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·  RVU: CMS Lookup
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·  LEIE-Monthly: LEIE Exclusion
·  GSA-Annual: GSA Exclusion

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2022 MIPS Documents 
It is normal, in the first quarter of each new year, for the QPP Resource Library to change. Listing documents in this section will be completed after this library has settled down. In the meantime, visit https://qpp.cms.gov/resources/resource-library.

Ohio Department of Health Medical Records Price Index 2022
·  Download Price Index 2022 pdf here

OSHA

Coding

September 2022

Updates for Monkeypox Coding

Laboratory test code

87593     Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each

Product code

90622    Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use

90611     Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.

New CPT Codes for Covid Boosters

For quick reference, the new product and administration codes assigned to each bivalent COVID-19 vaccine booster are:

Moderna bivalent booster – 18 years and older
• 91313    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
• 0134A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose

Moderna bivalent booster – 6 years through 11 years
• 91314    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use
• 0144A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose

Pfizer-BioNTech bivalent booster – 12 years and older
• 91312    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
• 0124A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose

Pfizer-BioNTech bivalent booster – 5 years through 11 years
• 91315    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
• 0154A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose

July 2022

New COVID Vaccine codes for children from CMS

Code 91308 for vaccine product:
• Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
• Short descriptor: SARSCOV2 VAC 3 MCG TRS-SUCR

Code 0081A for vaccine administration, first dose:
• Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose
• Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 1

Code: 0082A for vaccine administration, second dose:
• Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose
• Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 2

Code 0083A for vaccine administration, third dose:
• Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose
• Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 3

2023 E/M Coding from the AMA effective January 1, 2023
• E/M Introductory Guidelines related to Hospital Inpatient and Observation Care Services codes 99221-99223, 99231-99239, Consultations codes 99242- 99245, 99252-99255, Emergency Department Services codes 99281-99285, Nursing Facility Services codes 99304-99310, 99315, 99316, Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
• Deletion of Hospital Observation Services E/M codes 99217-99220
• Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
• Deletion of Consultations E/M codes 99241 and 99251
• Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
• Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
• Deletion of Nursing Facility Services E/M code 99318
• Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
• Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
• Deletion of Home or Residence Services E/M code 99343
• Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
• Deletion of Prolonged Services E/M codes 99354-99357
• Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
• Revision of Prolonged Services E/M code 99417 and guidelines
• Establishment of Prolonged Services E/M code 993X0 and guidelines

May 2022

Connect Patients on Medicare With Services To Improve Care for Chronic Conditions

Chronic diseases and their risk factors can often develop due to complex factors that limit access to resources for improved health, including poverty, lack of education, racism or discrimination, lack of access to healthy foods and opportunities for physical activity, and less access to high-quality health services.

Chronic Care Management (CCM) are coordination services, conducted outside regular office visits for Medicare patients with 2+ chronic conditions that routinely require extra time for you and your staff. Managing chronic conditions is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients.

CLICK HERE to read more.

For Medicare Patients:

Beginning January 1, 2022, when a screening colorectal cancer procedure G0104, G0105, or G0121 has the PT modifier submitted on the claim line item with HCPCS codes 10000-69999, G0500, 00811, or CPT code 99153 for diagnostic colonoscopy or other procedure to indicate that a screening colorectal cancer procedure, HCPCS G0104, G0105, or G0121 has become a diagnostic or therapeutic service, coinsurance is reduced or waived on claims as follows:

For dates of service in calendar years 2023-2026, the reduced coinsurance is 15%.
For dates of service calendar years 2027-2029, the reduced coinsurance is 10%.
For dates of service on or after calendar year 2030, Medicare waives the coinsurance.
MLN Matters: MM12656
CR12656.

COVID-19: 

CMS issued new codes, effective March 29, 2022, for the vaccine booster and administration:

Code: 91309
•    Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
•    Short descriptor: SARSCOV2 VAC 50MCG/0.5ML IM

Code: 0094A
•    Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, booster dose
•    Short descriptor: ADM SARSCOV2 50 MCG/.5 MLBST

March 2022

The new product code and administration codes assigned to the Pfizer-BioNTech COVID-19 vaccine for children in the age range of 6 months to 5 years are:

Product Code
91308: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use

Administration Codes
0081A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose

0082A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose

Short, medium and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and the COVID-19 disease.

The FDA has authorized bebtelovimab for emergency use for certain non-hospitalized patients with mild-to-moderate COVID-19 at high risk of progression to severe disease for whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically appropriate. Bebtelovimah neutralizes Omicron as demonstrated by pseidovirus and authentic virus data.

CMS created new codes, effective February 11, 2022:

Q0222:

  • Long descriptor: Injection, bebtelovimab, 175 mg
  • Short descriptor: Bebtelovimab 175

M0222:

  • Long Descriptor: Intravenous injection, bebtelovimab, includes injection and post administration monitoring
  • Short Descriptor: Bebtelovimab injection

M0223:

  • Long Descriptor: Intravenous injection, bebtelovimab, includes 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
  • Short Descriptor: Bebtelovimab injection home

 

PA Services 
– provided by Maxine Lewis

The Consolidated Appropriations Act (CAA) removes the requirement to make payment for PA services only to the employer of a PA effective January 1, 2022. Now PAs will be authorized to bill Medicare and paid directly for their services in the same way that NPs and CNSs are paid.

PAs may also reassign their rights to payments for their services and choose to incorporate as a group comprised only of practitioners in their specialty and bill the Medicare program.

This statutory billing construct does not change the statutory benefit category or the requirements that PA services are performed under physician supervision.

 

News about shared/split visits in institutional setting
– provided by Maxine Lewis

A split (or shared) visit as an E/M visit in the facility setting that is performed in part by both a physician and an NPP who are in the same group, in accordance with applicable laws and regulations. Split (or shared) visits as those that:

  • Are furnished in a facility setting by a physician and an NPP in the same group, where the facility setting is defined as an institutional setting in which payment for services and supplies furnished incident to a physician or practitioner’s professional services is previously prohibited under our regulation at § 410.26(b)(1).
  • Are furnished in accordance with applicable law and regulations, including conditions of coverage and payment, such that the E/M visit could be billed by either the physician or the NPP if it were furnished independently by only one of them in the facility setting (rather than as a split (or shared) visit).
  • CMS has modified their policy to allow physicians and NPPs to bill for split (or shared) visits for both new and established patients, and for critical care and certain Skilled Nursing Facility /Nursing Facility (SNF/NF) E/M visits payment for split (or shared) visits to account for changes that have occurred in medical practice patterns, including the evolving role of NPPs as part of the medical team.

Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.

 

There are a number of new HCPCS modifiers that are important to be used in reporting claims to insurers:
FS: Split (or shared) Evaluation and Management visit

A split or shared visit is an E/M service in a Facility such as a hospital performed in part by a physician and in part by an NPP in the same group, in accordance with the guidelines and regulations. A modifier must be appended:

Another new modifier is to be used when a provider sees a patient during the postoperative period of a surgery and the service is unrelated to the original surgery.

FT: Unrelated E/M visit during a postoperative period, or on the same day as a procedure or another E/M visit. (Report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated).

Depending upon the payers, this modifier may be appropriate for critical care E/M service.

PT: Colorectal cancer screening test, converted to diagnostic test or other procedure.

Append modifier when the provider performs screening colonoscopy or barium enema and finds or removes or performs a biopsy during the same encounter. In the coming years, the copayment will be less for the procedure.

 

Mandated Sequestration for Medicare Fee-For-Service Payment 
– provided by Maxine Lewis

  • Effective for dates of service on or after April 1, 2013, all Medicare FFS claims incur a 2% reduction.
  • The CARES Act suspended the payment adjustment from May 1, 2020 through December 31, 2020.
  • The Consolidated Appropriation Act 2021 extended the suspension period to March 31, 2021.
  • Signed into law on April 14, 2021, the suspension period was extended to December 31, 2021.

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims:

  • No payment adjustment through March 31, 2022
  • 1% payment adjustment April 1 – June 30, 2022
  • 2% payment adjustment beginning July 1, 2022