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Thursday, May 25, 2023


Claims, Pricers, & Codes

MLN Matters® Articles



Information for Patients




DMEPOS Competitive Bidding Program: Temporary Gap Period Starts January 1

All Medicare Round 2021 DMEPOS Competitive Bidding Program contracts for off-the-shelf back and knee braces expire on December 31, 2023. Starting January 1, 2024, there will be a temporary gap in the program.

CMS plans to conduct bidding for the next round after the upcoming rulemaking process, including public notice and comment.

See the Temporary Gap Period fact sheet for more information. Continue to monitor these webpages for updates:


CMS Roundup (May 19, 2023)

You may be interested in these topics from the CMS Roundup:

  • CMS Continues to Provide Timely Updates to Providers, Partners, and the Public Related to the End of the COVID-19 Public Health Emergency (PHE)
  • Medicare Home Health Value-Based Purchasing Model Shows Improved Quality of Care & Reduced Spending
  • CMS Updates Strategic Plan, Includes Expanding Access to Oral Health, Outlines Advances in Health Equity and Promoting Alignment to Ensure Seamless Care Across Programs
  • CMS Releases Accountable Health Communities Model Second Evaluation Report


Medicare Providers: Deadlines for Joining an Accountable Care Organization

To participate in an Accountable Care Organization (ACO) for performance year 2024, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:

Participant taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 5.

More Information:


ESRD-Related Services: Comparative Billing Report in May

This month, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for ESRD-related services. Use the data-driven report to compare your billing practices with those of your peers in your specialty and across the nation.

Look for an email from cbrpepper.noreply@religroupinc.com to access your report.

More Information:

  • View a webinar recording
  • Visit the CBR website
  • Register for a live webinar June 7 from 3–4 pm ET


Claims, Pricers, & Codes


COVID-19 Pfizer-BioNTech & Moderna Vaccines: Product & Administration Code Updates

On April 18, 2023, the FDA amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent vaccines to simplify the vaccination schedule for most people. This action includes authorizing the current bivalent vaccines (original and omicron BA.4/BA.5 strains) for all doses administered to individuals 6 months of age and older, including for an additional dose or doses for certain populations.

Use 6 new CPT codes effective April 18, 2023:

  1. Code 0121A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent (12 yrs and older) – Single Dose
  2. Code 0141A for Moderna COVID-19 Vaccine, Bivalent (Pediatric 6 mos – 11 yrs) – First Dose
  3. Code 0142A for Moderna COVID-19 Vaccine, Bivalent (Pediatric 6 mos – 11 yrs) – Second Dose
  4. Code 0151A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Pediatric 5 – 11 yrs) – Single Dose
  5. Code 0171A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Pediatric 6 mos – 4 yrs) – First Dose
  6. Code 0172A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Pediatric 6 mos – 4 yrs) – Second Dose

The FDA also indicated that the monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the U.S. CMS added an April 18, 2023, termination date.

CPT code revisions:

  • Codes 0124A, 0154A, and 0174A: describing the service to administer the “Pfizer-BioNTech COVID-19 Vaccine, Bivalent” (91312, 91315, 91317, respectively) to replace the term “booster” with “additional dose”
  • Code 0173A: describing the service to administer the “Pfizer-BioNTech COVID-19 Vaccine, Bivalent” (91317) to align the coding guidance with updated FDA dosing guidance
  • Codes 0134A, 0144A, and 0164A: describing the service to administer the “Moderna COVID-19 Vaccine, Bivalent” (91313, 91314, 91316, respectively) to replace the term “booster” with “additional dose”
  • Code 91314: describing the “Moderna COVID-19 Vaccine, Bivalent” to reflect individuals 6 months through 11 years

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


MLN Matters® Articles


Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised

Learn about what’s changed:

  • CMS won’t require in-person visits until January 1, 2025
  • Use modifier FQ or 93 to report audio-only mental health visits




Checking Medicare Claim Status

Find out how to get claim status information electronically, including:

  • What happens after I submit a claim?
  • How do I know my accepted claim’s status, and when should I check payment status?
  • What’s a clean claim and its waiting period?
  • Which NPI number should I use?




J0510–J0530 Pain Interview: Understanding How a Patient Communicates Pain Video

This short, animated video helps you code J0510–J0530 Pain Interview items for the Inpatient Rehabilitation Facility (IRF) – Patient Assessment Instrument 4.0 and Long-Term Care Hospital (LTCH) Care Data Set 5.0. You’ll also learn about pain assessment strategies and patient communication.

More Information:


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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