2022-07-14-MLNC

Date
2022-07-14
Title
COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits

Thursday, July 14, 2022

 

News

Compliance

Claims, Pricers, & Codes

Events

Information for Patients

 

 

News

 

COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits

The FDA issued an emergency use authorization (EUA) for PAXLOVID (nirmatrelvir co-packaged with ritonavir) for the treatment of mild-to-moderate COVID-19 in certain adults and pediatric patients at high risk for progression to severe COVID-19, including hospitalization or death. On July 6, the FDA revised the EUA to let pharmacists prescribe and dispense PAXLOVID to eligible patients without seeing a doctor or other clinician.

More Information:

 

COVID-19: Moderna Vaccines for Children as Young as 6 Months — New Codes

The FDA amended the Moderna COVID-19 vaccine emergency use authorization (PDF) to authorize use for all patients 6 months – 17 years old.

CMS issued 7 new CPT codes effective June 17, 2022:

Code 91311 for vaccine product:

  • Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use
  • Short descriptor: SARSCOV2 VAC 25MCG/0.25ML IM

Code 0111A for vaccine administration, first 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, preservative free, 25 mcg/0.25 mL dosage; first dose
  • Short descriptor: ADM SARSCOV2 25MCG/0.25ML1ST

Code 0112A for vaccine administration, second 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, preservative free, 25 mcg/0.25 mL dosage; second dose
  • Short descriptor: ADM SARSCOV2 25MCG/0.25ML2ND

Code 0113A for vaccine 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, spike protein, preservative free, 25 mcg/0.25 mL dosage; third dose
  • Short descriptor: ADM SARSCOV2 25MCG/0.25ML3RD

Code 0091A for vaccine administration, first 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, preservative free, 50 mcg/0.5 mL dosage; first dose, when administered to individuals 6 through 11 years
  • Short descriptor: ADM SARSCOV2 50 MCG/.5 ML1ST

Code 0092A for vaccine administration, second 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, preservative free, 50 mcg/0.5 mL dosage; second dose, when administered to individuals 6 through 11 years
  • Short descriptor: ADM SARSCOV2 50 MCG/.5 ML2ND

Code 0093A for vaccine 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, spike protein, preservative free, 50 mcg/0.5 mL dosage; third dose, when administered to individuals 6 through 11 years
  • Short descriptor: ADM SARSCOV2 50 MCG/.5 ML3RD

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.

 

Establishing the Framework for Health Equity at CMS

CMS is the nation’s largest health insurer and has a critical role in driving improvements in health equity over the next decade. As CMS continues to lead the way to a more equitable health care system, we are taking another bold step in asserting our commitment to move our health care system from disparities to equity, through the release of the CMS Framework for Health Equity. 

Read the full blog.

 

Post-Acute Care Report to Congress: Prototype Unified Payment for Medicare

On July 1, CMS issued a prototype for a unified post-acute care (PAC) prospective payment system in a Report to Congress (PDF), required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The report includes a prototype unified case mix methodology using standardized patient assessment data collected from the 4 Medicare PAC settings: inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and long-term care hospitals.

More Information:

 

Long Term Care Facilities: Nursing Home Five Star Rating Changes

With the July 2022 Care Compare refresh, CMS revised the Nursing Home Five Star Quality Rating System to include weekend staffing and staff turnover measures.

More Information:

 

Program for Evaluating Payment Patterns Electronic Reports for Home Health Agencies & Partial Hospitalization Programs

CMS released fourth quarter calendar year 2021 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for home health agencies and partial hospitalization programs. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. Use the data to support internal auditing and monitoring activities.

More Information:

 

Home Health Quality Reporting Program: Final OASIS Data Specifications

Home health agencies: Use the Outcome and Assessment Information Set (OASIS) Data Submission Specifications Version 3.00.1 (ZIP) for the OASIS-E item set effective January 1, 2023. 

More Information:

 

Compliance

 

Collaborative Patient Care is a Provider Partnership

Learn about coverage criteria and documentation when you partner with others to care for your patient (PDF):

  • If you don’t provide enough information to support medical necessity when you refer or write orders, the other provider or supplier may not get paid, which can cause delays or no treatment for your patient
  • You must provide documentation and information to other health care providers to support their claims
  • You can give protected health information, without patient authorization, to other health care providers covered under the privacy rule to carry out treatment, payment, or health care operations

 

Claims, Pricers, & Codes

 

Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759

CMS pays for the new Hepatitis B vaccine provided on after January 11, 2022. Starting July 5, we process claims for HCPCS code 90759 and price the vaccine per the average sales price drug pricing file. Coinsurance and deductible don’t apply.

See the instruction to your Medicare Administrative Contractor (PDF).

 

HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals

CMS published the second quarter 2022 HCPCS Level II Application Summary and Coding Decisions for Drugs and Biologicals (PDF).

Visit the HCPCS Level II Coding Decisions webpage for more information.

 

New Edit for Prospective Payment System (PPS) Outpatient and Inpatient Bill Types Receiving an Outlier Payment When a Device Credit is Reported

Effective January 1, 2023, CMS will suspend outpatient and inpatient prospective payment system claims getting an outlier payment when a device credit is reported. This will allow Medicare Administrative Contractors (MACs) to review the charges and device reduction amounts for fully or partially credited devices. There’s no policy change.

See the instruction to your MAC (PDF).

 

Events

 

Medicare Ground Ambulance Data Collection System Webinar: Allocating Expenses & Revenue — July 21

Thursday, July 21 from 2–3 pm ET

Register for this webinar.

CMS will cover approaches to allocate expenses and revenue when reporting information to the Medicare Ground Ambulance Data Collection System.

While everyone is welcome to listen in and participate, the target audience is ground ambulance organizations:

  • Fire, police, and other public safety department-based  
  • Medicare providers such as hospitals
  • Providers and suppliers of other services such as non-medical transport, community paramedicine, and air ambulance

The target audience also includes ground ambulance organizations operated by:

  • Municipal governments
  • Parent organizations billing under multiple NPIs

A Q&A session will follow the presentation. You may send questions in advance to AmbulanceDataCollection@cms.hhs.gov with “July 21 Allocation Webinar” in the subject line. During the webinar, we’ll answer these and live questions from the chat box.

More Information:

 

Information for Patients

 

Affordable Connectivity Program Lowers Cost of Broadband Services for Eligible Households

CMS is working to help build awareness about the Affordable Connectivity Program (ACP), a Federal Communications Commission program. Your patients who use telehealth services might ask you about the new long-term benefit to help lower the cost of broadband service for eligible households struggling to afford internet service.

The ACP provides:

  • Up to $30/month discount for broadband service
  • Up to $75/month discount for households on qualifying tribal lands
  • One-time discount of up to $100 for a laptop, desktop computer, or tablet purchased through a participating provider if the household contributes more than $10 but less than $50 toward the purchase price

The ACP is limited to 1 monthly service discount and 1 device discount per household.

Who’s Eligible?

Your patient’s household is eligible for the ACP if the household income is at or below 200% of the Federal Poverty Guidelines or if a member of the household meets at least 1 of the criteria outlined at fcc.gov/acp.

Your patients can enroll in 2 steps by:

  1. Going to ACPBenefit.org to apply or print a mail-in application
  2. Contacting their preferred participating ACP provider to select a plan, and they’ll apply the discount to the patient’s bill

Some ACP providers may ask your patients to complete an alternative application. Eligible households must apply for the program, and contact a participating provider to select a service plan.

More Information:

 

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