CMS
PUBLIC HEALTH EMERGENCY EXTENDED THROUGH MID JANUARY
October 18, 2021
The Department of Health and Human Services has once again renewed the determination that a Public Health Emergency (PHE) exists. Linked below is the Renewal Notice. The PHE has now been extended through mid-January 2022. Until further notice, waivers that have been in place since January 2020 will remain in place. For more information on the latest renewal, click here.
COVID-19 CODE ADDITIONS: BILLING FOR VACCINES
August 12, 2021
Effective August 12, 2021, CMS will now pay to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs. CPT code 0003A is for the Pfizer vaccine and CPT code 0013A is for the Moderna vaccine.
ABILITY has added the following code sets for customers to bill for COVID-19 services. These codes apply to ABILITY CHOICE® All Payer, ABILITY CHOICE® All Payer Claims, ABILITY EASE® All-Payer and ABILITY PC-ACE applications.
| CODE | CPT SHORT DESCRIPTOR | VACCINE/PROCEDURE NAME | EFFECTIVE DATES |
|---|---|---|---|
| 0003A | ADM SARSCOV2 30MCG/0.3ML 3RD Pfizer | 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, 30 mcg/0.3 mL dosage, diluent reconstituted: third dose | 8.12.21 |
| 0013A | ADM SARSCOV2 100MCG/0.5ML3RD Moderna | 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, 100 mcg/0.5 mL dosage; third dose | 8.12.21 |
COVID-19 CODE ADDITIONS: EUA FOR TOCILIZUMAB MONOCLONAL ANTIBODY PRODUCT (Q0249, M0249, M0250)
June 24, 2021
ABILITY has added the following code sets for customers to bill for COVID-19 services.
These codes apply to ABILITY CHOICE All Payer (EAP Platform), ABILITY CHOICE All Payer Claims (APC), ABILITY EASE All-Payer, and *PC-ACE applications.
| CODE | CPT SHORT DESCRIPTOR | VACCINE/PROCEDURE NAME | EFFECTIVE DATES |
|---|---|---|---|
| Q0249 | Tocilizumab for covid-19 | Long descriptor: Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg | 6.24.21-TBD |
| M0249 | Adm tocilizu covid-19 1st | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose | 6.24.21-TBD |
| M0250 | Adm tocilizu covid-19 2nd | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose | 6.24.21-TBD |
*PC-ACE will reflect these codes on October 1, 2021 within the application release.
**Billing Note: You can’t use the Roster Bill form to report multiple units or infusions. Submit individual claims for the tocilizumab product and infusions when reporting multiple units of the product and/or the first and second infusions.
NEW COVID VACCINE RULES FOR LONG-TERM FACILITIES
June 22, 2021
Long-term care facilities now must provide weekly reports of staff and resident COVID-19 vaccinations to the Centers for Disease Control and Prevention’s National Healthcare Safety Network, according to an interim rule announced by the Centers for Medicare & Medicaid Services. The rule also requires that all facilities have programs in place to provide COVID-19 vaccinations to all residents and staff who wish to be vaccinated and to educate residents and staff on the benefits of COVID-19 vaccination.
The new reporting requirements are added to the existing requirements to report COVID-19 testing, cases and deaths. The reporting protocol is similar to requirements for influenza and pneumococcal vaccinations in long-term care facilities. The new interim rule also applies to intermediate-care facilities for individuals with intellectual disabilities.
More information about the interim rule can be found in the CMS announcement.
01.06.2021 COVID-19 CODE ADDITIONS
ABILITY has added the following code sets for customers to bill for COVID-19 services.
These codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE applications.
| CODE | CPT SHORT DESCRIPTOR | LABELER NAME | VACCINE/PROCEDURE NAME | EFFECTIVE DATES |
|---|---|---|---|---|
| Q0239 | bamlanivimab-xxxx | Eli Lilly | Injection, bamlanivimab, 700 mg | 11.10.2020 – TBD |
| M0239 | bamlanivimab-xxxx infusion | Eli Lilly | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring | 11.10.2020 – TBD |
| Q0243 | casirivimab and imdevimab | Regeneron | Injection, casirivimab and imdevimab, 2400 mg | 11.21.2020 – TBD |
| M0243 | casirivi and imdevi infusion | Regeneron | intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring | 11.21.2020 – TBD |
| CODE | CPT SHORT DESCRIPTOR | LABELER NAME | VACCINE/PROCEDURE NAME | EFFECTIVE DATES |
|---|---|---|---|---|
| 91300 | SARSCOV2 VAC 30MCG/0.3ML IM | Pfizer | Pfizer-Biontech Covid-19 Vaccine | 12.11.2020 – TBD |
| 0001A | ADM SARSCOV2 30MCG/0.3ML 1ST | Pfizer | Pfizer-Biontech Covid-19 Vaccine Administration – First Dose | 12.11.2020 – TBD |
| 0002A | ADM SARSCOV2 30MCG/0.3ML 2ND | Pfizer | Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose | 12.11.2020 – TBD |
| 91301 | SARSCOV2 VAC 100MCG/0.5ML IM | Moderna | Moderna Covid-19 Vaccine | 12.18.2020 – TBD |
| 0011A | ADM SARSCOV2 100MCG/0.5ML1ST | Moderna | Moderna Covid-19 Vaccine Administration – First Dose | 12.18.2020 – TBD |
| 0012A | ADM SARSCOV2 100MCG/0.5ML2ND | Moderna | Moderna Covid-19 Vaccine Administration – Second Dose | 12.18.2020 – TBD |
Additional information can be found on the Centers for Medicare & Medicaid Services (CMS) website by clicking here.
CMS PUBLISHES BILLING INFO FOR COVID-19 VACCINE ADMINISTRATION
The Centers for Medicare & Medicaid Services (CMS) published billing guidelines for providers administering COVID-19 vaccinations. Essentially, while the vaccine is provided for free to patients and providers, you can mitigate costs by claiming reimbursement for vaccine administration. And you can do it in one of two ways:
- Single claims
- Roster billing
Unlike previous instances in which vaccines and other medications were covered by Medicare, you will not include the vaccine codes in your claims. For more information on how to get paid for COVID-19 vaccine administration, visit CMS’s info page on Medicare billing for COVID-19 vaccine shots.
CMS FINALIZES THE HOSPITAL PRICE TRANSPARENCY RULE
Hospital patients will soon have more control over their care. The Centers for Medicare & Medicaid Services (CMS) announced that the Hospital Price Transparency rule, created to empower patients and facilitate patient-driven healthcare, goes into effect January 1, 2021.
Under this rule, hospitals will be required to establish, update and make public an annual list of the hospital’s standard charges for items and services. In simple terms, it means patients will be able to more accurately estimate the cost of a hospital stay before they check in. It also allows patients to evaluate hospitals based on both quality and price.
The four main parts of this final rule include:
- Formal definitions of “hospital,” “standard charges,” and “items and services”
- Requirements for making information accessible to patients online
- Communicating payer-specific negotiated charges, cash discounts, and other items affecting pricing
- How hospitals will be monitored and/or penalized for noncompliance
Is your organization ready for the change? For more information on the rule and the requirements for compliance, visit the CMS information page.
CMS ACCELERATED AND ADVANCE PAYMENTS
UPDATE 12.21.2020
The Centers for Medicare & Medicaid Services (CMS) announced the amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program.
Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will begin a year from the date of the provider or supplier’s payment. Previously, providers were to begin making repayments in August.
A recent CMS Newsroom article indicates that “after the first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.”
Click here to view an updated fact sheet on the Accelerated and Advance Payment Programs.
UPDATE 12.01.2020
ABILITY has added the following code sets for customers to bill for COVID-19 services:
87636: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
87637: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
These code updates apply specifically to the ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE applications.
Additional information can be found on the American Medical Association site by clicking here and here.
UPDATE 8.24.2020
CMS announces resumption of routine inspections of all providers and suppliers, issues updated enforcement guidance to states and posts toolkit to assist nursing homes
Click here to view the press release from CMS.
8.24.2020 CODE ADDITIONS
The following new codes have been added (or are in the process of being added):
| EFFECTIVE DATE | CODE | CODE TYPE | DESCRIPTION |
|---|---|---|---|
| 4/10/2020 | 86318 | CPT | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip) |
| 8/10/2020 | 86408 | CPT | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen |
| 8/10/2020 | 86409 | CPT | SARS-CoV-2 neutralizing antibody screen for SARS-CoV-2 neutralizing antibody titer |
| 4/10/2020 | 86602 | CPT | Actinomyces antibody |
| 4/10/2020 | 86635 | CPT | Coccidioides antibody; for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] |
| 6/25/2020 | 87426 | CPT | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) |
| 5/20/2020 | 0202U | HCPC | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected |
| 6/25/2020 | 0223U | HCPC | Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected |
| 6/25/2020 | 0224U | HCPC | Antibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed |
| 8/10/2020 | 0225U | HCPC | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected |
| 8/10/2020 | 0226U | HCPC | Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum |
| 4/1/2020 | G2061 | HCPC | Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes |
| 4/1/2020 | G2062 | HCPC | Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes |
| 4/1/2020 | G2063 | HCPC | Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes. |
UPDATE 8.3.2020
CMS to restart Medicare claims audits of healthcare providers on August 3
Months after suspending routine audits of Medicare claims due to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) will resume the practice August 3. Providers selected for review should discuss with their contractor any pandemic-related hardships affecting audit response timeliness.
In a four-page document of frequently asked questions, CMS noted that:
- It will not enforce signature requirements for Medicare Fee-For-Service (FFS) reviews, Part B drugs, DME, and DMEPOS
- The agency will enforce prior authorization and signature requirements for non-emergent medical transport
- It will resume Review Choice Demonstration for Home Health Services in all states
In addition, any waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.
All U.S. nursing homes to receive point-of-care COVID-19 test kits from CMS
The nation’s 15,400 nursing homes will soon be able to conduct up to 20 COVID-19 tests per hour with rapid, on-the-spot results, according to an initiative announced this month by the U.S. Department of Health and Human Services.
The distribution of on-site tests for residents and staff will be prioritized by CMS, according to a press release that announced:
- Each facility will receive only one diagnostic test instrument and associated tests
- SNFs can obtain additional tests directly from test manufacturers
- Facilities may choose to test visitors, as necessary
UPDATE 6.15.2020
The World Health Organization approved the following COVID-19 related diagnosis code U07.2 “COVID-19, virus not identified’ is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.” The Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency responsible for maintaining ICD-10-CM in the US, is monitoring the situation. The HIPAA code set standard for diagnosis coding in the US is ICD-10-CM, not ICD-10. As shown in the April 1, 2020 Addenda on the CDC website, the only new code being implemented in the US for COVID-19 is U07.1.
Once this new code U07.2 is added as an ICD-10-CM then it can be added to ABILITY’s applications.
COVID-19 CODE ADDITIONS
UPDATE 5.6.2020
ABILITY has added the following code sets for customers to bill for COVID-19 services.
- New CPT and HCPC code announced to report Novel Coronavirus test
- 87635 (CPT) – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplitude probe technique.
- U0001 (HCPC) – CDC 2019 Novel Coronavirus (2019-ncov) real-time rt-pcr diagnostic panel
- U0002 (HCPC) – CDC 2019 Novel Coronavirus (COVID-19), any technique, multiple types or subtypes
- CMS established two Level II HCPCS codes, effective with line item date of service on or after March 1, 2020:
- G2023 – specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
- G2024 – specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
AMA announces new codes for antibody tests
The following codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE.
- 86328 – Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
New HCPCS codes for COVID-19 testing
The following HCPC codes apply to ABILITY EASE All-Payer, ABILITY CHOICE and PC-ACE. They apply to dates of service on and after 4/14/20 and will remain active until the end of the public health emergency.
- U0003 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), 2 amplified probe technique, making use of high throughput technologies
- U0004 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies
OTHER RECENT TOPICS AND HELPFUL LINKS:
- CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
The federal government has placed blanket waivers in effect to assist hospitals (including psychiatric and Critical Access Hospitals), plus cancer centers and long-term care hospitals. Learn more at https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf - Medicaid State Plan Fee-for-Service Payments for Services Delivered via Telehealth
CMS is promoting telehealth options in combating the COVID-19 pandemic and increasing access to care. Get details at https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf - CMS General Provider Telehealth and Telemedicine Tool Kit
During the pandemic, Medicare can pay for office, hospital and other visits furnished via telehealth. A range of providers, such as doctors, nurse practitioners, clinical psychologists and licensed clinical social workers, can offer telehealth to their patients. Learn more at https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf - RHC & FQHCs: Telehealth and Virtual Communications Flexibilities During COVID-19 Public Health Emergency
CMS has made several changes to RHC and FQHC requirements and payments to facilitate telehealth services for providers in rural areas. Learn more at https://www.cms.gov/files/document/se20016.pdf - CMS Non-emergent, Elective Medical Services and Treatment Recommendations
Health officials have created a tiered framework to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition. Learn more at https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf - CMS COVID-19 Medicare Provider Enrollment Relief Frequently Asked Questions
Get the information you need, from how to contact your Medicare Provider Enrollment Hotline to which screening requirements CMS is waiving. View the FAQs at https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf
CMS ACCELERATED AND ADVANCE PAYMENTS
UPDATE 4.28.2020
On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers, effective immediately.
Funding will continue to be available to hospitals and other healthcare providers on the front lines of the coronavirus response primarily from the Provider Relief Fund.
For an updated fact sheet on the Accelerated and Advance Payment Programs, visit: https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf
- Is CMS issuing Accelerated Payment to Medicare providers during the COVID-19 pandemic?Yes, CMS is offering an Accelerated and Advanced Payment Program to a broader group of Medicare providers to increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic.The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet.
- How do I know if I’m eligible?There are criteria that a provider/supplier must meet to be eligible. Please review the four criteria on the CMS fact sheet.
- Who do I contact for more information regarding CMS’ Accelerated and Advanced Payment Program?ABILITY has gathered the following links to help guide you to the Medicare Administrative Contractor (MAC) sites. Every site is different; if you have difficulties finding what you need you can contact the MAC directly.
- How do I know how much to request?Specific amounts vary depending on the type of provider/supplier. Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of the Medicare payment amount for a six-month period. Critical access hospitals (CAH) can request up to 125% of their payment amount for a six-month period.
- How will these payments be repaid or recouped?According to CMS: Accelerated/advance payments will be recovered from the receiving provider or supplier by one of two methods: 1) For the small subset of Part A providers who receive Period Interim Payment (PIP), the accelerated payment will be included in the reconciliation and settlement of the final cost report. 2) All other providers and suppliers will begin repayment of the accelerated/advance payment 120 calendar days after payment is issued.
- Am I able to use the ABILITY EASE Medicare or ABILITY EASE All-Payer applications to determine how much to request?Contact us for a demo to see how ABILITY EASE applications can help providers navigate this process.
https://www.abilitynetwork.com/about/contact/request-a-demo/
ABILITY is continuing to monitor information from CMS and the various MACs. We will provide additional information and updates related to the CMS Accelerated and Advanced Payment process as it becomes available.
Originally posted 4.9.2020
UPDATED 4.28.2020
