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Thursday, January 6, 2021


Claims, Pricers, & Codes


MLN Matters® Articles





COVID-19 Vaccine Access in Long-term Care Settings

The federal government is committed to ensuring that residents and staff in long-term care settings, like nursing homes, assisted living, residential care communities, group homes, and senior housing, have access to COVID-19 vaccines to get primary series and booster shots.

We encourage long-term care providers to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. The CDC has additional details on these options. Find Medicare billing and payment information.

As a reminder, through enforcement discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and get direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility residents.


SNF VBP: Nominate Technical Expert Panel Members by January 16

CMS is creating a technical expert panel to help develop quality and cost measures for the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) program. Nominate people to serve on the panel by January 16. Visit the Technical Expert Panels: Currently Accepting Nominations webpage for more information.


COVID-19 Vaccine & Monoclonal Antibody Products: Changes for MA Plan Claims Started January 1

If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.

More Information:


Claims, Pricers, & Codes


IPPS: Updated Web Pricer Features

CMS added the health maintenance organization paid claim and cost outlier threshold fields to the Inpatient Prospective Payment System (IPPS) Web Pricer. CMS will no longer release the IPPS PC Pricer applications.

For the best experience, access the Web Pricer through Google Chrome. You may also use Microsoft Edge or Mozilla Firefox, but not Microsoft Internet Explorer. Email your feedback on the IPPS Web Pricer to WebPricers@cms.hhs.gov using the subject line “IPPS Web Pricer.”




Medicare Ground Ambulance Data Collection System: Q&A Session — January 18

Tuesday, January 18 from 2 – 3 pm ET

Register for the session.

Do you have questions about the Medicare Ground Ambulance Data Collection System? Join this live Q&A session. You may also send your questions in advance to AmbulanceDataCollection@cms.hhs.gov with “January 18 Q&A” in the subject line. We’ll update documents on our Ambulances Services Center webpage with answers to common questions from this session.

More Information:


MLN Matters® Articles


January 2022 Update of the Ambulatory Surgical Center (ASC) Payment System

Learn about January updates, including (PDF):

  • Payment offsets for HCPCS codes C1832 and C1833
  • Changes to the ASC Covered Procedure List Policy for CY 2022


Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) Section 240.6

CMS removed the NCD for TPEs (PDF). Your Medicare Administrative Contractor will make TPE coverage determinations.


Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022

Learn about changes in the edit module’s quarterly release (PDF) and how to view them in the NCD spreadsheet.


Implementation of the Capital Related Assets Adjustment (CRA) for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Under the End Stage Renal Disease Prospective Payment System (ESRD PPS) — Revised

CRAs reported on a claim can’t exceed the number of treatments billed (PDF).




Original Medicare vs. Medicare Advantage

Learn how different coverage affects (PDF):

  • Treating patients
  • Processing claims
  • Filing appeals


Medicare Learning Network® (MLN) Provider Compliance Products — Revised

CMS updated the list of provider compliance products (PDF) and moved provider compliance tips into a new Medicare Provider Compliance Tips educational tool.


Opioid Treatment Programs (OTPs) Medicare Enrollment — Revised

See the updated enrollment application and a new OTP personnel attachment (PDF).


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