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2022-01-27-MLNC



Date
2022-01-27
Subject
COVID-19: Tools to Determine if Vaccine Requirements Apply

 

Thursday, January 27, 2022

News

 * COVID-19: Tools to Determine if Vaccine Requirements Apply
 * COVID-19 Vaccine Codes: Pfizer Pre-Diluted Vaccine for Patients Ages 12+ &
   Third Dose for Immunocompromised Patients Ages 5–11
 * COVID-19: Vaccine Access in Long-term Care Settings
 * Medicare Diabetes Prevention Program: New for Calendar Year 2022

Claims, Pricers, & Codes

 * Acute Hospital Care at Home: New Occurrence Span Code and Revenue Code

MLN Matters® Articles

 * April 2022 Update to the Medicare Severity - Diagnosis Related Group (MS-DRG)
   Grouper and Medicare Code Editor (MCE) Version 39.1 for the International
   Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019
   Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding
   System (PCS) Codes for Introduction or Infusion of Therapeutics and Vaccines
   for COVID-19 Treatment
 * Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for
   Collection of Specimens
 * CY2022 Telehealth Update Medicare Physician Fee Schedule
 * Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and
   Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
 * Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation
   and Management Services, Teaching Physicians, & Physician Assistants
 * New Waived Tests

Publications

 * Home Infusion Therapy Services Monitoring Report

 


NEWS

 


COVID-19: TOOLS TO DETERMINE IF VACCINE REQUIREMENTS APPLY

In light of the recent Supreme Court ruling on January 13, 2022, employee
vaccination requirements from the Centers for Medicare & Medicaid Services (CMS)
now apply to certain Medicare or Medicaid providers and suppliers. Please see
below for new and updated tools and resources developed by CMS to help you
navigate and determine if these vaccine requirements apply to you. These
materials are all available from the CMS Current Emergencies page:

 * Guidance memo (cms.gov) – This memo provides guidance for assessing and
   maintaining compliance with this new regulatory requirement for certain
   Medicare and Medicaid providers and suppliers.
 * CMS Omnibus COVID-19 Health Care Staff Vaccination Requirements FAQ (PDF
   cms.gov) (PDF) – These FAQs have been updated to explain the recent ruling
   and how it impacts employee vaccination requirements.
 * IFC-6 Vaccination Requirements Infographic (cms.gov) (PDF) – This infographic
   visually shows the types of providers and suppliers the vaccine requirement
   applies to, how the requirement can be met, and associated requirement
   enforcement actions.
 * Vaccine Requirement Implementation Timeline (cms.gov) (PDF) – This
   infographic illustrates the phases of the vaccination rule implementation,
   state-by-state, and their associated deadlines. Note that the phased
   deadlines vary by state.
 * Vaccine Requirement Decision Tree (cms.gov) (PDF) – This handy decision tree
   visually explains the steps in determining to which providers and suppliers
   the vaccine requirement applies.

 


COVID-19 VACCINE CODES: PFIZER PRE-DILUTED VACCINE FOR PATIENTS AGES 12+ & THIRD
DOSE FOR IMMUNOCOMPROMISED PATIENTS AGES 5–11

On January 3, the FDA:

 * Authorized an additional pre-diluted formulation (gray cap) for patients 12
   years and older
 * Amended the Pfizer-BioNTech COVID-19 vaccine (PDF) emergency use
   authorization to allow for third pediatric doses (orange cap) for
   5–11-year-old solid organ transplant patients or patients with a similar
   level of immunocompromise

Get the most current list of billing codes, payment allowances, and effective
dates.

More Information:

 * COVID-19 provider toolkit
 * Vaccine payment rates
 * How to bill to administer vaccines

 


COVID-19: VACCINE ACCESS IN LONG-TERM CARE SETTINGS

The federal government is committed to ensuring that residents and staff in
long-term care settings, like nursing homes, assisted living, residential care
communities, group homes, and senior housing, have access to COVID-19 vaccines
to get primary series and booster shots.

We encourage long-term care providers to consider the option that works best for
their residents and staff when coordinating access to COVID-19 vaccines, either
in the local community or on-site. The CDC has additional details on these
options.

As a reminder, through enforcement discretion, CMS will allow Medicare-enrolled
immunizers, including but not limited to pharmacies working with the U.S., to
bill directly and get direct reimbursement from the Medicare program for
vaccinating Medicare skilled nursing facility residents. Find Medicare billing
and payment information.

 


MEDICARE DIABETES PREVENTION PROGRAM: NEW FOR CALENDAR YEAR 2022

The calendar year (CY) 2022 Physician Fee Schedule (PFS) final rule and
correction notice include information on the Medicare Diabetes Prevention
Program (MDPP) expanded model. The MDPP changes that went into effect January 1
include:

 * Shortening the MDPP services period to 1 year for patients who enrolled on or
   after January 1; the first core session date is the enrollment date
 * Redistributing all ongoing maintenance session payments to the first year
   with a focus on increasing attendance-based performance payments
 * Removing the ongoing maintenance session payments for patients whose first
   core session occurs on or after January 1
 * Maintaining the 2021 payment amounts for ongoing maintenance sessions for
   patients who started MDPP in 2021 or earlier and maintain 5% weight loss and
   attendance requirements; the first core session date is the enrollment date
 * Waiving the MDPP supplier enrollment fee

Find CY 2022 payment rates.

More Information:

 * See the official instruction to your Medicare Administrative Contractor (MAC)
   (PDF)
 * Find your MAC’s website
 * Final Policies for the MDPP Expanded Model for CY 2022 Medicare PFS fact
   sheet
 * MDPP webpage
 * Information for your patients

 


CLAIMS, PRICERS, & CODES

 


ACUTE HOSPITAL CARE AT HOME: NEW OCCURRENCE SPAN CODE AND REVENUE CODE

To track inpatient claims submitted for the Acute Hospital Care at Home program,
the National Uniform Billing Committee approved the following codes for claims
received on or after July 1, 2022:

 * Revenue Code 0161: Hospital at Home, R&B/Hospital at Home
 * Occurrence Span Code 82: Hospital at Home Care Dates

For more information, see the official instruction to your Medicare
Administrative Contractor (PDF).

 


MLN MATTERS® ARTICLES

 


APRIL 2022 UPDATE TO THE MEDICARE SEVERITY - DIAGNOSIS RELATED GROUP (MS-DRG)
GROUPER AND MEDICARE CODE EDITOR (MCE) VERSION 39.1 FOR THE INTERNATIONAL
CLASSIFICATION OF DISEASES, TENTH REVISION (ICD-10) DIAGNOSIS CODES FOR 2019
NOVEL CORONAVIRUS (COVID-19) VACCINATION STATUS AND ICD-10 PROCEDURE CODING
SYSTEM (PCS) CODES FOR INTRODUCTION OR INFUSION OF THERAPEUTICS AND VACCINES FOR
COVID-19 TREATMENT

Learn about new ICD-10 codes for COVID-19 (PDF):

 * Diagnosis codes for reporting vaccination status
 * Procedure codes for introducing or infusing therapeutics, including COVID-19
   vaccines
 * MCE edit for unspecified ICD-10-CM diagnosis codes

 


CLINICAL LABORATORY FEE SCHEDULE – MEDICARE TRAVEL ALLOWANCE FEES FOR COLLECTION
OF SPECIMENS

Learn about calendar year 2022 travel allowances (PDF):

 * Per mile
 * Flat rate

 


CY2022 TELEHEALTH UPDATE MEDICARE PHYSICIAN FEE SCHEDULE

Learn about telehealth billing changes, including (PDF):

 * 2 new modifiers
 * Telehealth services list update

 


HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODES SUBJECT TO AND EXCLUDED
FROM CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA) EDITS

Learn about new and discontinued HCPCS codes and those subject to and excluded
from CLIA edits. (PDF)

 


INTERNET-ONLY MANUAL UPDATES (IOM) FOR CRITICAL CARE, SPLIT/SHARED EVALUATION
AND MANAGEMENT SERVICES, TEACHING PHYSICIANS, & PHYSICIAN ASSISTANTS

CMS revised Medicare manuals (PDF) for:

 * Critical care services
 * Split (or shared) evaluation and management visits
 * Teaching physician services
 * Physician assistant billing and payment

 


NEW WAIVED TESTS

Learn about the latest waived tests approved by the FDA under the Clinical
Laboratory Improvement Amendments of 1988 (PDF).

 


PUBLICATIONS

 


HOME INFUSION THERAPY SERVICES MONITORING REPORT

Read the January 2022 Home Infusion Therapy (HIT) Monitoring Report (PDF) about
HIT benefit use from January 1, 2019–March 31, 2021, including:

 * Visits
 * Patients
 * Supplier organizations

More Information:

 * Home Infusion Therapy Services webpage
 * Email questions to HomeInfusionPolicy@cms.hhs.gov
 * Information for your patients

 

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