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Wednesday, November 24, 2021



Claims, Pricers, & Codes

MLN Matters® Articles





Provider Relief Fund Reporting Deadline: November 30, 2021

If you got 1 or more Provider Relief Fund (PRF) payments totaling more than $10,000 during the first Payment Received Period, you must report by November 30, 2021 at 11:59 pm ET to avoid further enforcement actions like repayment or other debt collection activities. The original deadline to report on how you used the funds was September 30, 2021, but HHS observed a 60-day grace period to help providers who didn’t meet the Reporting Period 1 deadline.

To get started, register in the PRF Reporting Portal. Review technical assistance resources on the PRF Reporting webpage for updated FAQs and user guides. You can get real-time help through the Provider Support Line at 866-569-3522; for TTY dial 711. They’re open from 8 am – 10 pm central time, Monday through Friday.


HIV: Talk to Your Patients About Prevention & Screening

Medicare covers Human Immunodeficiency Virus (HIV) screening, and your patients pay nothing if you accept assignment. December 1 is World AIDS Day—a good time to talk to your patients about HIV prevention, recommend screening if appropriate, and share patient information on HIV screenings.

More Information:


Home Health & Hospice: Medicare Provider Resources

Medicare covers a wide range of home health and hospice services. November, Home Care & Hospice Month, is a great time to get familiar with these resources:

Home Health:



COVID-19: Pfizer & Modena Booster Shots for 18 Years and Older

FDA amended the emergency use authorizations (EUAs) for the Pfizer and Moderna COVID-19 vaccines to authorize the use of a single booster dose for patients 18 years and older:

Get the most current list of billing codes, payment allowances and effective dates.

More Information:



DMEPOS Standard Written Order Requirements

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers—follow requirements for Standard Written Orders (SWOs):

  • Keep a SWO from the treating practitioner on file
  • Get the SWO before submitting a claim for all DMEPOS items
  • Get the SWO before delivery for certain items
  • Submit completed SWOs for all DMEPOS services billed if there is an audit

Review 42 CFR 410.38 and MLN Matters Special Edition Article SE20007 (PDF) to learn what elements to include on the order and related documentation:

  • Beneficiary name or Medicare beneficiary identifier
  • General description of the item
  • Quantity you’ll dispense, if applicable
  • Order date
  • Treating practitioner name or national provider identifier
  • Treating practitioner signature

More information:


Claims, Pricers, & Codes

IPPS, IRF & LTCH: New Web Pricer Released for FY 2022

CMS released the Fiscal Years (FYs) 2020 – 2022 Web Pricer for the:

  • Inpatient Prospective Payment System (IPPS)
  • Inpatient Rehabilitation Facility (IRF) PPS
  • Long-Term Care Hospital (LTCH) PPS

For the best experience, access the Web Pricers through Google Chrome. You may also use Microsoft Edge or Mozilla Firefox, but not Microsoft Internet Explorer.


MLN Matters® Articles

Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List

Learn about CY 2022 MPFS updates (PDF):

  • Physician and non-physician practitioner payment policy and payment rates
  • Telehealth services and telehealth origination site facility fee payment amounts
  • Medicare Part B policy changes including physician assistant services billing


The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year (FY) 2019 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs)

Learn about disproportionate share adjustments for IPPS hospitals (PDF), and:

  • Low-income patient adjustment for IRFs
  • Applicable payments for LTCH discharges


Claims Processing Instructions for the New Pneumococcal 20-valent Conjugate Vaccine Code 90677

Learn about a new code for the new pneumococcal vaccine (PDF), effective for dates of service on or after October 1, 2021, including:

  • Where to find pricing
  • How Medicare will calculate institutional provider payments


New Waived Tests

Learn about Clinical Laboratory Improvement Amendments (CLIA) requirements (PDF), including:

  • New CLIA-waived tests approved by the FDA
  • Modifier QW for CLIA-waived tests


International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) — April 2022

Learn about ICD-10 conversion and other coding updates specific to NCDs in two updates (update 1 (PDF) and update 2 (PDF)). These changes result from:

  • Newly-available codes
  • Separate NCD coding revisions
  • Coding feedback

CMS isn’t including any policy changes in this ICD-10 quarterly update. We cover NCD policy changes using the current, longstanding NCD process.



Medicare Provider Compliance Tips

Learn coverage and compliance tips for:

  • Ordering and billing for items and services
  • Meeting medical necessity requirements


National Expansion of the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model

Learn about the RSNAT Prior Authorization model (PDF), including:

  • Who can participate
  • When it will start in your area
  • How to request RSNAT prior authorization



CLFS Data Reporting Clinical Diagnostic Laboratory Tests Webinar Materials

CMS posted the recording (password: W&KZ@=7?) and presentation (PDF) from the November 10, 2021 Protecting Access to Medicare Act of 2014 (PAMA) Data Reporting webinar.

Learn about clinical laboratory fee schedule private payor data collection and reporting requirements:

  • Next data reporting period is January 1 – March 31, 2022
  • Reporting is based on the original data collection period, January 1 – June 30, 2019

Visit the PAMA webpage for more information.


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