- 988 Suicide & Crisis Lifeline Available Nationwide
- COVID-19: Novavax Vaccine, Adjuvanted — New Codes
- Allergy & Immunology: Comparative Billing Report in July
- Inpatient Rehabilitation Facilities: Care Compare July Refresh
- Long-Term Care Hospitals: Care Compare July Refresh
- Hospices & Home Health Agencies: Submit Technical Expert Panel Nominations by August 12
- Skilled Nursing Facility Provider Preview Reports: Review by August 15
- Opioid Treatment Programs: Comment by September 6
News
988 Suicide & Crisis Lifeline Available Nationwide
Anyone experiencing a mental health crisis, including substance use crisis or thoughts of suicide, can get confidential support 24/7 by calling 988 or visiting 988lifeline.org. Visit the Substance Abuse and Mental Health Administration 988 Partner Toolkit for information and resources.
COVID-19: Novavax Vaccine, Adjuvanted — New Codes
The FDA authorized emergency use of the Novavax COVID-19 vaccine, Adjuvanted for the prevention of COVID-19 disease in patients 18 years and older.
CMS issued 3 new CPT codes effective July 13, 2022:
Code 91304 for vaccine product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC 5MCG/0.5ML IM
Code 0041A for vaccine administration, first dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; first dose
- Short descriptor: ADM SARSCOV2 5MCG/0.5ML 1ST
Code 0042A for vaccine administration, second dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; second dose
- Short descriptor: ADM SARSCOV2 5MCG/0.5ML 2ND
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.
Allergy & Immunology: Comparative Billing Report in July
In late July, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for allergy and immunology. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.
CBRs aren’t publicly available. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your email address in PECOS to make sure you get it.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on August 10 from 3–4 pm ET
Inpatient Rehabilitation Facilities: Care Compare July Refresh
View the July refresh of Inpatient Rehabilitation Facility Quality Reporting Program data on the Care Compare webpage and in the Provider Data Catalog.
Visit the Updates section of the Public Reporting webpage to learn more.
Long-Term Care Hospitals: Care Compare July Refresh
View the July refresh of Long-term Care Hospital Quality Reporting Program data on the Care Compare webpage and in the Provider Data Catalog.
Visit the Updates section of the Public Reporting webpage to learn more.
Hospices & Home Health Agencies: Submit Technical Expert Panel Nominations by August 12
CMS wants input on a proposed health equity structural composite measure for hospice and home health care settings. Visit the Current Technical Expert Panel Opportunities webpage to submit a nomination, or learn more.
Skilled Nursing Facility Provider Preview Reports: Review by August 15
Review your data by August 15, and contact CMS if you have questions about your scores. We’ll publish the data on the Care Compare webpage and in the Provider Data Catalog in October.
Visit the Updates section of the Public Reporting webpage for more information.
Opioid Treatment Programs: Comment by September 6
CMS issued the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule that includes proposals to strengthen Opioid Treatment Program (OTP) policies. See a summary of key provisions.
Proposals include:
- Revising pricing methodology for drug component of methadone weekly bundle and add-on code for take-home methadone supplies
- Modifying payment rate for individual therapy in non-drug component of the bundled payments for episodes of care
- Allowing OTP intake add-on code to initiate treatment with buprenorphine provided via 2-way audio-video communications technology or audio-only technology when audio-video technology isn’t available and all requirements are met
- Clarifying OTPs can bill for medically reasonable and necessary services provided via mobile units
We encourage you to review the rule, and submit formal comments by September 6, 2022.
Compliance
Implanted Spinal Neurostimulators: Document Medical Records
In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.
Learn what you need to include in patient medical records:
- Prior Authorization and Pre-Claim Review Initiatives webpage
- Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
- Section 6.3.2.2 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
- 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
Information for Patients
Medicare Savings Programs Help Pay Premiums
Do you have low-income patients with limited resources? If they meet certain conditions, they can get help paying their Medicare premiums from the state. Visit the Medicare Savings Programs webpage for income and resource limits and information on how to apply.
Learn about the 4 programs:
- Qualified Medicare Beneficiary (QMB) Program: Pays Part A and Part B premiums, deductibles, coinsurance, and copayments. Providers can’t bill QMB patients for Medicare cost-sharing.
- Specified Low-Income Medicare Beneficiary Program: Pays only the Part B premiums.
- Qualifying Individual Program: Pays only Part B premium (individuals enrolled in this program have no other Medicaid eligibility).
- Qualified Disabled and Working Individuals Program: Pays only Part A premium for certain individuals under age 65 with disabilities who have returned to work.
See the Beneficiaries Dually Eligible for Medicare & Medicaid (PDF) booklet for more information.
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