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Thursday, March 30, 2023


Claims, Pricers, & Codes

MLN Matters® Articles

Publications & Multimedia

Information for Patients



COVID-19: Booster Dose for Children 6 months – 4 years

On March 14, 2023, the FDA amended the emergency use authorization of the updated (bivalent) Pfizer-BioNTech COVID-19 vaccine to include a single booster dose of the vaccine in children 6 months – 4 years old at least 2 months after completion of primary vaccination with 3 doses of the monovalent (single strain) Pfizer-BioNTech COVID-19 vaccine.

Effective March 14, 2023, use new CPT code 0174A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent - Administration – Booster Dose:

  • Long descriptor: 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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose
  • Short descriptor: ADM SARSCV2 BVL 3MCG/0.2ML B

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.

Identity & Access Management System: Easier for Surrogates

Do you access, view, and modify information for providers in NPPES and PECOS? You can now request connection with multiple providers at the same time in the Identity & Access Management (I&A) System. Learn more in the I&A System Quick Reference Guide.

Medicare Advantage Value-Based Insurance Design Model Extended

CMS extended the Medicare Advantage Value-Based Insurance Design Model for CY 2025–2030. We’ll make changes to address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.

For more information, see Medicare Advantage Value-Based Insurance Design Model, or email VBID@cms.hhs.gov.

Supplemental Security Income & Medicare Beneficiary Data: FY 2021

Get FY 2021 supplemental security income and Medicare beneficiary data for:

See the instruction to your Medicare Administrative Contractor.

DMEPOS for Skilled Nursing Facility: Pre-Discharge Delivery for Fitting & Training

The pre-discharge delivery instructions in Section 110.3 of the Medicare Claims Processing Manual, Chapter 20 don’t apply to customized prosthetics excluded from skilled nursing facility consolidated billing. These items may be billed separately during the skilled nursing stay.

See the instruction to your Medicare Administrative Contractor.

Claims, Pricers, & Codes

COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency

The end of the COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023.

Skilled Nursing Facility & Swing Bed Providers

For benefit period and qualifying stay waivers, submit condition code DR for inpatient claims with admission dates before May 12, 2023.

For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38.

April 2023 Quarterly Pricing File Revisions

See revisions to the April Average Sales Price public file.

Revisions to the April OPPS Addendum B public file and April ASC public file will be available in the next few days.

More Information:

MLN Matters® Articles

Medicare Part B Coverage of Pneumococcal Vaccinations

Learn about coverage updates.

Supervision Requirements for Diagnostic Tests: Manual Update

Learn about updates to the Medicare Benefit Policy Manual, including an expanded list of provider types authorized to supervise diagnostic tests.

Publications & Multimedia

Post-Acute Care Quality Reporting Program: Videos & Patient Cue Cards

Watch short videos to learn how to code patient assessment instruments for the following Post-Acute Care Quality Reporting Programs:

Help LTCH, IRF, and HH patients select responses by showing them the new cue cards for:

See LTCH, IRF, HH, and SNF Quality Reporting Program Training for more information.

Expanded Home Health Value-Based Purchasing Model: March Newsletter, FAQs, & Recordings

Get the latest information on the Expanded Home Health Value-Based Purchasing Model, including:

Information for Patients

States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now

Share the Renew Your Medicaid or CHIP Coverage flyer with your Medicaid and Children’s Health Insurance Program (CHIP) patients.

Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.

Here are 3 things your patients with Medicaid or CHIP can do to prepare:

  1. Make sure their state has their current contact information
  2. Check the mail for a letter about their Medicaid or CHIP coverage
  3. Complete their renewal form right away (if they get one)

Related Resources:

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