Knowledge Base Article

In the early days of the COVID-19 Public Health Emergency (PHE) guidance and information was coming at us fast and furious by the likes of the CMS, CDC, OIG, and the AMA. Early on, MMP provided weekly COVID-19 updates. We later transitioned to including highlights in our end of the month Medicare updates article.

However, with new codes related to COVID-19 becoming effective April 1, 2022, the recent launch of an OIG telehealth webpage, and CMS announcing the end of specific COVID-19 waivers for inpatient hospices, intermediate care facilities for individuals with intellectual disabilities, and end-stage renal disease facilities, updating our readers couldn’t wait until the end of April.

April 1, 2022: Reminder, New COVID-19 Codes Effective April 1, 2022

As a reminder, effective April 1, 2022, there are new ICD-10-CM diagnosis codes for reporting COVID-19 vaccination status as well as new ICD-10-PCS procedure codes describing the introduction or infusion of therapeutics, including vaccines for COVID-19 treatments.

In a related MLN Matters Article MM12578 (link), “CMS notes that for hospitalized patients, Medicare pays for COVID-19 vaccines and their administration separately from the Diagnosis-Related Group rate. Medicare expects that the appropriate CPT codes will be used when a Medicare patient is administered a vaccine while a hospital inpatient. For details on billing Medicare for the COVID-19 vaccine appropriately, please see this page in our provider toolkit.”

Information about a new Pfizer BioNTech COVDI-19 vaccine code and changes for COVID-19 monoclonal antibody therapy product and administration codes can be found in MLN Matters Article MM12666 (link).

April 4, 2022: New Way for Medicare Beneficiaries to Get Free Over the Counter COVID-19 Tests

In an April 4, 2022, Special Edition of MLN Connects (link), CMS announced that Medicare beneficiaries, including Medicare Advantage enrollees, can now get free COVID-19 tests with a few caveats:

• They must be FDA approved, authorized, or cleared over the counter COVID-19 tests,
• You are limited to up to 8 tests per calendar month from participating pharmacies and health care providers, and
• Free testing is available for the duration of the COVID-19 public health emergency (PHE).

CMS also provided a list of national pharmacy chains participating in this initiative that includes Albertsons Companies, Inc., Costco Pharmacy, CVS, Food Lion, Giant Food, The Giant Company, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Family of Pharmacies, Rite Aid Corp., Shop & Stop, Walgreens, and Walmart.

This new option for receiving COVID-19 tests is an addition to the following options outlined in the Special Edition MLN Connects:

• Requesting free over-the-counter tests for home delivery at covidtests.gov. Every home in the U.S. is eligible to order 2 sets of 4 at-home COVID-19 tests.
• Access to no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here.
• Access to lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare.
• In addition to accessing a COVID-19 laboratory test ordered by a health care professional, people with Medicare can also access one lab-performed test without an order and cost-sharing during the public health emergency.

April 4, 2022: OIG Launches Telehealth Webpage

The OIG announced the launch of a new telehealth webpage (link). In the announcement they note that they are “conducting oversight work assessing telehealth services, including the impact of the public health emergency flexibilities. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering changes to telehealth policies. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs.”

April 6, 2022: CMS to Pay for Second COVID-19 Booster without Cost Sharing

CMS announced (link) that they will pay for a second COVID-19 booster at no cost for people with Medicare or Medicaid coverage. They go on to note that the CDC recently updated their recommendation regarding COVID-19 vaccinations. Specifically, “Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least 4 months ago are eligible for another booster to increase their protection against severe disease from COVID-19. Additionally, the CDC recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.”

April 7, 2022: CMS Returns to Certain Pre-COVID-19 Policies in Long-term Care and Other Facilities

In a CMS Press Release (link), they note that they have seen steadily increasing vaccination rates for nursing home residents and staff, and improvements in nursing homes’ abilities to respond to COVID-19 outbreaks. This provided the impetus for CMS to announce they will be phasing out certain flexibilities related to the COVID-19 PHE to re-establish certain minimum standards. Some of the same waivers are also being terminated for inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities.

Specifically, CMS is ending specific waivers in two groups: one group of waivers will terminate 30 days from the issuance of this new guidance, and the other group will terminate 60 days from issuance. CMS notes in the related memorandum Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers (link), that at this time “applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).”

Note, CMS has updated their COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (link) document to reflect the dates for when the waivers are to terminated.