Thursday, June 17, 2021
- COVID-19: EUA for Sotrovimab Monoclonal Antibody Product
- COVID-19: EUA for Regeneron Monoclonal Antibody Product Casirivimab & Imdevimab
- Men’s Health: Medicare Covers Preventive Services
- Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 0240U, 0241U, and 87637
- Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2021
- Quarterly Update to Home Health (HH) Grouper
- July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files — Revised
- Medicare Mental Health — Revised
- Medicare Secondary Payer — Revised
- Skilled Nursing Facility 3-Day Rule Billing — Revised
View this edition as PDF (PDF)
News
COVID-19: EUA for Sotrovimab Monoclonal Antibody Product
On May 26, the FDA released an Emergency Use Authorization (EUA) for sotrovimab, a COVID-19 monoclonal antibody product. CMS created new HCPCS codes, effective May 26, for sotrovimab and to administer sotrovimab in health care settings and the home:
Q0247:
- Long descriptor: Injection, sotrovimab, 500 mg
- Short descriptor: Sotrovimab
- Price: The government won’t provide this drug for free; visit the COVID-19 Vaccines and Monoclonal Antibodies webpage for pricing information (available soon)
M0247:
- Long Descriptor: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
- Short Descriptor: Sotrovimab infusion
- Price: $450.00 per infusion
M0248:
- Long Descriptor: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency
- Short Descriptor: Sotrovimab inf, home admin
- Price: $750.00 per infusion
More Information:
COVID-19: EUA for Regeneron Monoclonal Antibody Product Casirivimab & Imdevimab
On June 3, the FDA released a revised Emergency Use Authorization (EUA) for Regeneron’s COVID-19 monoclonal antibody combination product casirivimab and imdevimab. The updated EUA includes a new dosing regimen (1200 mg vs. 2400 mg) and allows a new route of administration. In response to this change, CMS created a new HCPCS code, effective June 3, and updated the short and long code descriptors for 2 codes:
New HCPCS Code Q0244:
- Long descriptor: Injection, casirivimab and imdevimab, 1200 mg
- Short descriptor: Casirivi and imdevi 1200 mg
- Price: $0.01
Updated HCPCS Code M0243:
- Long descriptor: *Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring*
- Short descriptor: *Casirivi and imdevi inj*
- Price: $450
Updated HCPCS Code M0244:
- Long descriptor: *Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency*
- Short descriptor: *Casirivi and imdevi inj hm*
- Price: $750
When the government provides monoclonal antibody products to treat COVID-19 for free, you should only bill for the administration. Don’t include the monoclonal antibody product codes on the claim.
More Information:
Men’s Health: Medicare Covers Preventive Services
Medicare covers preventive services, and your patients pay nothing if you accept assignment. During Men’s Health Week, encourage your male patients to make their health a priority.
More Information:
- Medicare Preventive Services educational tool
- Preventive Services webpage
- Men’s Health Week webpage
- Information for your patients on preventive and screening services
Compliance
Hospice Care: Safeguards for Medicare Patients
An Office of Inspector General report focused on hospice:
- Quality of care and common deficiencies
- Instances of patient harm and vulnerabilities
Review the Safeguards for Medicare Patients in Hospice Care (PDF) fact sheet to recognize and address deficiencies in care and protect your patients from harm. Additional resources:
- Medicare Claims Processing Manual, Chapter 11 (PDF), Section 30.1
- Eldercare Locator website
- Contact Information for Filing a Complaint with the State Survey Agency (PDF)
Events
HCPCS Public Meeting — Begins July 7
July 7 and 8 (July 9 if needed)
Attend a virtual public meeting for the first 2021 biannual HCPCS coding cycle. Visit the HCPCS Public Meetings webpage for more information, including meeting materials:
MLN Matters® Articles
Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 0240U, 0241U, and 87637
Learn about this change for COVID-19 laboratory service claims (PDF).
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2021
Learn about changes to HCPCS codes, ZIP codes, and single payment amounts (PDF).
Quarterly Update to Home Health (HH) Grouper
Learn about annual diagnosis code changes (PDF).
July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files — Revised
Read additional information on Section 405 of the Consolidated Appropriations Act, 2021 (PDF).
Publications
Medicare Mental Health — Revised
Medicare Mental Health (PDF) Medicare Learning Network booklet: Clarified nurse practitioner coverage requirements.
Medicare Secondary Payer — Revised
Medicare Secondary Payer (PDF) Medicare Learning Network booklet: Clarified policy on accepting payment for services if another insurer is primary.
Skilled Nursing Facility 3-Day Rule Billing — Revised
Skilled Nursing Facility 3-Day Rule Billing (PDF) Medicare Learning Network fact sheet: Added information on temporary emergency coverage without a qualifying hospital stay due to the COVID-19 public health emergency.
Multimedia
World of Medicare Web-Based Training — Revised
World of Medicare Medicare Learning Network (MLN) web-based training course: Learn about:
- Parts A, B, C, and D
- Patient eligibility, enrollment, and benefit options
- Role of providers, agencies, contractors, and organizations
- Steps to enroll as a Medicare provider
Visit the MLN Web-Based Training webpage for a current list of courses.
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