2022 Part A MAC Update

2022 Part A MAC Update:

The SNF consolidated billing file reflects new codes that have been developed for 2022. In addition, the file reflects additions to categories of services excluded from consolidated billing.

The annual update file below contains the complete list of HCPCS codes that are excluded from SNF CB for claims submitted to Part A MACs for payment. This file is effective for claims with dates of service on or after 1/1/2022 unless otherwise noted below.

Major Category III. A. - Chemotherapy

ADD

J9010 ALEMTUZUMAB INJECTION

J9175 ELLIOTTS B SOLUTION PER ML

J9177 INJ ENFORT VEDO-EJFV 0.25MG

J9247 INJ, MELPHALAN FLUFENAMI 1MG

J9265 PACLITAXEL INJECTION

J9300 GEMTUZUMAB OZOGAMICIN INJ

J9309 INJ, POLATUZUMAB VEDOTIN 1MG

J9310 RITUXIMAB INJECTION

J9318 INJ ROMIDEPSIN NON-LYO 0.1MG

J9319 INJ ROMIDEPSIN LYOPHIL 0.1MG

J9348 INJ. NAXITAMAB-GQGK, 1 MG

J9349 INJ., TAFASITAMAB-CXIX

J9353 INJ. MARGETUXIMAB-CMKB, 5 MG

J9358 INJ FAM-TRASTU DERU-NXKI 1MG

DELETE

J9315 ROMIDEPSIN INJECTION
 

MAJOR CATEGORY III. D. - CUSTOMIZED PROSTHETIC DEVICES

ADD

L6711 PED TERM DEV, HOOK, VOL OPEN

L6712 PED TERM DEV, HOOK, VOL CLOS

L6713 PED TERM DEV, HAND, VOL OPEN

L6714 PED TERM DEV, HAND, VOL CLOS

L6721 HOOK/HAND, HVY DTY, VOL OPEN

L6722 HOOK/HAND, HVY DTY, VOL CLOS
 

MAJOR CATEGORY III. E. - CERTAIN BLOOD CLOTTING FACTORS INDICATED FOR THE TREATMENT OF HEMOPHILIA AND OTHER BLEEDING DISORDERS, AND ITEMS AND SERVICES RELATED TO THE FURNISHING OF SUCH FACTORS. (EFFECTIVE 10/1/2021)

ADD

J7170 INJ., EMICIZUMAB-KXWH 0.5 MG

J7175 INJ, FACTOR X, (HUMAN), 1IU

J7177 INJ., FIBRYGA, 1 MG

J7178 INJ HUMAN FIBRINOGEN CON NOS

J7179 VONVENDI INJ 1 IU VWF:RCO

J7180 FACTOR XIII ANTI-HEM FACTOR

J7181 FACTOR XIII RECOMB A-SUBUNIT

J7182 FACTOR VIII RECOMB NOVOEIGHT

J7183 WILATE INJECTION

J7185 XYNTHA INJ

J7186 ANTIHEMOPHILIC VIII/VWF COMP

J7187 HUMATE-P, INJ

J7188 FACTOR VIII RECOMB OBIZUR

J7189 FACTOR VIIA RECOMB NOVOSEVEN

J7190 FACTOR VIII

J7191 FACTOR VIII (PORCINE)

J7192 FACTOR VIII RECOMBINANT NOS

J7193 FACTOR IX NON-RECOMBINANT

J7194 FACTOR IX COMPLEX

J7195 FACTOR IX RECOMBINANT NOS

J7196 ANTITHROMBIN RECOMBINANT

J7197 ANTITHROMBIN III INJECTION

J7198 ANTI-INHIBITOR

J7199 HEMOPHILIA CLOT FACTOR NOC

J7200 FACTOR IX RECOMBINAN RIXUBIS

J7201 FACTOR IX ALPROLIX RECOMB

J7202 FACTOR IX IDELVION INJ

J7203 FACTOR IX RECOMB GLY REBINYN

J7204 "FACTOR VIII, RECOMB, ESPEROCT, GLYCOPEGYLATED-EXEI

J7205 FACTOR VIII FC FUSION RECOMB

J7207 FACTOR VIII PEGYLATED RECOMB

J7209 FACTOR VIII NUWIQ RECOMB 1IU

J7210 INJ, AFSTYLA, 1 I.U.

J7211 INJ, KOVALTRY, 1 I.U.

J7212 FACTOR VIIA RECOMB SEVENFACT
 

MAJOR CATEGORY IV. B. - VACCINES (PNEUMOCOCCAL, FLU OR HEPATITIS B OR COVID-19) (EFFECTIVE 9/20/21)

ADD

90630 FLU VACC IIV4 NO PRESERV ID

90653 IIV ADJUVANT VACCINE IM

90655 IIV3 VACC NO PRSV 0.25 ML IM

90661 CCIIV3 VAC NO PRSV 0.5 ML IM

90672 LAIV4 VACCINE INTRANASAL

90673 RIV3 VACCINE NO PRESERV IM

90677 PCV20 VACCINE IM

90682 RIV4 VACC RECOMBINANT DNA IM

90685 IIV4 VACC NO PRSV 0.25 ML IM

90686 IIV4 VACC NO PRSV 0.5 ML IM

90687 IIV4 VACCINE SPLT 0.25 ML IM

90688 IIV4 VACCINE SPLT 0.5 ML IM

90689 VACC IIV4 NO PRSRV 0.25ML IM

90694 VACC AIIV4 NO PRSRV 0.5ML IM

90732 PNEUMOCOCCAL VACC, ADULT/ILL

90756 CCIIV4 VACC ABX FREE IM

G0008 ADMIN INFLUENZA VIRUS VAC

G0009 ADMIN PNEUMOCOCCAL VACCINE

91300 SARSCOV2 VAC 30MCG/0.3ML IM

0001A ADM SARSCOV2 30MCG/0.3ML 1ST

0002A ADM SARSCOV2 30MCG/0.3ML 2ND

0003A ADM SARSCOV2 30MCG/0.3ML 3RD

0004A ADM SARSCOV2 30MCG/0.3ML BST

91301 SARSCOV2 VAC 100MCG/0.5ML IM

0011A ADM SARSCOV2 100MCG/0.5ML1ST

0012A ADM SARSCOV2 100MCG/0.5ML2ND

0013A ADM SARSCOV2 100MCG/0.5ML3RD

91302 SARSCOV2 VAC 5X10^10VP/.5MLIM

0021A ADM SARSCOV2 5X10^10VP/.5ML 1

0022A ADM SARSCOV2 5X10^10VP/.5ML 2

91303 SARSCOV2 VAC AD26 .5ML IM

0031A ADM SARSCOV2 VAC AD26 .5ML

91304 SARSCOV2 VAC 5MCG/0.5ML IM

0041A ADM SARSCOV2 5MCG/0.5ML 1ST

0042A ADM SARSCOV2 5MCG/0.5ML 2ND

91305 SARSCOV2 VAC 30 MCG TRS-SUCR

0051A ADM SARSCV2 30MCG TRS-SUCR 1

0052A ADM SARSCV2 30MCG TRS-SUCR 2

0053A ADM SARSCV2 30MCG TRS-SUCR 3

0054A ADM SARSCV2 30MCG TRS-SUCR B

91306 SARSCOV2 VAC 50MCG/0.25ML IM

0064A ADM SARSCOV2 50MCG/0.25MLBST

DELETE

G9142 INFLUENZA A H1N1, VACCINE