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

PROVIDER RECEIVE THE INCREASED PAYMENTS UPTO 5 TIMES

To enhance access to COVID-19 vaccinations and promote health equity, the Biden-Harris Administration is expanding home-based vaccination options through CMS.

To ensure Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach can receive the vaccination, health care providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.  

This 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.

The allowing vaccine providers to receive the increased payment up to 5 times when fewer than 10 Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. 

CMS' Amended repayment process for accelerated and advance repayments

AAP - Repayment Process

CMS issued payments to providers and suppliers to help ease financial strain due to a disruption in claims submission and/or claims processing related to the COVID-19 public health emergency.

The Congress amended repayment process for the accelerated and advance payments through the Continuing Appropriations Act, 2021 and Other Extensions Act:

Repayment will now begin one year after the date of the issuance of the payment.

During the first 11 months after repayment begins, repayment will occur through automatic recoupment of 25% of Medicare payments otherwise owed to you.

During the succeeding six months, repayment will occur through an automatic recoupment of 50% of Medicare payments otherwise owed to you.

If AAP payment is not completed within 29 months, the provider will receive a demand letter requiring repayment of any outstanding balance with an interest rate of 4%. 

Additional New CPT codes and Payments - COVID-19 Vaccine - Effective from 08/12/2021

COVID-19 Vaccine Additional Dose - Payment

Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA emergency use authorization (EUA). 

They will pay the same amount to administer this additional dose as we did for other doses of the COVID-19 vaccine (approximately $40 each). 

The U.S. Food and Drug Administration amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.

Additional New CPT codes - COVID-19 Vaccine - Effective from 08/12/2021

When COVID-19 vaccine and monoclonal antibody doses are provided by the government without charge, only bill for the vaccine administration. Don't include the vaccine codes on the claim when the vaccines are free.

If the patient is enrolled in a Medicare Advantage (MA) plan, submit your COVID-19 vaccine and monoclonal antibody infusion claims to Original Medicare in 2020 and 2021.

The specified below codes are effective date from August 12th, 2021.

Code	Description	Label name	Vaccine/procedure name	Effective date	Dosing interval

0003A

ADM SARSCOV2 30MCG/0.3ML3RD

Pfizer

Pfizer-Biontech COVID-19 Vaccine Administration – Third Dose

08/12/2021

28 days

0013A

ADM SARSCOV2 100MCG/0.5ML3RD

Moderna

Moderna COVID-19 Vaccine Administration – Third Dose

08/12/2021

28 days

DIFFERNCE BETWEEN ICD 10 AND ICD 11

WHO recently already released ICD 11th edition and will come into effect on Jan 01, 2022. Let’s all not come into panic mode and note that so far the USA is not sure about when they’ll be ready to implement ICD 11 so far, but still, we cannot say anything.

Let’s see the Difference between the ICD 10 and the ICD 11 Coding systems. The ICD-11 MMS is the primary derivative of the Foundation Component, and that is commonly referred to and recognized as "ICD-11 MMS. The abbreviation is variously written with or without a hyphen between 11 and MMS. 

• MMS stands for Mortality and Morbidity Statistics.
• These codes are a minimum of 4 character codes in ICD 11 and 2 levels of subcategories.
• The chapter numbering of ICD 11 is Arabic numbers, not Roman numbers

ICD 10 represents 14400 diagnosis but ICD 11 has 55,000 unique codes to represent the comprehensive list of diagnosis. Changing the number of items in the ICD is considered extremely useful because it allows researchers and health care organizers to have a more complete picture. 

For example, in ICD-11 all types of diabetes and other conditions are described in detail

There is major codes structural difference between ICD 10 and ICD 11. ICD-11 changes the 3- character category codes (the characters to the left of the decimal) to four with an alpha-character in the second position and a number always in the third position. 

So the coding scheme always has a letter in the second position to differentiate from the codes of ICD-10 For example, 1A00

In the ICD-10, every code starts with a letter, indicating the chapter. The first character of code always relates to the chapter. Numbers 1-9 are used for the first nine chapters and letters are used for chapters 10 to 26. A letter is always in the 2nd position to differentiate from ICD-10 codes.

• No more “I” and “O” in ICD MMS to avoid confusion between “1” and “0” in ICD 11.
• Residual categories use Y for other, Z for Other Specified, and unspecified Category. 

For Example

• 1C4Y – Other Specified Bacterial Disease and 1C4Z - Unspecified Bacterial Disease.

Below is the list of ICD 11 MMS Chapters

1. A00–1H0Z Certain infectious or parasitic diseases
2. A00–2F9Z Neoplasms
3. A00–3C0Z Diseases of the blood or blood-forming organs
4. A00–4B4Z Diseases of the immune system
5. A00–5D46 Endocrine, nutritional or metabolic diseases
6. A00–6E8Z Mental, behavioral or neurodevelopmental disorders
7. A00–7B2Z Sleep-wake disorders
8. A00–8E7Z Diseases of the nervous system
9. A00–9E1Z Diseases of the visual system
10. AA00–AC0Z Diseases of the ear or mastoid process
11. BA00–BE2Z Diseases of the circulatory system
12. CA00–CB7Z Diseases of the respiratory system
13. DA00–DE2Z Diseases of the digestive system
14. EA00–EM0Z Diseases of the skin 
15. FA00–FC0Z Diseases of the musculoskeletal system or connective tissue
16. GA00–GC8Z Diseases of the genitourinary system
17. HA00–HA8Z Conditions related to sexual health
18. JA00–JB6Z Pregnancy, childbirth or the puerperium
19. KA00–KD5Z Certain conditions originating in the perinatal period
20. LA00–LD9Z Developmental anomalies
21. MA00–MH2Y Symptoms, signs or clinical findings, not elsewhere classified
22. NA00–NF2Z Injury, poisoning or certain other consequences of external causes
23. PA00–PL2Z External causes of morbidity or mortality
24. QA00–QF4Z Factors influencing health status or contact with health services
25. RA00–RA26 Codes for special purposes
26. SA00–SJ3Z Supplementary Chapter Traditional Medicine Conditions - Module I
27. VA00–VC50 Supplementary section for functioning assessment
28. X...–X... Extension Codes

With the addition of New Chapters related to Disorders of the Immune system, Diseases of the blood and blood-forming organs, Conditions related to sexual health, and Sleep-Wake Disorder, Extension codes, Traditional medicine in ICD 11 represents the more complex diagnosis. 

For example delayed sleep-wake phase disorder (7A60), advanced sleep-wake phase disorder (7A61), Irregular sleep-wake rhythm disorder (7A62)

• Skin Ca type – Basalioma was missing in ICD 10, so added in ICD 11. 

So many new conditions Compulsive sexual behavior disorder, Body integrity dysphoria, Gaming disorder categorized in mental, behavioral, and neurodevelopmental disorders. MBND contains 21 disorder groupings compared with 11 disorder groupings in ICD-10.

In below list of each disorder added into the ICD 11 list under Mental Health Disorders

• Anxiety or fear-related disorders
• Catatonia
• Disorders of bodily distress or bodily experience
• Disorders due to substance use or addictive behaviors
• Disorders specifically associated with stress
• Disruptive behavior or dissocial disorders
• Dissociative disorders
• Elimination disorders
• Factitious disorders
• Feeding or eating disorders
• Impulse control disorders
• Mental or behavioral disorders associated with pregnancy, childbirth, and the puerperium
• Mood disorders
• Neurocognitive disorders
• Neurodevelopmental disorders
• Obsessive-compulsive or related disorders
• Paraphilic disorders
• Personality disorders and related traits
• Schizophrenia or other primary psychotic disorders

Please note that ICD-11 is only for diagnosis coding and ICD-10-PCS is completely separate from ICD-10 and will not be updated with the transition of ICD-10 to ICD-11. ICD-10-PCS is not a WHO-developed or maintained vocabulary. ICD-10-PCS is a procedure classification system designed by CMS for coding hospital-based procedures.

ICD 10 CM Official Updates and Changes - 2022 - Revised Codes

REVISED CODE EFFECTIVE FROM OCTOBER 1ST, 2021 TO SEPTEMBER 30, 2022

Code Description

F32 Depressive episode

G71.20 Congenital myopathy, unspecified

M35.00 Sjogren syndrome, unspecified

M35.01 Sjogren syndrome with keratoconjunctivitis

M35.02 Sjogren syndrome with lung involvement

M35.03 Sjogren syndrome with myopathy

M35.04 Sjogren syndrome with tubulo-interstitial nephropathy

M35.09 Sjogren syndrome with other organ involvement

T63.611A Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), initial encounter

T63.611D Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), subsequent encounter

T63.611S Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), sequela

T63.612A Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, initial encounter

T63.612D Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, subsequent encounter

T63.612S Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, sequela

T63.613A Toxic effect of contact with Portuguese Man-o-war, assault, initial encounter

T63.613D Toxic effect of contact with Portuguese Man-o-war, assault, subsequent encounter

T63.613S Toxic effect of contact with Portuguese Man-o-war, assault, sequela

T63.614A Toxic effect of contact with Portuguese Man-o-war, undetermined, initial encounter

T63.614D Toxic effect of contact with Portuguese Man-o-war, undetermined, subsequent encounter

T63.614S Toxic effect of contact with Portuguese Man-o-war, undetermined, sequela

Z92.25 Personal history of immunosuppression therapy

See also Deleted Codes

Click Here to View New Codes

ICD 10 CM Official Updates and Changes - 2022 - Deleted Codes

DELETED CODE EFFECTIVE FROM OCTOBER 1ST, 2021 TO SEPTEMBER 30, 2022

Code Description

T40.7X1A Poisoning by cannabis (derivatives), accidental (unintentional), initial encounter

T40.7X1D Poisoning by cannabis (derivatives), accidental (unintentional), subsequent encounter

T40.7X1S Poisoning by cannabis (derivatives), accidental (unintentional), sequela

T40.7X2A Poisoning by cannabis (derivatives), intentional self-harm, initial encounter

T40.7X2D Poisoning by cannabis (derivatives), intentional self-harm, subsequent encounter

T40.7X2S Poisoning by cannabis (derivatives), intentional self-harm, sequela

T40.7X3A Poisoning by cannabis (derivatives), assault, initial encounter

T40.7X3D Poisoning by cannabis (derivatives), assault, subsequent encounter

T40.7X3S Poisoning by cannabis (derivatives), assault, sequela

T40.7X4A Poisoning by cannabis (derivatives), undetermined, initial encounter

T40.7X4D Poisoning by cannabis (derivatives), undetermined, subsequent encounter

T40.7X4S Poisoning by cannabis (derivatives), undetermined, sequela

T40.7X5A Adverse effect of cannabis (derivatives), initial encounter

T40.7X5D Adverse effect of cannabis (derivatives), subsequent encounter

T40.7X5S Adverse effect of cannabis (derivatives), sequela

T40.7X6A Underdosing of cannabis (derivatives), initial encounter

T40.7X6D Underdosing of cannabis (derivatives), subsequent encounter

T40.7X6S Underdosing of cannabis (derivatives), sequela

Return to view Revised Codes

See also New Codes