Thursday, October 27, 2022
- COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11
- Oversight of Nation’s Poorest-Performing Nursing Homes
- Initial Nursing Facility Evaluation & Management Visits: Comparative Billing Report in October
- Help Promote Efficiency, Reduce Burden, & Advance Equity: Submit Comments by November 4
- Extension of Changes to the Low-Volume Hospital Payment Adjustment and the Medicare Dependent Hospital Program
- Patient Driven Payment Model: Claim Edit Enhancements
News
COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11
The CDC recently expanded the use of updated (bivalent) COVID-19 vaccines to children ages 5 through 11 years. This followed the FDA’s authorization of updated COVID-19 vaccines from Pfizer-BioNTech for children ages 5 through 11 years and from Moderna for children and adolescents ages 6 through 17 years. People with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines.
CMS issued 4 new CPT codes effective October 12, 2022:
Code 91314 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, 25 mcg/0.25 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 25MCG/.25ML
Code 91315 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 10MCG/0.2ML
Code 0144A 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, 25 mcg/0.25 mL dosage, booster dose
- Short descriptor: ADM SRSCV2 BVL 25MCG/.25ML B
Code 0154A 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose
- Short descriptor: ADM SARSCV2 BVL 10MCG/.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.
See the full news alert.
Oversight of Nation’s Poorest-Performing Nursing Homes
Changes to CMS’ Special Focus Facilities program will increase scrutiny, hold facilities accountable for substandard safety and quality, and improve care for residents.
For more information, see the full press release.
Initial Nursing Facility Evaluation & Management Visits: Comparative Billing Report in October
In late October, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for initial nursing facility evaluation and management visits. Use the data-driven report to compare your billing practices with those of your peers in your state and across the nation.
Look for an email from cbrpepper.noreply@religroupinc.com to access your report.
More Information:
- View a webinar recording
- Visit the CBR webpage
- Register for a live webinar on November 9 from 3–4 pm ET
Help Promote Efficiency, Reduce Burden, & Advance Equity: Submit Comments by November 4
CMS released the “Make Your Voice Heard” Request for Information to get your input. Share your health care experience by commenting before the November 4 deadline.
We want to:
- Understand your experience, including factors that affect provider wellness
- Learn about strategies that successfully address drivers of health inequities
- Assess the impact of waivers and flexibilities provided in response to the COVID-19 public health emergency
We encourage comments from all interested individuals and institutions, in particular:
- Individuals serving and located in underserved communities
- All CMS stakeholders serving populations facing disparities in health and health care
More Information:
MLN Matters® Articles
Extension of Changes to the Low-Volume Hospital Payment Adjustment and the Medicare Dependent Hospital Program
CMS implemented the extension of these temporary changes (PDF) through December 16, 2022. Learn how this affects you:
- Send a written request to your Medicare Administrative Contractor by November 16 to get the applicable low-volume hospital payment adjustment
- Find out if you’re eligible for continued Medicare dependent hospital status
Patient Driven Payment Model: Claim Edit Enhancements
Learn about changes to skilled nursing facility (SNF) billing (PDF):
- Corrected SNF Type of Bill 21X claims edits
- Changed certain hospital overlap edits
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