News

COVID-19: Updated Vaccines for Children Ages 6 Months – 5 Years

On December 8, 2022, the FDA amended the emergency use authorizations of the updated (bivalent) Pfizer-BioNTech and Moderna COVID-19 vaccines to include use in children down to 6 months old. Your patients may know these as “updated COVID-19 vaccines”:

Pfizer-BioNTech: all patients 6 months – 4 years old. Get important prescribing information.
Moderna: all patients 6 months – 5 years old. Get important prescribing information.

Use 4 new CPT codes effective December 8, 2022:

Code 91316 for Moderna COVID-19 Vaccine, Bivalent Product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 10MCG/0.2ML
Code 91317 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 3MCG/0.2ML
Code 0164A for Moderna COVID-19 Vaccine, Bivalent - Administration – Booster Dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, booster dose
- Short descriptor: ADM SRSCV2 BVL 10MCG/0.2ML B
Code 0173A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent - Administration – Third Dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose
- Short descriptor: ADM SARSCV2 BVL 3MCG/0.2ML 3

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.

Advisory Panel on Hospital Outpatient Payment: Request for Nominations

CMS seeks nominations to fill vacancies on the Advisory Panel on Hospital Outpatient Payment. The panel advises the HHS Secretary and CMS Administrator on specific aspects of the Hospital Outpatient Prospective Payment System (OPPS). Do you or someone you know meet the criteria?

Full-time employee of an OPPS hospital or health system participating in the OPPS
Minimum 5 years of expert experience

See the announcement for information on how to nominate someone for the panel.

Certificates of Medical Necessity & DME Information Forms Discontinued January 1

You don’t need to submit certificates of medical necessity (CMNs) and durable medical equipment (DME) information forms (DIFs) for claims with dates of service on or after January 1, 2023. If CMS gets a claim with a CMN or DIF, we’ll reject the claim and return it to you.

For services before January 1, 2023, continue to submit CMN and DIF forms if required.

See MLN Matters Article SE22002 (PDF) for more information.

Cervical Health: Encourage Screening

All women are at risk for cervical cancer, but it occurs most often in women over age 30 (see CDC fact sheet). Cervical Health Awareness Month is the perfect time to talk with your patients about cervical and vaginal cancer screenings.

Medicare covers:

Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these screenings. If you need help, contact your eligibility service provider.

More Information:

CDC Cervical Cancer
Cervical and vaginal cancer screenings: Get information for your patients

Claims, Pricers, & Codes

Home Oxygen: 3 New Claims Modifiers

CMS added 3 new modifiers for home oxygen use under national coverage determination (NCD) 240.2 to indicate the appropriate treatment regimen and presence of supporting documentation for each Medicare patient group:

Section B, Group I: modifier N1
Section B, Group II: modifier N2
Section D: modifier N3

Patients under NCD Section B, Group II and Section D have payment and recertification requirements that don’t apply to Group I. The new modifiers are effective January 1, 2023, and will be available in the April 2023 HCPCS code release.

Your Medicare Administrative Contractor will provide more details.

Home Health Prospective Payment System: CY 2023 Rural Add-on Policy

Section 4137 of the Consolidated Appropriations Act, 2023 extends the 1% rural add-on payment for home health periods and visits that end in CY 2023 for counties classified as ‘‘low population density.’’ CMS will increase the 30-day base payment rates by the 1% rural add-on before applying any case-mix and wage index adjustments. There are no changes to the fixed-dollar loss ratio, budget neutrality factors, or final base payment rates.

Skilled Nursing Facility Consolidated Billing: CY 2023 HCPCS Codes

Get updated HCPCS codes to accurately pay for Part A skilled nursing facility stays. See General Explanation of the Major Categories (PDF), including additional exclusions.

More Information: