NOTE: All in-article links open in a new tab.

August 2022 Monthly COVID-19 and Other Medicare Updates

Published on 

Wednesday, August 24, 2022

 | Billing 
 | Coding 
 | Medicare Coverage 
 | Outpatient Services 

This article was updated on September 2, 2022.
Please see correction below.

COVID-19 Updates

August 18, 2022: Roadmap for the End of the COVID-19 Public Health Emergency

CMS published a blog (link), announcing their efforts to create a roadmap for the end of the COVID-19 PHE. CMS reminds you that “HHS Secretary Becerra has committed to giving states and the health care community writ large 60 days’ notice before ending the PHE. In the meantime, CMS encourages health care providers to prepare for the end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards and billing practices.”

Included in this CMS Blog is a list of fact sheets summarizing the status of Medicare Blanket waivers and flexibilities by provider type. The fact sheets include information about waivers and flexibilities that:

  • Have already been terminated,
  • Will be made permanent, or
  • Will end at the end of the PHE.

CMS expects “that the health care system can begin taking prudent action to prepare to return to normal operations and to wind down those flexibilities that are no longer critical in nature.”

The COVID-19 PHE declaration was last extended on July 15, 2022 (link). PHE declarations last for the duration of the emergency or 90 days and may be extended by the Secretary meaning the current COVID-19 PHE declaration will last until October 13, 2022.

With the CMS release of a Road Map to wind down the COVID-19 PHE, it seems hospitals are being put on notice that the end of the PHE is near.

Other Updates

Friday, July 27, 2022: CMS Releases Three FY 2023 Final Rules

In late July, CMS published Fiscal Year (FY) 2023 Final Rules. You can read about each of the Final Rules in related CMS Fact Sheets.

  • FY 2023 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule (CMS-1767-F) CMS Fact Sheet: link
  • FY 2023 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1769-F) CMS Fact Sheet: link
  • FY 2023 Hospice Payment Rate Update Final Rule (CMS-1773-F) CMS Fact Sheet: link
Monkeypox & Smallpox Vaccines: New Product Codes

CMS included the following guidance related to monkeypox and smallpox vaccines in the August 11, 2022 edition of MLN Connects (link).

On July 23, the World Health Organization declared monkeypox a public health emergency, and HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, testing, and treatments available. CMS issued two new CPT codes effective July 26, 2022:

Code 90611 for smallpox and monkeypox vaccine product:

  • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
  • Short descriptor: SMALLPOX&MONKEYPOX VAC 0.5ML
Code 90622 for vaccinia (smallpox) virus vaccine product:
  • Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
  • Short descriptor: VACCINIA VRS VAC 0.3 ML PERQ

When the government provides vaccines at no cost, only bill for the vaccine administration:

  • Do not include the vaccine codes on the claim when the vaccines are free
  • Patient cost sharing applies

Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims

Initially, Medicare instructed to only bill for vaccine administration when you got the vaccine at no cost from the government. In the September 1, 2022 MLN Connects newsletter, these instructions were changed. These new instructions are to include these 3 elements on your claim, even if you get the vaccine from the government for free:

  1. product code (90611 or 90622)
  2. applicable ICD-10-CM diagnosis code
  3. administration code

We’ll address the no cost government vaccine product payment adjustments during claims processing. You’ll see it on your remittance advice.

Code 90611 for smallpox and monkeypox vaccine product:

  • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
  • Short descriptor: SMALLPOX&MONKEYPOX VAC 0.5ML

Code 90622 for vaccinia (smallpox) virus vaccine product:

  • Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
  • Short descriptor: VACCINIA VRS VAC 0.3 ML PERQ

Patient cost sharing applies. Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

‍

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.