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Provider Compliance Virtual Focus Group — February 24

Thursday, February 3, 2022



Claims, Pricers, & Codes


MLN Matters® Articles






COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule

Read the Health Care Worker Vaccination Rule letter that CMS issued to health care facility administrators (PDF).


COVID-19 Vaccine & Monoclonal Antibody Products: Changes for Medicare Advantage Plan Claims Started January 1 — Reminder

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:




Home Health Low Utilization Payment Adjustment Threshold: Bill Correctly

In a recent report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5–7 visits in a payment episode. Review the Medicare Home Health Benefit (PDF) and Home Health Prospective Payment System (PPS) booklets to properly bill for services slightly above the low utilization payment adjustment threshold.

Visit the Home Health PPS webpage to stay informed about the latest policy and payment updates:


Claims, Pricers, & Codes


SNF Consolidated Billing Codes for CY 2022

CMS updated HCPCS codes and Medicare Physician Fee Schedule designations to accurately pay for Part A Skilled Nursing Facility (SNF) stays that begin during calendar year (CY) 2022. View the updates:

For more information, see sections 20.6 and 110.4.1 of the Medicare Claims Processing Manual (104), Chapter 6 (PDF) and the official instruction to your Medicare Administrative Contractor (PDF).




Provider Compliance Virtual Focus Group — February 24

Thursday, February 24 from 1–4 pm ET

Register by Friday, February 18.

How can CMS improve its processes and eliminate unnecessary requirements for medical review and prior authorization? Join us on February 24, and let us know.

Target audience: physicians, non-physician practitioners, billing specialists, suppliers, associations, coders, medical review contractors


MLN Matters® Articles


Expedited Review Process for Hospital Inpatients in Original Medicare

Learn about updates (PDF) to section 200 of the Medicare Claims Processing Manual, Chapter 30, including:

  • Hospital responsibilities
  • Detailed Notice of Discharge


Internet-Only Manual Updates for Critical Care Evaluation and Management Services

Learn about critical care services provided during the global surgery period (PDF) and updates to section 40 of the Medicare Claims Processing Manual, Chapter 12, including:

  • Using modifier FT
  • Billing requirements, claims review, and adjudication


Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Learn about instructions and new codes, effective April 1, 2022 (PDF), and the reporting delay for private payor data.


National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds — Revised

Learn about HCPCS codes G0465 and G0460 for autologous platelet rich plasma (PDF).




Medicare Preventive Services — Revised

Learn about updates to preventive services, including:

  • Mammography screening: added ICD-10 code C84.7A, effective October 1, 2021
  • Medicare Diabetes Prevention Program: added information about the first ongoing maintenance session interval requirement and waived supplier enrollment application fee
  • Pap tests screening: added ICD-10 codes Z92.850, Z92.858, and Z92.86, effective October 1, 2021
  • Pneumococcal shot: added CPT code 90671, effective July 16, 2021, and CPT code 90677, effective July 1, 2021
  • Screening pelvic exams: added ICD-10 codes Z92.850, Z92.858, and Z92.86, effective October 1, 2021


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