Before you submit a Medicare claim for administering COVID-19 vaccines, you must find out if: You must gather information both from patients with Original Medicare and those enrolled in Medicare Advantage plans. Copyright 2023 American Academy of Family Physicians. Coverage of other vaccines provided as a preventive service may be covered under a patient'sPart D coverage. $535. Download and use free PC-ACE billing software (PDF)to electronically submit professional claim roster billing directly to your MAC. You may use roster billing format or submit individual claims using the CMS-1500 form (PDF) or the 837P electronic format. website belongs to an official government organization in the United States. 2022-2023 Payment Allowances and Effective Dates for the 2022-2023 Flu Season: Code Labeler Name Vaccine Name Payment Allowance Effective Dates; 90662: Sanofi Pasteur: Fluzone High-Dose Quadrivalent (2022/2023) $ 69.941: . The condition requires development, monitoring, or revision of the disease-specific care plan. $152. Applications are available at the AMA website. The national (not geographically adjusted) 2022 Medicare payment allowance for this code was estimated at $27.21 in the nonfacility (e.g., office) setting, though this could change with the conversion factor. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. However, CMS is making a few notable changes to the Merit-based Incentive Payment System (MIPS). Influenza and Pneumonia Billing - JE Part B - Noridian There are several telehealth-related changes this year, including a Medicare provision for ongoing coverage of audio-only mental health services under certain conditions. If you submit roster bills for administering the COVID-19 vaccine in the home, you must submit 2 roster bills: A roster bill containing the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration, A second roster bill containing the HCPCS Level II code (M0201) for the additional in-home payment amount. When providing a Part D covered vaccine to a Medicare patient, the physician should charge the patient for the vaccine and its administration. Use codes 98976 and 98977 to report supplying the device for scheduled recordings and/or programmed alert transmissions (98976 is for respiratory system monitoring, and 98977 is for musculoskeletal system monitoring). The improvement activities and promoting interoperability performance category weights remain unchanged at 15% and 25%, respectively. Codes 99424 and 99425 are for services personally provided by a physician or QHP. Learn more about, You canbill on single claims for administering the COVID-19 vaccine, or submit claims on a. CPT Assistant provides guidance for new codes. E/M services. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. MIPS promoting interoperability (PI) category. In addition, hospitals don't bill vaccines on an 11X type of bill. (Note that state law may require an order and/or supervision.). Deadline for Submitting the 2022 Medicare Wage Index Occupational Mix Survey for Use Beginning With the FY 2025 Wage Index . Practices must accept or claim an applicable exclusion to two registry measures that were previously optional: immunization registry reporting and electronic case reporting. the administration and product codes to clarify the appropriate use of these new codes. Codes 99424 and 99426 are for the first 30 minutes per calendar month. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Non-participating physicians may choose not to accept assignment on the administration fee. G0009 - administration of pneumococcal vaccine. If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine. You can report these codes when a physician or QHP uses the results of remote therapeutic monitoring to manage the patient under a specific treatment plan. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Font Size: We are also proposing to make technical changes to the form and manner of the administration of the . Measures must have a benchmark and meet data completeness and case minimum criteria to qualify for the scoring floor. Related Change Request (CR) Number: 12943 . If you do not agree to the terms and conditions, you may not access or use the software. This is to be used in conjunction with the appropriate CPT code for COVID-19 vaccine product and dose and can only be utilized if vaccination is the sole reason for the in-home patient visit. But, you cant charge your patients or ask them to submit a claim to Medicare or another insurer. Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B (www.cms.gov). Secure .gov websites use HTTPSA CPT identifies codes that can be reported using telemedicine with a star symbol () and lists them in Appendix P. This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. The extreme and uncontrollable circumstances policy allows MIPS participants to request reweighting for any of the performance categories. Beginning in performance year 2022, CMS will apply automatic reweighting of the PI category to small practices and clinical social workers. 90626: Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use. All Rights Reserved. Certain settings utilize other payment methodologies, such as payment based on reasonable costs. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. Some of this year's changes are much-needed, which will hopefully lessen the pain of adjusting to them. A physician might report code 99213-25 with diagnosis code E11.9 in addition to the appropriate flu vaccine and administration codes. We will adjudicate benefits in accordance with the member's health plan. If your patients only have Part A Medicare coverage, ask if they have other medical insurance to cover Part B services, like vaccine administration. End Users do not act for or on behalf of the CMS. Clarifying when to report a test that is considered but not selected after shared decision making: A test that is considered but not performed counts as long as the consideration is documented. . Related CR Transmittal Number: R11710OTN . CDT is a trademark of the ADA. Therefore, youmay not administersotrovimab to treat COVID-19 under the EUA until further notice. + | CMS will continue to double the complex patient bonus for the 2021 performance year and cap it at a maximum of 10 points. The 2022 flu, pneumococcal, and hepatitis B vaccine administration reimbursement rate is identical for all three administration codes. Note: This product isnt currently authorized[12], Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg, Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg, Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring, Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiarys home that has been made provider-based to the hospital during the covid-19 public health emergency, Note: This product isnt currently authorized[11], Intravenous injection, bebtelovimab, includes injection and post administration monitoring, Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiarys home that has been made provider-based to the hospital during the covid-19 public health emergency, Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring, Q0240[6]Note: This product isnt currently authorized[9], Injection, casirivimab and imdevimab, 600 mg, M0240[6]Note: This product isnt currently authorized[9], Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses, M0241[6]Note: This product isnt currently authorized[9], Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency,subsequent repeat doses, Q0243Note: This product isnt currently authorized[9], Injection, casirivimab and imdevimab, 2400 mg, M0243Note: This product isnt currently authorized[9], Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, Q0244[5]Note: This product isnt currently authorized[9], Injection, casirivimab and imdevimab, 1200 mg, M0244Note: This product isnt currently authorized[9], Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiarys home that has been made provider-based to the hospital during the covid-19 public health emergency, Q0245[8]Note: This product isnt currently authorized[9], Injection, bamlanivimab and etesevimab, 2100 mg, M0245[8]Note: This product isnt currently authorized[9], intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring, M0246[8]Note: This product isnt currently authorized[9], Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiarys home that has been made provider-based to the hospital during the covid-19 public health emergency, Note: This product isnt currently authorized[10], Intravenous infusion, sotrovimab, includes infusion and post administration monitoring, Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiarys home that has been made provider-based to the hospital during the covid-19 public health emergency, 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, 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, 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. 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. Valid code for the vaccine - refer to the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM), referenced below Condition Code: A6 Diagnosis code: Z23 Note: For vaccines provided for inpatients, use the date of discharge or date Part A benefits exhausted as the date of service. Appendix Q details the vaccine codes, their associated vaccine adminis-tration code(s), the vaccine manufacturers and names, the National Drug Code (NDC) labeler product ID, PDF CPT Assistant guide: Coronavirus (SARS-CoV-2); April 2022 Code 98980 is for the first 20 minutes of service during a calendar month, and code 98981 is an add-on code for each additional 20 minutes. PCM services that require fewer than 30 minutes a month are not reported separately. https:// $515. Much of the Quality Payment Program will remain the same for performance year 2022. COVID-19 vaccine administration codes . This content is owned by the AAFP. [1]Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date. 2022 Administration Codes - Immunization Vaccine Codes (Influenza and 168 0 obj <> endobj This license will terminate upon notice to you if you violate the terms of this license. Therefore, CMS will base benchmarks for the 2022 MIPS performance period on data from 2020. Finally, CMS is permanently adopting payment for code G2252 (Brief communication technology-based service, e.g., virtual check-in, by a physician or other QHP who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 1120 minutes of medical discussion). Effective August 24, 2021, when fewer than 10 Medicare patients are vaccinated on the same date at the same group living setting, you may submit a roster bill for M0201 for up to a maximum of 5 Medicare patients in the same home, including for multiple Medicare patients vaccinated in a communal space of the multi-unit living arrangement. Sign up to get the latest information about your choice of CMS topics. $115. PDF AAP Vaccine Coding Table endstream endobj startxref Heres how you know. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.