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COVID-19: Long-term Care, Remdesivir, & Booster Doses

Thursday, January 13, 2022



Claims, Pricers, & Codes






COVID-19: Updated Materials for Visiting Nursing Homes During Omicron Surge

CMS updated our Nursing Home Resource Center with 2 new informational products.

As of January 6, we updated the Nursing Home Visitation FAQs (PDF) to give additional guidance about visitation during the Omicron surge. We also created an infographic (PDF) to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. Nursing home providers, patients, caregivers, and CMS partners can use these 2 new resources to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.


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.

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


COVID-19: New HCPCS Code for Remdesivir Antiviral Medication – Updated NIH Treatment Guidelines Panel Link

Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel about therapies for the COVID-19 Omicron variant, CMS created HCPCS code J0248 for VEKLURY™ (remdesivir) antiviral medication when administered in an outpatient setting. This code is available for use by all payers and is effective for dates of service on or after December 23, 2021:

  • Long descriptor: Injection, remdesivir, 1 mg
  • Short descriptor: Inj, remdesivir, 1 mg

Medicare Administrative Contractors (MACs) determine Medicare coverage when there’s no national coverage determination, including in cases when providers use FDA-approved drugs for indications other than what’s on the approved label. The MACs consider the major drug compendia, authoritative medical literature and accepted standards of medical practice to determine medical necessity when considering coverage. Therefore, the MACs will determine Medicare coverage for HCPCS code J0248 for VEKLURY™ (remdesivir) administered in an outpatient setting.

Your MAC will share coverage and claims processing information for J0248. Find your MAC's website if you have questions about coverage.

Visit the Monoclonal Antibody COVID-19 Infusion webpage for more information.


COVID-19: Pfizer Booster Doses for Ages 12+ & Immunocompromised Ages 5–11

On January 3, the FDA amended the Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization (PDF) to authorize the use of a single booster dose for:

  • All patients 12 years and older
  • Immunocompromised patients 5–11 years old

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

More Information:


CMS Proposes Medicare Coverage Policy for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease & National Stakeholder Call

On January 11, CMS released a proposed National Coverage Determination (NCD) decision memorandum. The proposed NCD would cover FDA approved monoclonal antibodies that target amyloid for the treatment of Alzheimer’s disease through coverage with evidence development—which means that FDA-approved drugs in this class would be covered for people with Medicare only if they are enrolled in qualifying clinical trials. The proposed NCD is open to public comment for 30 days… Read the full press release.

Register for a CMS stakeholder call on the proposed NCD, January 13 at 3 pm ET.


Additional Residency Positions: Apply by March 31

You can apply online for Consolidated Appropriations Act, 2021, section 126 additional residency positions. Submit fiscal year 2023 applications no later than March 31, 2022. For details, see section 126: Distribution of Additional Residency Positions of the Direct Graduate Medical Education webpage.


Medicare Ground Ambulance Data Collection System: Updated Documents

CMS updated these documents based on clarifications and changes we finalized in the CY 2022 Physician Fee Schedule Final Rule:

Find this and more in the Ambulances Services Center webpage Spotlights section.


DMEPOS Requirement Updates Effective April 13

CMS added 31 items and deleted 5 items on the Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Master List.

If you order or supply these items, you may need to:

  • Meet with your patient and give them a written order before delivering the item
  • Ask your Medicare Administrative Contractor to authorize the item in advance

Learn more about these requirements:


RHC: AIR Payment Limit for CY 2022

From January 1-December 31, 2022, the Rural Health Clinic (RHC) Medicare payment limit per visit is $113.00. The national statutory payment limit per visit will increase each year from 2021 through 2028 for all RHCs, including independent RHCs and provider-based RHCs in a hospital with 50 or more beds. Beginning in 2029, we’ll update the payment limit per visit each year by the percentage increase in the Medicare economic index.

For more information, see the official instruction to your Medicare Administrative Contractor (PDF).


Non-Medical Factors Can Affect Patient Health

Help advance health equity for all Americans. Use Z codes (PDF) to identify poverty, unemployment, homelessness, and other social determinants. 37.2 million Americans living in poverty have an increased risk of chronic conditions, lower life expectancy, and barriers to quality health care; and racial and ethnic minorities have poverty rates more than twice that of white Americans. The COVID-19 pandemic has significantly affected these populations and low-income families.

During National Poverty in America Awareness Month, learn more about health disparities:




DMEPOS Items: Documenting Medical Records

For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for:

  • Type and quantity of items ordered
  • Frequency of use (or replacement if applicable)

The medical record should include the patient’s diagnosis and:

  • Condition duration
  • Clinical course (worsening or improving)
  • Prognosis
  • Nature and extent of functional limits
  • Other therapeutic interventions and results
  • Experience with related items

The medical record may include records from hospitals, nursing facilities, home health agencies, and other health care professionals.

For more information, see the Medicare Program Integrity Manual, Chapter 5 (PDF), section 5.9.


Claims, Pricers, & Codes


DMEPOS: Accreditation Claims Edits

CMS will deny your claims if you aren’t accredited by a CMS-approved organization (AO). Starting January 3, we’ll tell you on your remittance advice if you aren’t properly accredited. Contact an AO (PDF) to get accredited. If you believe this message is incorrect:

  • Review your enrollment to ensure your accreditation information is up to date. Contact the National Supplier Clearinghouse for help changing your enrollment record.
  • If your record is correct, ask your AO to check their records.

Read the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation (PDF) fact sheet for more information.




National Stakeholder Call with the CMS Administrator — January 18

Tuesday, January 18 from 1–1:45pm ET

Register for the call.

Join CMS Administrator Chiquita Brooks-LaSure and her leadership team for this second national stakeholder call. The Administrator’s vision is for CMS to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes as we engage the communities we serve while developing and implementing policy. Learn how you can partner with us as we implement our vision.


  • Extraordinary legacy of Dr. Martin Luther King
  • CMS strategic vision and key 2021 accomplishments
  • 2022 goals

Target audience: National and local CMS stakeholders and partners




Clinical Lab Fee Schedule — Revised 

Learn about updated Medicare payment rules (PDF) to pay independent labs for collecting specimens from homebound patients and inpatients.


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