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Thursday, November 3, 2022


Claims, Pricers, & Codes






COVID-19 Vaccine: Novavax Booster Authorized

On October 19, the FDA amended the Novavax COVID-19 Vaccine, Adjuvanted emergency use authorization to authorize the use of a first booster dose for patients 18 years and older:

  • For whom an FDA-authorized bivalent (updated) booster isn’t accessible or clinically appropriate
  • Who choose to get the Novavax booster because they wouldn’t otherwise get a COVID-19 booster

Use the new CPT code effective October 19, 2022:

Code 0044A for Novavax Covid-19 Vaccine, Adjuvanted - Administration - Booster Dose:

  • Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; booster dose
  • Short descriptor: ADM SARSCOV2 5MCG/0.5ML BST

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.


Medicare Part B Immunosuppressive Drug: Get Information on New Benefit

Patients with Medicare because of ESRD currently lose coverage 36 months after a kidney transplant unless otherwise eligible for Medicare. Patients who meet certain criteria will be able to qualify for continuous Medicare-covered immunosuppressive drugs. Find out about the new Medicare Part B immunosuppressive drug benefit:

  • Who’s eligible to enroll & when?
  • When does coverage start & what’s covered?
  • How does it work with other insurance?
  • What are the out-of-pocket costs?
  • How can I help my patients enroll?
  • What else do I need to know & where can I get more information?

This benefit only covers immunosuppressive drugs and no other items or services.


Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility

Starting January 1, 2023, Medicare will offer a new benefit that helps continue to pay for immunosuppressive drugs. The Part B immunosuppressive drug (Part B-ID) benefit is for patients who will lose ESRD Medicare coverage 36 months after a kidney transplant and who don’t have, and don’t expect to have, certain other types of health care coverage. The new benefit only covers immunosuppressive drugs and no other items or services.

Starting now, when you check patient eligibility for this benefit (PDF), the response may indicate Part B-ID coverage effective as early as January 1, 2023, with enrollment reason code “P-Part B Immunosuppressive Drug Benefit.” This response means that the patient only has coverage for immunosuppressive drugs starting January 1. They don’t have coverage for other items or services, even though the response indicates they do. 

Starting mid-December, the eligibility system will return noncoverage for all items and services except immunosuppressive drugs.

If you need help, contact your eligibility service provider.


Skilled Nursing Facilities: October Care Compare Release

View the October release of Skilled Nursing Facility Quality Reporting Program data on Care Compare and in the Provider Data Catalog. Visit the Updates Section of the Public Reporting webpage to learn more.


Clinical Diagnostic Laboratories: Report Private Payor Rate Data Beginning January 1

Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule? If so, you must report data from the original collection period (January 1 – June 30, 2019) between January 1 – March 31, 2023, including:

  • Laboratory test HCPCS codes
  • Associated private payor rates
  • Volume data

More Information:


Diabetes: Recommend Preventive Services

In 2019, 27.5% of Medicare Fee-for-Service patients had a diagnosis of diabetes (see data snapshot (PDF)). National Diabetes Month is the perfect time to talk with your patients about their risk factors, and recommend preventive services to detect, prevent, and treat diabetes.

Medicare covers:

Find out when your patient is eligible (PDF) for diabetes screenings and the Medicare Diabetes Prevention Program. If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes


Home Health Consolidated Billing Enforcement: CY 2023 HCPCS Codes

Effective, January 3, 2023, CMS will add the following codes to the home health consolidated billing non-routine supply code list:

  • A2014 Omeza collag per 100 mg Omeza collagen matrix, per 100 mg
  • A2015 Phoenix wnd mtrx, per sq cm Phoenix wound matrix, per square centimeter
  • A2016 Permeaderm b, per sq cm Permeaderm b, per square centimeter
  • A2017 Permeaderm glove, each Permeaderm glove, each
  • A2018 Permeaderm c, per sq cm Permeaderm c, per square centimeter

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




Medicare Provider Compliance Tips — Revised

CMS updated compliance tips with the latest improper payment rates, denial reasons, and codes. We also added information on:

  • Diabetic supplies
  • Inpatient rehabilitation services
  • Nebulizers
  • Oxygen

Find new tips for:

  • Allergy & immunology
  • Annual wellness visits & personalized prevention plan of service
  • Cataract removal
  • Chiropractor
  • Echography & sonography
  • Lipid panels
  • Physical therapy in private practice
  • Podiatry
  • Psychiatry




Hospice Quality Reporting Program: September Forum Materials

CMS posted the presentation, transcript, and audio recording (ZIP) from the September Hospice Quality Reporting Program Forum. Learn about:

  • FY 2023 final rule
  • Recent public reporting activity
  • Additional updates

See Provider and Stakeholder Engagement for more information.

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