Thursday, March 30, 2023
- COVID-19: Booster Dose for Children 6 months – 4 years
- Identity & Access Management System: Easier for Surrogates
- Medicare Advantage Value-Based Insurance Design Model Extended
- Supplemental Security Income & Medicare Beneficiary Data: FY 2021
- DMEPOS for Skilled Nursing Facility: Pre-Discharge Delivery for Fitting & Training
- COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency
- April 2023 Quarterly Pricing File Revisions
- Medicare Part B Coverage of Pneumococcal Vaccinations
- Supervision Requirements for Diagnostic Tests: Manual Update
- Post-Acute Care Quality Reporting Program: Videos & Patient Cue Cards
- Expanded Home Health Value-Based Purchasing Model: March Newsletter, FAQs, & Recordings
News
COVID-19: Booster Dose for Children 6 months – 4 years
On March 14, 2023, the FDA amended the emergency use authorization of the updated (bivalent) Pfizer-BioNTech COVID-19 vaccine to include a single booster dose of the vaccine in children 6 months – 4 years old at least 2 months after completion of primary vaccination with 3 doses of the monovalent (single strain) Pfizer-BioNTech COVID-19 vaccine.
Effective March 14, 2023, use new CPT code 0174A for Pfizer-BioNTech 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, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose
- Short descriptor: ADM SARSCV2 BVL 3MCG/0.2ML B
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.
Identity & Access Management System: Easier for Surrogates
Do you access, view, and modify information for providers in NPPES and PECOS? You can now request connection with multiple providers at the same time in the Identity & Access Management (I&A) System. Learn more in the I&A System Quick Reference Guide.
Medicare Advantage Value-Based Insurance Design Model Extended
CMS extended the Medicare Advantage Value-Based Insurance Design Model for CY 2025–2030. We’ll make changes to address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.
For more information, see Medicare Advantage Value-Based Insurance Design Model, or email VBID@cms.hhs.gov.
Supplemental Security Income & Medicare Beneficiary Data: FY 2021
Get FY 2021 supplemental security income and Medicare beneficiary data for:
- Inpatient Prospective Payment System hospitals
- Inpatient rehabilitation facilities
- Long-term care hospitals
See the instruction to your Medicare Administrative Contractor (PDF).
DMEPOS for Skilled Nursing Facility: Pre-Discharge Delivery for Fitting & Training
The pre-discharge delivery instructions in Section 110.3 of the Medicare Claims Processing Manual, Chapter 20 (PDF) don’t apply to customized prosthetics excluded from skilled nursing facility consolidated billing. These items may be billed separately during the skilled nursing stay.
See the instruction to your Medicare Administrative Contractor (PDF).
Claims, Pricers, & Codes
COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency
The end of the COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023.
Skilled Nursing Facility & Swing Bed Providers
For benefit period and qualifying stay waivers, submit condition code DR for inpatient claims with admission dates before May 12, 2023.
For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38 (PDF).
April 2023 Quarterly Pricing File Revisions
See revisions to the April Average Sales Price public file.
Revisions to the April OPPS Addendum B public file and April ASC public file will be available in the next few days.
More Information:
MLN Matters® Articles
Medicare Part B Coverage of Pneumococcal Vaccinations
Learn about coverage updates (PDF).
Supervision Requirements for Diagnostic Tests: Manual Update
Learn about updates to the Medicare Benefit Policy Manual (PDF), including an expanded list of provider types authorized to supervise diagnostic tests.
Publications & Multimedia
Post-Acute Care Quality Reporting Program: Videos & Patient Cue Cards
Watch short videos to learn how to code patient assessment instruments for the following Post-Acute Care Quality Reporting Programs:
- Long-term care hospital (LTCH), inpatient rehabilitation facility (IRF), home health (HH), and skilled nursing facility (SNF): GG0170C. Lying to Sitting on Side of Bed
- LTCH & IRF: Transfer of Health Items
- LTCH: GG0170L. Walking 10 Feet on Uneven Surfaces and GG0170P. Picking Up Object
Help LTCH, IRF, and HH patients select responses by showing them the new cue cards for:
- Administration of the Brief Interview for Mental Status in Writing (PDF)
- PHQ-2 to 9 (PDF)
- Pain Interview (PDF)
See LTCH, IRF, HH, and SNF Quality Reporting Program Training for more information.
Expanded Home Health Value-Based Purchasing Model: March Newsletter, FAQs, & Recordings
Get the latest information on the Expanded Home Health Value-Based Purchasing Model, including:
- March Newsletter
- FAQs
- Essentials Module Refresh recordings:
Information for Patients
States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now
Share the Renew Your Medicaid or CHIP Coverage flyer (PDF) with your Medicaid and Children’s Health Insurance Program (CHIP) patients.
Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.
Here are 3 things your patients with Medicaid or CHIP can do to prepare:
- Make sure their state has their current contact information
- Check the mail for a letter about their Medicaid or CHIP coverage
- Complete their renewal form right away (if they get one)
Related Resources:
- Renew Your Medicaid or CHIP Coverage
- Medicaid and CHIP Continuous Enrollment Unwinding: A Communications Toolkit
- Marketplace Temporary Special Enrollment Period FAQs (PDF)
- Unwinding and Returning to Regular Operations after COVID-19
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