ParaRev Weekly eJournal July 13, 2022

ej o u r n a l july 13, 2022

Mental Health Telehealth

Modifier For Payable Drugs

RHC And FQHC Visits Following PHE

Proposed Rule Adds Modifier

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PARA Weekly eJournal: July 13, 2022

GENDER ISSUE

Q.

Billing is having issues filing a claim for a patient who was born male, but had gender

reassignment surgery and is now female. The biller is getting an edit on CPT® 00924, that is something to do with the patient's gender. Do you have any suggestions on to file this claim?

A.

The document provided indicates that the problem is occurring with professional billing.

The item that is missing is the KX Modifier. The KX modifier is a multipurpose informational modifier that alerts the MAC that it is not an error and will allow the claim to continue with normal processing. In this situation, KX should be appended to 00914.

Chapter 32 of the Medicare Claims Processing Manual offers special instructions for services with a gender/procedure conflict. We have included a link and excerpt for your review.

Medicare Claims Processing Manual (cms.gov)

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PARA Weekly eJournal: July 13, 2022

MPFS PROPOSED RULE ADDS ANOTHER MODIFIER FOR PAYABLE DRUGS

CMShasproposedthat hospital , physician, and Ambul atory Surgery Center cl aims reportingexpensive drugs(OPPSStatus KandG)appendanewmodifier -- JZ-- tothedrugHCPCSwhennoportionof a singl e-usevial iscl aimedaswaste.

The proposal is discussed beginning on page 491 of the unpublished version of the CY 2023 Payment Policies under the Physician Fee Schedule: https://www.federalregister.gov/public-inspection/2022-14562/medicare-and-medicaidprograms-calendar-year-2023-payment-policies-under-the-physician-fee-schedule

Currently, hospitals are required to report the wasted portion of expensive drugs on a separate line with modifier JW appended to the HCPCS, but if no wasted portion of a single-use vial is claimed, neither a modifier nor a second line reporting the drug is required.New modifier JZ would be appended to the single-line HCPCS when no second line of wastage would be claimed, to verify that no portion was wasted.

For example, if the proposed rule is adopted, when the full contents of a 2-milligram vial of CathFlow ® , J2997, is used for a declotting procedure, a claim to Medicare would append modifier JZ to J2997 as indicated in this screen shot from the PARA Dat a Edit or : (see next page)

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PARA Weekly eJournal: July 13, 2022

MPFS PROPOSED RULE ADDS ANOTHER MODIFIER FOR PAYABLE DRUGS

CMS hopes the modifier will improve billing data needed to facilitate refunds from drug manufacturers for wasted drugs. The Infrastructure Investment and Jobs Act (Pub. L. 117-9, November 15, 2021) requires drug manufacturers to issue a refund to CMS for certain discarded amounts from certain single-dose container or single-use package drug. To claim the maximum refund, CMS needs accurate data, and seeks to improve reporting from hospitals to ensure the refund amounts are appropriate.

Medicare?s proposed rule indicates they are not confident the data from the JW modifier is adequate: ?Under our current discarded drug policy, no modifier is required when there are no discarded amounts from a single use vial or single use package drug. However, we are aware that the JW modifier is often omitted on claims, and it is unclear whether the absence of the JW modifier on a claim for a single-dose container drug indicates that there were no discarded amounts or that the modifier was incorrectly omitted from the claim.

This has led to incomplete data describing quantities of discarded amounts and the associated Medicare payments.?? Because JW modifier data is incomplete and because refund amounts would rely on this data, we propose that for dates of service on or after January 1, 2023, the JW modifier be required on claims for all single-dose container or single use drugs for which any amount is discarded (as reflected in our current policy and proposed above), and a separate modifier be required on claims for these drugs when there are no discarded amounts. Specifically, we propose to require the use of a separate modifier, the JZ modifier, to attest that there were no discarded amounts.?

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PARA Weekly eJournal: July 13, 2022

MPFS PROPOSED RULE ADDS ANOTHER MODIFIER FOR PAYABLE DRUGS

Since 2017, Medicare has required hospitals to report the wasted portion of a single-use vial on a second line item for each payable drug HCPCS. The second line, with modifier JW appended to the drug HCPCS, allows CMS to monitor wastage while permitting the provider to receive reimbursement for the entire vial contents.If the new proposed rule is adopted, hospitals would report the JZ modifier if no wastage was claimed, for instance if an entire vial was administered to the patient. A new claim edit would reject any claim for an OPPS status K or G drug which failed to report either 1) the JZ modifier, or 2) a second line of the same HCPCS with modifier JW appended.

Her e ar e a f ew m or e excer pt s f r om t h e n ar r at ive of t h e pr oposed r u le: ?More than half of Medicare spending for discarded amounts in 2020 represents about 40 billing and payment codes (that is, HCPCS codes), for which 10 percent or more of the total charges for the drug were for discarded units. A large proportion of single source drugs with 10 percent or more discarded units are dosed based on patient?s body weight or BSA. We note that the JW modifier data published on the CMS website is limited to only billing and payment codes that are published on the ASP Drug Pricing File. There are likely additional billing and payment codes payable under Medicare Part B available in single-dose containers that would be subject to the JW modifier policy and are not reflected in the data discussed above.? " ?? Because JW modifier data is incomplete and because refund amounts would rely on this data, we propose that for dates of service on or after January 1, 2023, the JW modifier be required on claims for all single-dose container or single use drugs for which any amount is discarded (as reflected in our current policy and proposed above), and a separate modifier be required on claims for these drugs when there are no discarded amounts.

Specifically, we propose to require the use of a separate modifier, the JZ modifier, to attest that there were no discarded amounts. To align with the JW modifier policy, the JZ modifier would be required when there are no discarded amounts from single use vials or single use packages payable under Part B for which the JW modifier would be required if there were discarded amounts. So, on all claims for single use vials or single use packages payable under Part B, either the JW modifier would be used (on a separate line) to identify any discarded amounts or the JZ modifier (on the claim line with the administered amount) would be present to attest that there were no discarded amounts. We believe the proposed JZ modifier requirement would not increase burden on the provider because under the current JW modifier policy, the provider already needs to determine whether or not there are any discarded units from a single use vial or package, record discarded amounts in the patient medical record, and specify administered and discarded amounts on the claim form." CMS seeks comments on the proposed rule.

Comments may be submitted after the final publication of the proposed rule, expected on 7/29/2022.Interested parties may submit electronic comments on the proposed rule to http://www.regulations.gov. Follow the ?Submit a comment? instructions.

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PARA Weekly eJournal: July 13, 2022

PALMETTO OPPS EDIT ISSUE: MODIFIER PT ON COLONOSCOPY CODES

Two Par aRev clients recently reported an unexpected edit when submitting claims to Palmetto GBA, the Medicare Administrative Contractor (MAC) Jurisdiction JM (West Virginia, Virginia, North Carolina, and South Carolina) for colonoscopy claims reporting the PT modifier. Palmetto has acknowledged a system error which applied to claims reporting only one diagnostic colonoscopy code, such as 45380 (COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE) with modifier PT appended.

The system error triggered Edit 120, which states:?Incorrect reporting of modifier PT ? A claim is submitted with only one procedure from the designated surgical ranges (10000-69999 or 0000T-9999T) and reported with modifier PT for a single date of service. This edit is returned at the line level.?

CMS acknowledged the payment error in its May 5, 2022 edition of MLNConnects: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogproviderpartnership-email-archive/2022-05-05-mlnc#_Toc102553738

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PARA Weekly eJournal: July 13, 2022

PALMETTO OPPS EDIT ISSUE: MODIFIER PT ON COLONOSCOPY CODES

The April 1, 2022 update to the Integrated Outpatient Code Editor (IOCE) from CMS at the national level appears to be at the root of the problem.The April 1, 2022 IOCE update added the following sentence to adjudication instructions under section 5.10 --Preventive Services and Deductible/Coinsurance Waiver Processing: ?Note: Given that multiple procedures within the surgical ranges defined (10000-69999 or 0000T-9999T) are expected, if the claim submitted has only a single line, within those surgical ranges, reported with modifier PT for a single date of service, edit 120 is applied.?

The new sentence from the April 2022 IOCE update was the source of the problem. Although multiple codes reporting different colonoscopy procedures may be reported when more than one diagnostic or therapeutic procedure is performed in the same operative session, multiple codes are not always expected for colonoscopy claims.

The July 1 update appears to have corrected the language by deleting the ?Note? sentence and replacing it with the following paragraphs: https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs

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PARA Weekly eJournal: July 13, 2022

PALMETTO OPPS EDIT ISSUE: MODIFIER PT ON COLONOSCOPY CODES

Palmetto graciously acknowledged that the edit is incorrect, and advised the facility that they are working to resolve the problem. Following is an excerpt from the email the hospital received from Palmetto in response to their written inquiry: ?? The edit W7120 has been recognized as a system error and is currently under review.

There is no provider action necessary and any corrections or updates will be done internally.

Please allow more time for correction.? ?

The PT modifier is used to identify a colonoscopy that began as a screening colonoscopy, but was converted to a diagnostic or therapeutic colonoscopy due to the discovery of cancer or precancerous conditions (such as polyps) during the screening procedure.

Although screening colonoscopies are covered by Medicare in full, without patient liability, if evidence of colon cancer or precancerous conditions are discovered during the procedure, the service cannot be reported using the screening colonoscopy HCPCS (i.e. G0121 -- COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK).

The findings during the colonoscopy procedure require it to be reported with diagnostic HCPCS codes, such as 45380 (COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE.) Diagnostic colonoscopy codes are n ot covered in full ? these codes are adjudicated by Medicare to assign both deductible and coinsurance to patient liability.

The PT modifier attempts to alleviate some of the dissatisfaction generated when patients are assigned unexpected financial liability following the screening procedure. When modifier PT is appended to a diagnostic colonoscopy code, Medicare will waive the deductible that would otherwise apply ? although Medicare will not waive the coinsurance ? not just yet. Beginning in 2023, Medicare will gradually reduce the coinsurance obligation for diagnostic or therapeutic colonoscopy procedures when modifier PT is appended ? culminating in no patient liability for such procedures after 1/1/2030.

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PARA Weekly eJournal: July 13, 2022

RHC AND FQHC MENTAL HEALTH TELEHEALTH VISITS FOLLOWING PHE

On June 6, 2022, in MLN Article, "Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers," CMS revised in-person requirements for Mental Health Visits via Telecommunication for RHCs and FQHCs following the COVID-19 Public Health Emergency (PHE).

Per Section 304 of the Consolidated Appropriations Act (CAA) 2022, when a Medicare beneficiary receives mental health visits via telecommunications, RHCs and FQHCs will not require in-person visits until the 152nd day following the COVID-19 PHE. The exception applies only to RHC and FQHC mental health services; all other providers must abide by the following Medicare requirements? No other changes were made to the mental health visit telehealth requirements.

The exception applies only to RHC and FQHC mental health services; all other providers must abide by the following Medicare in-person visit requirements for beneficiaries receiving mental health visits via telecommunications: - At least 6 months prior to a telecommunication visit for mental health - With limited exceptions, at least every 12 months during mental health telecommunications to diagnose, evaluate or treat the patient's mental health issues and conditions

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PARA Weekly eJournal: July 13, 2022

RHC AND FQHC MENTAL HEALTH TELEHEALTH VISITS FOLLOWING PHE

CMS provides a non-exclusive list of exceptions to the 12-month in-person visit when:

- The patient is in full or partial remission and needs only maintenance care - The patient's condition may worsen, or an in-person visit may be disruptive - The patient's care has been effective, but the patient may stop care with a required in-person visit - The practitioner considers the patient clinically stable, but an in-person visit could impair the progress or create an undue hardship for the patient or the patient's family Practitioners need to document circumstances leading to exceptions of the in-person visit.

Additional information is available through the following links: Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers

Section 304 of the Consolidated Appropriations Act (CAA) 2022

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PARA Weekly eJournal: July 13, 2022

SUPREME COURT INVALIDATES 2018-2019 340(B) PAYMENT CUTS

On June15, 2022, t heSupr emeCour t of t he Unit ed St at es (SCOTUS) issued a decision t hat Medicar eimpr oper ly r educed OPPSr eimbur sement t o cer t ain hospit al s which pur chasedr ugs under HRSA?s 340(b) pr ogr am in 2018 and 2019.

The full text of the court?s decision is available at https://www.supremecourt.gov/opinions/ 21pdf/20-1114_09m1.pdf.)

Th e good n ew s is that hospitals which endured reduced Medicare payments for drugs purchased under the 340(b) program may eventually recover the 340(b) cuts to reimbursement taken by Medicare in 2018 and 2019 ? although how and when that might happen is not yet determined.

Th e bad n ew s is that due to budget neutrality requirements, reversing the current payment policy could cause Medicare to fund the additional expense by cutting OPPS reimbursement in other areas.According to a study commissioned by the Federation of American Hospitals, even rural OPPS hospitals that were exempted from the 340(b) cuts could eventually be affected by the fallout: https://avalere.com/insights/opps-340b-policy-reversal-lowers-hospital-paymentand-increases-copays# ? nearly half (49.4%) of all OPPS 340B hospitals would see a net payment decrease in total OPPS payments under a policy reversal. This occurs because the corresponding budget neutrality payment reduction for all non-drug items and services would outweigh the drug payment increase.

The aggregate beneficiary cost-sharing amount for separately payable drugs across all OPPS 340B hospitals is estimated to increase by $472.8 million under a policy reversal. Of note, the specific cost-sharing amount a beneficiary pays for a drug or a service under OPPS is capped at the amount of inpatient hospital deductible, which is $1,484 in 2021.

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PARA Weekly eJournal: July 13, 2022

SUPREME COURT INVALIDATES 2018-2019 340(B) PAYMENT CUTS

Par aRev clients may assess the impact of the 340(b) reductions by reviewing the outpatient claim lines adjudicated by original Medicare in prior years, namely 2018 and 2019, on the CMS tab of the PARA Dat a Edit or . Simply enter ?JG? in the modifier field, and download (with detail) a list of claims paid by CMS according to CMS published data for 2019 and 2020.The data is exactly as published by Medicare in the MEDPAR Limited Data Set.

The downloaded spreadsheet offers two tabs - a list of claims (Headers), and line item details:

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PARA Weekly eJournal: July 13, 2022

SUPREME COURT INVALIDATES 2018-2019 340(B) PAYMENT CUTS

On the Det ails tab, clients can filter the results to only those line items reported with modifier JG; the sum of the CMS Payment Amount, beneficiary deductible, and beneficiary coinsurance is the total ?allowed? amount that was reduced under the 340(b) cuts:

The American Hospital Association published a Special Bulletin on June 15, 2022 stating that ?Now that the Supreme Court has ruled, we look forward to working with the Administration and the courts to develop a plan to reimburse 340B hospitals affected by these unlawful cuts while ensuring the remainder of the hospital field is not disadvantaged as they also continue to serve their communities.? https://www.aha.org/system/files/media/file/2022/06/2022-0615-Special-Bulletin -340B-Supreme-Court-Decision.pdf

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PARA Weekly eJournal: July 13, 2022

SUPREME COURT INVALIDATES 2018-2019 340(B) PAYMENT CUTS

According to the AHA bulletin, the Supreme Court concluded that ?[u]nder the text and structure of the statute,? the case was ?straightforward? as a matter of law: ? Because HHS did not conduct a survey of hospitals?acquisition costs, HHS acted unlawfully by reducing the reimbursement rates for 340B hospitals.?

(Although rates in 2020 could arguably be affected by the SCOTUS decision, reimbursement rates in 2021 and 2022 are not covered because CMS conducted a survey of hospital acquisition costs for those years.)

Beginning January 1, 2018, Medicare reduced OPPS reimbursement for separately payable (Status K) drugs purchased under the 340(b) program at certain hospitals. In 2018, CMS adjusted the reimbursement amount for 340(b) drugs at the average sales price (ASP) minus 28.5 percent, although certain hospitals were excepted from the payment adjustment policy.In 2019, CMS dropped the reduction to ASP minus 22.5%.

Drugs that were not acquired through the 340(b) program were paid under the OPPS at ASP+6 percent in both 2018 and 2019. Affected hospitals are required to append modifier ?JG? (Drug or biological acquired with 340B drug pricing program discount) to outpatient claims reporting payable drugs to facilitate the discounted rate of payment.

In 2019, CMS calculated payments made on drug charges with the JG modifier appended at .775 of the ASP (in other words, ASP minus 22.5%.) That rate is lower than standard OPPS methodology of 106% ASP (ASP plus 6%.) Therefore, for every $100 in allowable paid on lines reporting modifier JG in 2019, affected hospitals might recover an additional $36.77.

However, since 20% of the allowable would have been adjudicated to beneficiary liability, there will be some negotiation over the precise amount that CMS will pay ? and where the money will come from, since budget neutrality requires the additional payments to be offset from other OPPS expenditures.

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PARA Weekly eJournal: July 13, 2022

COVID PHE EXTENSION EXPECTED WITHOUT ADDED HRSA FUNDS

Although it has not announced an extension to the COVID-19 Public Health Emergency (PHE) past July 15, 2022, the Biden administration is expected to extend the Public Health Emergency (PHE) for at least another 90 days. (Under federal law, the HHS Secretary may extend PHE declarations only 90 days at a time.)

In a Letter to Governors dated January 22, 2022, the administration indicated that HHS will provide states with 60 days notice prior to the termination of the public health emergency declaration for COVID-19.No advance notice has yet been issued. https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx

Meantime, program funding to cover vaccination, testing, and treatment of uninsured individuals under the Health Resource Services Administration (HRSA) has been exhausted, and Congress has shown little interest in replenishing those funds.

When the PHE ends, numerous regulatory waivers and subsidy programs that benefit both providers and patients will be at risk, unless Congress takes additional action, including: - The number of individuals obtaining health insurance coverage with subsidized premiums among plans on the federal Marketplace and state-based Marketplaces could be reduced, causing an estimated 3 million individuals to lose coverage; - Disenrollment of millions of people from Medicaid could result as states resume checking family income to verify eligibility for Medicaid coverage, which has been on hold since March of 2020. Telehealth services may be curtailed, particularly outside of rural areas.

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PARA Weekly eJournal: July 13, 2022

CMS ISSUES REMINDER ON CARDIAC DEVICE CREDITS

In May 2022, Medicare released a new MLN which reminds hospitals of the special billing rules for cardiac device charges if the hospital obtains the device at full or partial credit due to a manufacturer warranty or recall. Readers may recall the November 2020 audit report released

by The Health and Human Services Office of Inspector General (OIG), which found Medicare overpaid hospitals for reimbursements for medical devices supplied at a reduced cost for specific patients. The full OIG audit report is available on the PARA Dat a Edit or Advisor tab:

The new MLN reminds hospitals of the proper modifiers, condition codes and value codes that must be used for billing when receiving cardiac devices at no cost or with credits from the device manufacturers for the replacements. Below lists key billing information for reporting cardiac devices at no costs or credits.

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PARA Weekly eJournal: July 13, 2022

NAVIGATING COMPLIANCE: NO SECRETS IN PRICE TRANSPARENCY

The American Hospital Association said patients should be wary of reports regarding federal hospital price transparency compliance reports from organizations other than CMS. The group said in a June 16, 2022 post on its website that organizations have reached "wildly different conclusions about the status of implementation across the hospital field." It points to two reports as examples. A report from Patient Rights Advocate said 14 percent of hospitals are compliant. Another from Milliman found a 68 percent compliance rate.

The American Hospital Association said these groups are ignoring CMS's guidance on aspects of the rule, such as how to fill in an individual negotiated rate when such a rate does not exist due to patient services being bundled and billed together. In this instance a blank cell is appropriate, but outside reports count any file with blank cells as non-compliant.

"CMS, the only true arbiter, has indicated about 160 hospitals remain out of compliance, a much smaller number than either the Patient Rights Advocate or Milliman reports suggest," the American Hospital Association said in the post.

CMS h an ded dow n the first price transparency violation fines June 7. Atlanta-based Northside Hospital was fined more than $1 million for noncompliance at two of its hospitals.

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PARA Weekly eJournal: July 13, 2022

JULY 2022 OPPS CODING UPDATE

This paper summar izes t heJuly 2022 OPPS updat eas conv ey ed in t he CMS t r ansmit t al dat ed May 26, 2022. For a det ail ed l ist ing of t he OPPS codes, st at us indicat or s, and coding updat es, v isit t he OPPS t r ansmit t al at : https://www.cms.gov/files/document/r11435cp.pdf

Readers are advised that the July 2022 update to the OPPS Addendum A and Addendum B files was not available as of the date of this publication. The status indicator and payment information reported herein was derived entirely from the transmittal cited above.

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PARA Weekly eJournal: July 13, 2022

JULY 2022 OPPS CODING UPDATE

Su m m ar y of Ch an ges The update includes HCPCS additions, HCPCS changes, and payment policy indicators are generally described below; where the list of included HCPCS codes was lengthy, the list is provided on separate pages at the end of this paper.

- Pr opr iet ar y Lab An alysis Codes ? added 9 new codes for lab tests that are proprietary ? in other words, the test method applicable to that CPT® is owned by the patent holder for the test - Advan ced Diagn ost ic Lab Test - 1 new code was retroactively approved as an Advanced Diagnostic Lab Test (ADLT) to 3/24/2022. The ?TissueCypher Barrett?s Esophagus Assay?, CPT® 0108U, is OPPS Status Indicator A (paid under a fee schedule) - 24 n ew CPT Cat egor y III - codes have been added effective 7/1/2022. The AMA releases new codes in July and January of each year; Category III codes are temporary codes for emerging technology, services, procedures, and service paradigms - Pr ocedu r es assign ed t o New Tech n ology APC?s were updated: - Added CPT® 0721T -- The Optellum Lung Cancer Prediction (LCP) Procedure, which applies an algorithm to a patient?s CT scan to produce a raw risk score for a patient?s pulmonary nodule.Status indicator S, APC 1508 ($600-$700); effective 7/1/2022 - Added CPT® 0723T ? Quantitative Magnetic Resonance Cholangiopancreatography Procedure, which produces a three-dimensional reconstruction of the biliary tree, pancreatic duct, along with volume and duct metrics.Status indicator S, APC 1511 (Level 11, $900-$1,000), effective July 1, 2022 - Excluded the Argus®II Retinal Prosthesis implant codes, as the device is no longer available in the marketplace. The implantation procedure and programming procedures (0100T, 0472T, 0473T, C1841) will be assigned status E2, excluded from coverage, effective July 1, 2022 - Updated the description for HCPCS C9782 (CardiAMP cell therapy IDE study), which was established 4/1/2022.CMS revised the HCPCS description to specify inclusion of the device within the procedure code; assigned Status Indicator T, New Technology Level 39 ($15,001-$20,000.)

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PARA Weekly eJournal: July 13, 2022

JULY 2022 OPPS CODING UPDATE

- Sk in Su bst it u t es - Four Skin Substitute codes are newly assigned to the High Cost skin substitute group effective July 1, 2022.Among the four, A2001 (Innovamatrix ac, per square centimeter), will be retroactively payable as High-Cost effective April 1, 2022

- Dr u gs, Biologicals, an d Radioph ar m aceu t icals -Sixteen new drug codes were established effective July 1, 2022 ? of those, nine new codes were assigned pass-thru status, and four existing drugs with prior HCPCS assigned to pass-through status will have HCPCS updates to a new code:

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PARA Weekly eJournal: July 13, 2022

JULY 2022 OPPS CODING UPDATE

- J0879 (Injection, Difelikeafalin, 0.1 microgram (for End Stage Renal Disease on dialysis)) will become retroactively payable as status K under OPPS effective April 1, 2022.

- Covid-19 Labor at or y t est s an d ser vices (an d on e ot h er lab code)

- CMS provided a comprehensive list of COVID-19 lab tests and related services and OPPS status indicators. CPT® 87913 is relatively new, having been added in February 2022 - One lab code listed along with the COVID test codes, 0014M, is listed in this section, although it is not a COVID-19 lab test. It had been inadvertently omitted in the April OPPS update - HCPCS K1034 (Over-the-Counter Covid-19 Tests Demonstration) for providers who wish to supply home COVID-19 test kits to Medicare beneficiaries. HCPCS K1034 has been available to report dispensed test kits since April 4, 2022 - New Covid-19 Vaccin e an d Adm in ist r at ion codes - Effective 3/29/2022, CMS will recognize and reimburse the Moderna COVID-19 vaccine booster dose (91309) and its administration (0094A), which coincides with the date this vaccine received an Emergency Use Authorization (EUA) from the FDA - Several other new CPT ® codes were established by the AMA but cannot be billed to Medicare until they receive an Emergency Use Authorization (EUA), including the Sanofi Pasteur booster vaccine for adults 18 years and older, and the Pfizer booster code for pediatric patients 5-11 years old

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Click an yw h er e on t h is page t o be t ak en t o t h e f u ll on lin e docu m en t .

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PARA Weekly eJournal: July 13, 2022

MLN CONNECTS

PARA in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e!

Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces. Click each lin k f or t h e PDF!

Th u r sday, Ju ly 7, 2022 New s

-

Taking Action to Expand Access to Emergency Care Services in Rural Communities People with Disabilities: Help Address Disparities

Com plian ce -

DMEPOS Standard Written Order Requirements

Claim s, Pr icer s, & Codes -

Long COVID: Use ICD-10 Code U09.9

M LN M at t er s®Ar t icles -

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

Revised

Pu blicat ion s -

Teaching Physicians, Interns, & Residents Guidelines ? Revised

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TRANSMITTAL R11491OTN

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TRANSMITTAL R11492OTN

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TRANSMITTAL R11485OTN

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TRANSMITTAL R11488OTN

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PARA Weekly eJournal: July 13, 2022

FOR YOUR INFORMATION

The preceding materials are for instructional purposes only. The information is presented "as-is" and to the best of ParaRev?s knowledge is accurate at the time of distribution. However, due to the ever changing legal/regulatory landscape this information is subject to modification, as statutes/laws/regulations or other updates become available.

Nothing herein constitutes, is intended to constitute, or should be relied on as, legal advice. ParaRev expressly disclaims any responsibility for any direct or consequential damages related in any way to anything contained in the materials, which are provided on an ?as-is?basis and should be independently verified before being applied.

You expressly accept and agree to this absolute and unqualified disclaimer of liability.The information in this document is confidential and proprietary to ParaRev and is intended only for the named recipient. No part of this document may be reproduced or distributed without express permission. Permission to reproduce or transmit in any form or by any means electronic or mechanical, including presenting, photocopying, recording and broadcasting, or by any information storage and retrieval system must be obtained in writing from ParaRev. Request for permission should be directed to sales@pararevenue.com.

Par aRev is excited to announce we have joined industry leader Cor r oHealt h to enhance the reach of our offerings! Par aRev services lines are additive in nature strengthening Cor r oHealt h?s impact to clients?revenue cycle. In addition, you now have access to a robust set of mid-cycle tools and solutions from Cor r oHealt h that complement Par aRev offerings.

In terms of the impact you?ll see, there will be no change to the management or services we provide. The shared passion, philosophy and cultures of our organizations makes this exciting news for our team and you, our clients.

While you can review the Cor r oHealt h site HERE, we can coordinate a deeper dive into any of these solutions. Simply let us know and we?ll set up a meeting to connect.

As always, we are available to answer any questions you may have regarding this news. We thank you for your continued partnership.

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