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Encourage Preferred Flu Vaccines for Patients 65+
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Thursday, September 22, 2022


Claims, Pricers, & Codes

MLN Matters® Articles




Flu Shot: Encourage Preferred Vaccines for Patients 65+

It’s time to talk with your patients about flu shots. The CDC recommends annual flu shots for everyone 6 months and older by the end of October or as soon as possible each flu season. You can give flu and COVID-19 vaccines at the same visit.

New for this flu season: Patients 65 and older should get a preferred vaccine if available. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines:

  1. Fluzone High-Dose Quadrivalent vaccine
  2. Flublok Quadrivalent recombinant flu vaccine
  3. Fluad Quadrivalent adjuvanted flu vaccine

If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.

Medicare Part B covers the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

You can now check eligibility (PDF) for the flu shot. If you need help, contact your eligibility service provider. We give information from claims billed in the last 18 months:

  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

More Information:


Cataract Surgery: Comparative Billing Report

CMS issued a Comparative Billing Report (CBR) on Medicare Part B claims for cataract surgery. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.

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

More Information:


Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals Form (CMS-855O) is required beginning January 1, 2023. We’ll post it on the CMS Forms List by early fall.

Medicare Administrative Contractors will accept the current and revised versions of Form CMS-855O through December 31, 2022. Visit the Medicare Provider Enrollment and Certification webpage for more information.

Changes to the form include:

  • New title
  • Uniform language across all CMS 855 applications
  • Revised reporting requirements and formatting in Section 3: Final Adverse Legal Actions
  • 8 new specialties, including Adult Congenital Heart Disease
  • Corrections in response to public comments


Cardiovascular Disease: Talk with Your Patients about Screening

In 2017, 57% of Medicare Fee-for-Service patients had a diagnosis of hypertension, with disparities among racial and ethnic groups and geographic areas. On World Heart Day, talk with your patients about cardiovascular disease, cholesterol, and stroke.

Medicare covers cardiovascular disease screening tests, and your patients pay nothing if you accept assignment. Check to find out when your patient is eligible for a screening (PDF). If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes

October 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Learn about quarterly updates to the following pricing files effective for dates of service:

  • October 1–December 31, 2022: October 2022 ASP and ASP not otherwise classified (NOC)
  • July 1–September 30, 2022: July 2022 ASP

See the instruction to your Medicare Administrative Contractor (PDF).


MLN Matters® Articles

October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Learn about OPPS updates (PDF), including:

  • New COVID-19 CPT vaccine and administration codes
  • Redosing update for EVUSHELDTM
  • New procedure to assess coronary disease severity using computed tomography angiography



Hospice Quality Reporting Program: New Resources

CMS published new resources for the Hospice Quality Reporting Program (HQRP):

More Information:


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