assignments by adding the surgical 
option.

  Table 1--Affected Codes From the Mapping of the ICD-10-CM Recorded in
  Item I0020B of the MDS Assessment to PDPM Clinical Categories Adding
                             Surgical Option
------------------------------------------------------------------------
      ICD-10-CM code                 ICD-10-CM code description
------------------------------------------------------------------------
M84550A..................  Pathological fracture in neoplastic disease,
                            pelvis, initial encounter for fracture.
M84550D..................  Pathological fracture in neoplastic disease,
                            pelvis, subsequent encounter for fracture
                            with routine healing.
M84550G..................  Pathological fracture in neoplastic disease,
                            pelvis, subsequent encounter for fracture
                            with delayed healing.
M84550K..................  Pathological fracture in neoplastic disease,
                            pelvis, subsequent encounter for fracture
                            with nonunion.
M84550P..................  Pathological fracture in neoplastic disease,
                            pelvis, subsequent encounter for fracture
                            with malunion.
M84561A..................  Pathological fracture in neoplastic disease,
                            right tibia, initial encounter for fracture.
M84561D..................  Pathological fracture in neoplastic disease,
                            right tibia, subsequent encounter for
                            fracture with routine healing.
M84561G..................  Pathological fracture in neoplastic disease,
                            right tibia, subsequent encounter for
                            fracture with delayed healing.
M84561K..................  Pathological fracture in neoplastic disease,
                            right tibia, subsequent encounter for
                            fracture with nonunion.
M84561P..................  Pathological fracture in neoplastic disease,
                            right tibia, subsequent encounter for
                            fracture with malunion.
M84562A..................  Pathological fracture in neoplastic disease,
                            left tibia, initial encounter for fracture.
M84562D..................  Pathological fracture in neoplastic disease,
                            left tibia, subsequent encounter for
                            fracture with routine healing.
M84562G..................  Pathological fracture in neoplastic disease,
                            left tibia, subsequent encounter for
                            fracture with delayed healing.
M84562K..................  Pathological fracture in neoplastic disease,
                            left tibia, subsequent encounter for
                            fracture with nonunion.
M84562P..................  Pathological fracture in neoplastic disease,
                            left tibia, subsequent encounter for
                            fracture with malunion.
M84563A..................  Pathological fracture in neoplastic disease,
                            right fibula, initial encounter for
                            fracture.
M84563D..................  Pathological fracture in neoplastic disease,
                            right fibula, subsequent encounter for
                            fracture with routine healing.
M84563G..................  Pathological fracture in neoplastic disease,
                            right fibula, subsequent encounter for
                            fracture with delayed healing.
M84563K..................  Pathological fracture in neoplastic disease,
                            right fibula, subsequent encounter for
                            fracture with nonunion.
M84563P..................  Pathological fracture in neoplastic disease,
                            right fibula, subsequent encounter for
                            fracture with malunion.
M84564A..................  Pathological fracture in neoplastic disease,
                            left fibula, initial encounter for fracture.
M84564D..................  Pathological fracture in neoplastic disease,
                            left fibula, subsequent encounter for
                            fracture with routine healing.
M84564G..................  Pathological fracture in neoplastic disease,
                            left fibula, subsequent encounter for
                            fracture with delayed healing.
M84564K..................  Pathological fracture in neoplastic disease,
                            left fibula, subsequent encounter for
                            fracture with nonunion.
M84564P..................  Pathological fracture in neoplastic disease,
                            left fibula, subsequent encounter for
                            fracture with malunion.
M84571A..................  Pathological fracture in neoplastic disease,
                            right ankle, initial encounter for fracture.
M84571D..................  Pathological fracture in neoplastic disease,
                            right ankle, subsequent encounter for
                            fracture with routine healing.
M84571G..................  Pathological fracture in neoplastic disease,
                            right ankle, subsequent encounter for
                            fracture with delayed healing.
M84571K..................  Pathological fracture in neoplastic disease,
                            right ankle, subsequent encounter for
                            fracture with nonunion.
M84571P..................  Pathological fracture in neoplastic disease,
                            right ankle, subsequent encounter for
                            fracture with malunion.
M84572A..................  Pathological fracture in neoplastic disease,
                            left ankle, initial encounter for fracture.
M84572D..................  Pathological fracture in neoplastic disease,
                            left ankle, subsequent encounter for
                            fracture with routine healing.
M84572G..................  Pathological fracture in neoplastic disease,
                            left ankle, subsequent encounter for
                            fracture with delayed healing.
M84572K..................  Pathological fracture in neoplastic disease,
                            left ankle, subsequent encounter for
                            fracture with nonunion.
M84572P..................  Pathological fracture in neoplastic disease,
                            left ankle, subsequent encounter for
                            fracture with malunion.
------------------------------------------------------------------------

    Table 2 displays the list of affected ICD-10 codes for which we are 
correcting the clinical category assignments by removing the surgical 
option.

[[Page 25146]]



  Table 2--Affected Codes From the Mapping of the ICD-10-CM Recorded in
 Item I0020B of the MDS Assessment to PDPM Clinical Categories Removing
                             Surgical Option
------------------------------------------------------------------------
      ICD-10-CM code                 ICD-10-CM code description
------------------------------------------------------------------------
M84551S..................  Pathological fracture in neoplastic disease,
                            right femur, sequela.
M84552S..................  Pathological fracture in neoplastic disease,
                            left femur, sequela.
S42201A..................  Unspecified fracture of upper end of right
                            humerus, initial encounter for closed
                            fracture.
S42201D..................  Unspecified fracture of upper end of right
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42201G..................  Unspecified fracture of upper end of right
                            humerus, subsequent encounter for fracture
                            with delayed healing.
S42201K..................  Unspecified fracture of upper end of right
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42201P..................  Unspecified fracture of upper end of right
                            humerus, subsequent encounter for fracture
                            with malunion.
S42202A..................  Unspecified fracture of upper end of left
                            humerus, initial encounter for closed
                            fracture.
S42202D..................  Unspecified fracture of upper end of left
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42202G..................  Unspecified fracture of upper end of left
                            humerus, subsequent encounter for fracture
                            with delayed healing.
S42202K..................  Unspecified fracture of upper end of left
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42202P..................  Unspecified fracture of upper end of left
                            humerus, subsequent encounter for fracture
                            with malunion.
S42214A..................  Unspecified nondisplaced fracture of surgical
                            neck of right humerus, initial encounter for
                            closed fracture.
S42214D..................  Unspecified nondisplaced fracture of surgical
                            neck of right humerus, subsequent encounter
                            for fracture with routine healing.
S42214G..................  Unspecified nondisplaced fracture of surgical
                            neck of right humerus, subsequent encounter
                            for fracture with delayed healing.
S42214K..................  Unspecified nondisplaced fracture of surgical
                            neck of right humerus, subsequent encounter
                            for fracture with nonunion.
S42214P..................  Unspecified nondisplaced fracture of surgical
                            neck of right humerus, subsequent encounter
                            for fracture with malunion.
S42215A..................  Unspecified nondisplaced fracture of surgical
                            neck of left humerus, initial encounter for
                            closed fracture.
S42215D..................  Unspecified nondisplaced fracture of surgical
                            neck of left humerus, subsequent encounter
                            for fracture with routine healing.
S42215G..................  Unspecified nondisplaced fracture of surgical
                            neck of left humerus, subsequent encounter
                            for fracture with delayed healing.
S42215K..................  Unspecified nondisplaced fracture of surgical
                            neck of left humerus, subsequent encounter
                            for fracture with nonunion.
S42215P..................  Unspecified nondisplaced fracture of surgical
                            neck of left humerus, subsequent encounter
                            for fracture with malunion.
S42224D..................  2-part nondisplaced fracture of surgical neck
                            of right humerus, subsequent encounter for
                            fracture with routine healing.
S42224K..................  2-part nondisplaced fracture of surgical neck
                            of right humerus, subsequent encounter for
                            fracture with nonunion.
S42224P..................  2-part nondisplaced fracture of surgical neck
                            of right humerus, subsequent encounter for
                            fracture with malunion.
S42225D..................  2-part nondisplaced fracture of surgical neck
                            of left humerus, subsequent encounter for
                            fracture with routine healing.
S42225K..................  2-part nondisplaced fracture of surgical neck
                            of left humerus, subsequent encounter for
                            fracture with nonunion.
S42225P..................  2-part nondisplaced fracture of surgical neck
                            of left humerus, subsequent encounter for
                            fracture with malunion.
S42231D..................  3-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42231K..................  3-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42231P..................  3-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with malunion.
S42232D..................  3-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42232K..................  3-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42232P..................  3-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with malunion.
S42241D..................  4-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42241K..................  4-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42241P..................  4-part fracture of surgical neck of right
                            humerus, subsequent encounter for fracture
                            with malunion.
S42242D..................  4-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with routine healing.
S42242K..................  4-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with nonunion.
S42242P..................  4-part fracture of surgical neck of left
                            humerus, subsequent encounter for fracture
                            with malunion.
S42254A..................  Nondisplaced fracture of greater tuberosity
                            of right humerus, initial encounter for
                            closed fracture.
S42254D..................  Nondisplaced fracture of greater tuberosity
                            of right humerus, subsequent encounter for
                            fracture with routine healing.
S42254G..................  Nondisplaced fracture of greater tuberosity
                            of right humerus, subsequent encounter for
                            fracture with delayed healing.
S42254K..................  Nondisplaced fracture of greater tuberosity
                            of right humerus, subsequent encounter for
                            fracture with nonunion.
S42254P..................  Nondisplaced fracture of greater tuberosity
                            of right humerus, subsequent encounter for
                            fracture with malunion.
S42255A..................  Nondisplaced fracture of greater tuberosity
                            of left humerus, initial encounter for
                            closed fracture.
S42255D..................  Nondisplaced fracture of greater tuberosity
                            of left humerus, subsequent encounter for
                            fracture with routine healing.
S42255G..................  Nondisplaced fracture of greater tuberosity
                            of left humerus, subsequent encounter for
                            fracture with delayed healing.
S42255K..................  Nondisplaced fracture of greater tuberosity
                            of left humerus, subsequent encounter for
                            fracture with nonunion.
S42255P..................  Nondisplaced fracture of greater tuberosity
                            of left humerus, subsequent encounter for
                            fracture with malunion.
S42264A..................  Nondisplaced fracture of lesser tuberosity of
                            right humerus, initial encounter for closed
                            fracture.
S42264D..................  Nondisplaced fracture of lesser tuberosity of
                            right humerus, subsequent encounter for
                            fracture with routine healing.
S42264G..................  Nondisplaced fracture of lesser tuberosity of
                            right humerus, subsequent encounter for
                            fracture with delayed healing.
S42264K..................  Nondisplaced fracture of lesser tuberosity of
                            right humerus, subsequent encounter for
                            fracture with nonunion.
S42264P..................  Nondisplaced fracture of lesser tuberosity of
                            right humerus, subsequent encounter for
                            fracture with malunion.
S42265A..................  Nondisplaced fracture of lesser tuberosity of
                            left humerus, initial encounter for closed
                            fracture.
S42265D..................  Nondisplaced fracture of lesser tuberosity of
                            left humerus, subsequent encounter for
                            fracture with routine healing.
S42265G..................  Nondisplaced fracture of lesser tuberosity of
                            left humerus, subsequent encounter for
                            fracture with delayed healing.
S42265K..................  Nondisplaced fracture of lesser tuberosity of
                            left humerus, subsequent encounter for
                            fracture with nonunion.
S42265P..................  Nondisplaced fracture of lesser tuberosity of
                            left humerus, subsequent encounter for
                            fracture with malunion.
S42271A..................  Torus fracture of upper end of right humerus,
                            initial encounter for closed fracture.
S42271D..................  Torus fracture of upper end of right humerus,
                            subsequent encounter for fracture with
                            routine healing.
S42271G..................  Torus fracture of upper end of right humerus,
                            subsequent encounter for fracture with
                            delayed healing.
S42271K..................  Torus fracture of upper end of right humerus,
                            subsequent encounter for fracture with
                            nonunion.
S42271P..................  Torus fracture of upper end of right humerus,
                            subsequent encounter for fracture with
                            malunion.
S42272A..................  Torus fracture of upper end of left humerus,
                            initial encounter for closed fracture.
S42272D..................  Torus fracture of upper end of left humerus,
                            subsequent encounter for fracture with
                            routine healing.
S42272G..................  Torus fracture of upper end of left humerus,
                            subsequent encounter for fracture with
                            delayed healing.
S42272K..................  Torus fracture of upper end of left humerus,
                            subsequent encounter for fracture with
                            nonunion.
S42272P..................  Torus fracture of upper end of left humerus,
                            subsequent encounter for fracture with
                            malunion.

[[Page 25147]]

 
S42294A..................  Other nondisplaced fracture of upper end of
                            right humerus, initial encounter for closed
                            fracture.
S42294D..................  Other nondisplaced fracture of upper end of
                            right humerus, subsequent encounter for
                            fracture with routine healing.
S42294G..................  Other nondisplaced fracture of upper end of
                            right humerus, subsequent encounter for
                            fracture with delayed healing.
S42294K..................  Other nondisplaced fracture of upper end of
                            right humerus, subsequent encounter for
                            fracture with nonunion.
S42294P..................  Other nondisplaced fracture of upper end of
                            right humerus, subsequent encounter for
                            fracture with malunion.
S42295A..................  Other nondisplaced fracture of upper end of
                            left humerus, initial encounter for closed
                            fracture.
S42295D..................  Other nondisplaced fracture of upper end of
                            left humerus, subsequent encounter for
                            fracture with routine healing.
S42295G..................  Other nondisplaced fracture of upper end of
                            left humerus, subsequent encounter for
                            fracture with delayed healing.
S42295K..................  Other nondisplaced fracture of upper end of
                            left humerus, subsequent encounter for
                            fracture with nonunion.
S42295P..................  Other nondisplaced fracture of upper end of
                            left humerus, subsequent encounter for
                            fracture with malunion.
------------------------------------------------------------------------

    Given these errors, we are republishing the PDPM ICD-10 code 
mappings accordingly on the CMS website at https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/pdpm, applicable to 
October 1, 2023.

III. Waiver of Proposed Rulemaking

    Under section 553(b) of the Administrative Procedure Act (the APA) 
(5 U.S.C. 553(b)), the agency is required to publish a notice of 
proposed rulemaking in the Federal Register before the provisions of a 
rule take effect. Similarly, section 1871(b)(1) of the Social Security 
Act (the Act) requires the Secretary to provide for notice of the 
proposed rule in the Federal Register and provide a period of not less 
than 60 days for public comment. In addition, section 553(d) of the APA 
and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in 
effective date after issuance or publication of a rule. Sections 
553(b)(B) and 553(d)(3) of the APA provide for exceptions from the APA 
notice and comment, and delay in effective date requirements; in cases 
in which these exceptions apply, sections 1871(b)(2)(C) and 
1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-
day comment period and delay in effective date requirements of the Act 
as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the 
Act authorize an agency to dispense with normal notice and comment 
rulemaking procedures for good cause if the agency makes a finding that 
the notice and comment process is impracticable, unnecessary, or 
contrary to the public interest, and includes a statement of the 
finding and the reasons for it in the rule. In addition, section 
553(d)(3) of the APA and section 1871(e)(1)(B)(ii) allow the agency to 
avoid the 30-day delay in effective date where such delay is contrary 
to the public interest and the agency includes in the rule a statement 
of the finding and the reasons for it.
    In our view, this correcting document does not constitute a 
rulemaking that would be subject to notice and comment requirements. 
This document merely corrects technical errors in the FY 2024 SNF PPS 
final rule and in the tables referenced in the final rule. The 
corrections contained in this document are consistent with, and do not 
make substantive changes to, the policies and payment methodologies 
that were proposed, subject to notice and comment procedures, and 
adopted in the FY 2024 SNF PPS final rule. As a result, the corrections 
made through this correcting document are intended to resolve 
inadvertent errors so that the rule accurately reflects the policies 
adopted in the final rule. Even if this were a rulemaking to which the 
notice and comment and delayed effective date requirements applied, we 
find that there is good cause to waive such requirements. It is in the 
public interest for providers to receive appropriate payments in as 
timely a manner as possible, and to ensure that the FY 2024 SNF PPS 
final rule and the tables referenced in the final rule accurately 
reflect our methodologies, payment rates, and policies. This correcting 
document ensures that the FY 2024 SNF PPS final rule and the tables 
referenced in the final rule accurately reflect these methodologies and 
policies. Therefore, we believe we have good cause to waive the notice 
and comment and effective date requirements.

IV. Correction of Errors in the Preamble

    In FR Doc. 2023-16249 of August 7, 2023 (88 FR 53200), make the 
following corrections:
    1. On page 53221, second column, third full paragraph:
    a. Second sentence that reads, ``We proposed adding the surgical 
option that allows 45 subcategory S42.2--codes for displaced fractures 
to be eligible for one of two orthopedic surgery categories.'' is 
corrected to read, ``We proposed adding the surgical option that allows 
46 subcategory S42.2--codes for displaced fractures to be eligible for 
one of two orthopedic surgery categories.''
    b. Fourth sentence that reads, ``We also proposed adding the 
surgical option to subcategory 46 M84.5--codes for pathological 
fractures to certain major weight-bearing bones to be eligible for one 
of two orthopedic surgery categories.'' is corrected to read, ``We also 
proposed adding the surgical option to subcategory 45 M84.5--codes for 
pathological fractures to certain major weight-bearing bones to be 
eligible for one of two orthopedic surgery categories.''

Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2024-07522 Filed 4-9-24; 8:45 am]
BILLING CODE 4120-01-P