August 2021

Impact of the PHE on Telehealth: Comparative Billing Report in August

In late August, CMS will issue a Special Edition Comparative Billing Report (CBR) on the impact of the Public Health Emergency (PHE) on Part B claims for telehealth. Use the data-driven report to compare your billing practices during the PHE with those of your peers in your state and across the nation.

CBRs aren’t publicly available. Look for an email from to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery. 

More Information:

CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations

As part of the Biden-Harris Administration’s ongoing commitment to increasing access to vaccinations and improving health equity, the Centers for Medicare & Medicaid Services (CMS) is expanding opportunities for people to receive COVID-19 vaccinations in their home. To ensure Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach can receive the vaccination, healthcare providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.   

August 24th’s announcement aims to further boost the administration of COVID-19 vaccination – including second and third doses – in smaller group homes, assisted living facilities, and other group living situations by allowing vaccine providers to receive the increased payment up to five times when fewer than ten Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination. Read More

COVID-19 Vaccines Additional Doses: Codes & Payment

The FDA amended the emergency use authorizations (EUAs) for both the Pfizer BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine to allow for an additional dose in certain immunocompromised people.

Effective August 12, 2021, CMS will pay to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs, using CPT code 0003A for the Pfizer vaccine and CPT code 0013A for the Moderna vaccine. We’ll pay the same amount to administer this additional dose as we did for other doses of the COVID-19 vaccine (approximately $40 each).

We’ll hold and then process all claims with these codes after we complete claims system updates (no later than August 27).

Learn more about Medicare COVID-19 vaccine:

February 2021

COVID-19: Revised Clinician Codes Accepted with CS Modifier
Effective March 18, 2020, the Families First Coronavirus Response Act requires Medicare Part B to cover beneficiary cost-sharing for provider visits when a COVID-19 diagnostic test is administered or ordered. CMS updated the list of codes (ZIP) that physicians and non-physician practitioners can use with the Cost-Sharing (CS) modifier.

For dates of service on or after January 1, 2021, through the end of the public health emergency, we’ll accept these codes with the CS modifier:

HCPCS codes G2250, G2251, and G2252
CPT codes 98970, 98971, and 98972 (These replace HCPCS codes G2061 – G2063, which are accepted for services provided in 2020)  
CPT codes 98966, 98967, and 98968 are accepted for services with the CS modifier provided on or after March 18, 2020.

More information about cost-sharing: Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) (PDF) MLN Matters Article

Six codes to remember as COVID-19 cases surge across the country

COVID-19 cases are surging again in many states, with the U.S. setting new records for daily infections. These are the key codes to remember when testing for or diagnosing the illness:

ICD-10 codes:

U07.1, COVID-19. This is the diagnosis code for all cases of COVID-19, whether it’s diagnosed based on testing, symptoms, exposure, or any combination of the three.

Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. Use this code when you think a patient has been exposed to the novel coronavirus, but you’re uncertain about whether to diagnose COVID-19 (i.e., test results are not available). It should be accompanied by codes for the patient’s symptoms, if there are any.

B94.8, Sequelae of other specified infectious and parasitic diseases. Use this code for patients who are still suffering from COVID-19 complications after clearing the initial infection. It should be combined with other diagnosis codes for the patient’s ongoing symptoms.

CPT codes:

87426, Infectious agent antigen detection by immunoassay technique (e.g., enzyme immunoassay, enzyme-linked immunosorbent assay, fluorescence immunoassay, immunochemiluminometric assay), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2). This recently revised code is for administering an antigen test, which is quicker and simpler than other tests for COVID-19 and therefore is more likely to be done at the point of care.

86328, Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19]). This is the code for a single-step test to identify antibodies in patients previously or currently infected with the novel coronavirus.

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. This is a new code for a single genetic test that can identify COVID-19, the seasonal flu, or respiratory syncytial virus (for tests that combine only COVID-19 and the flu, report 87636).

Read more Coding & Documentation tips.

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