Medicare Part B: Vaccine Coverage. [5]On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mgto 1200 mg, and allow providers to administer the combination product by subcutaneous injection in limited circumstances. CMS also added a new, required attestation-based measure. PDF Third vaccine covered for ages 6 months through 5 years An official website of the United States government On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. This change extends beyond the pandemic. Key CPT and Medicare Changes for Family Medicine in 2022 CMS will also continue to allow audio-only. CMS extended the CMS Web Interface reporting option for MSSP accountable care organizations (ACOs). Coding for COVID-19 Immunizations | ACOG After that, CMS will reduce the COVID-19 vaccine administration payment rate to match other Medicare Part B vaccines. Share sensitive information only on official, secure websites. This license will terminate upon notice to you if you violate the terms of this license. For Medicare Advantage (MA) patients, RHCs and FQHCs should submit COVID-19 vaccine administration claims to the MAPlan. Tests with overlapping elements are not considered unique even if they have distinct CPT codes. Providers and suppliers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP. The influenza and pneumococcal vaccines and the administration of these vaccines are not subject to the Medicare Part B deductible or co-insurance. [4]On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. Measures in their second year will receive 510 points. 195 0 obj <>/Filter/FlateDecode/ID[<02DECBEECA02E24DB9AE02CE5827176A>]/Index[168 44]/Info 167 0 R/Length 122/Prev 159785/Root 169 0 R/Size 212/Type/XRef/W[1 3 1]>>stream Related CR Release Date: November 17, 2022 . Ongoing communication and care coordination between relevant clinicians providing care. Patients without health insurance can also get the COVID-19 vaccine and administration at no cost. These include: Administration services for these preventive vaccines are reported to Medicare using HCPCS codes as follows: The diagnosis code to report with these preventive vaccines is: Other immunizations are covered under Medicare Part B only if they are directly related to the treatment of an injury or direct exposure (such as antirabies treatment, tetanus antitoxin, or booster vaccine, botulin antitoxin, antivenin, or immune globulin) ) Coding for COVID-19 Vaccine Shots | CMS - Centers for Medicare The following links contain helpful information for providers. If you got the product for free, and your systems require a product code to bill for the administration, enter $0.01 for the billed amount. There are several telehealth-related changes this year, including a Medicare provision for ongoing coverage of audio-only mental health services under certain conditions. As a result, CMS issued a new product code for casirivimab and imdevimab (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244). Copyright 2022 by the American Academy of Family Physicians. All rights reserved. PDF CPT Assistant guide: Coronavirus (SARS-CoV-2); April 2022 CPT clarified aspects of last year's E/M coding changes, including the definition of a unique test, what discussion between physicians and patients means, and the difference between major and minor surgery. Last year CPT made substantial changes to new and established patient E/M codes (99202-99215).1 This year CPT clarified several aspects of those changes, including the following:2. CMS has identified specific codes for the COVID-19 vaccine administration codes. Codes 99424 and 99425 are for services personally provided by a physician or QHP. MVP will reimburse providers for administration of the COVID-19 vaccine according to the following . Prevnar 20 (Pneumococcal 20-valent Conjugate Vaccine) is covered by Medicare and commercial health plans. For dates of service between June 8, 2021, and August 24, 2021, you should bill for the additional payment amount of approximately $35 only once per date of servicein that home regardless of how many Medicare patients get the vaccine. When the government provides COVID-19 vaccines at no cost, only bill for the vaccine administration. You may submit a single set of roster bills (one containing M0201 and another containing the appropriate CPT code) for multiple Medicare patients who get the COVID-19 vaccine in their individual units of a multi-unit living arrangement. Effective Aug. 1, 2022, vaccine administration codes 90471, 90472, and 90474 will no longer be reimbursed at an Off Campus-Outpatient Hospital (POS 19) or an On Campus - Outpatient Hospital (POS 22) place of service. Medicare updates payment details for flu vaccine, COVID-19 boosters [6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 years through 17 years of age in addition to the 8/31/2022 FDA authorization as a single booster dose in individuals 18 years and older. CPT 2022 includes five new vaccine codes and nine new vaccine administration codes related to COVID-19. Submit COVID-19 vaccine administration claims to the Medicare Advantage Plan. G0010 - administration of hepatitis B vaccine. Heres how you know. [9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isnt currently authorized in any U.S region. Tests that do not require an analysis still count if they are a factor in diagnosis, evaluation, or treatment. Physicians who teach residents should know that CMS policy changes may affect payment for their services. Copyright 2023 American Academy of Family Physicians. The COVID-19 vaccine and administration codes are among 405 editorial changes in the 2022 CPT code set, including 249 new codes, 63 deletions and 93 revisions. Learn about claims & roster billing. 2022 Administration Codes - Immunization Vaccine Codes (Influenza and Pneumococcal) 2022 Administration Codes - Immunization Vaccine Codes (Influenza and Pneumococcal) LICENSES AND NOTICES. Clinical documentation should reflect coordination of care among the managing clinicians. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product.