This week in Medicare updates—10/27/2021

October 27, 2021
Medicare Insider

Renewal of COVID-19 PHE

On October 19, ASPR published a Notice announcing that the COVID-19 PHE has been extended effective October 18, 2021. This will extend the PHE and all applicable waivers tied to it for an additional 90 days.


Updated OIG Work Plan

On October 19, the OIG updated its Work Plan with the following new items:


Annual Inflation Updates to the Annual Cap on Patient Engagement Tools and Supports

On October 20, the OIG published the Update to the annual monetary cap for the safe harbor for arrangements for patient engagement and support by a value-based enterprise (VBE) at 42 CFR §1001.952(hh). The 2022 cap is $527.


Most Medicare Beneficiaries Received Telehealth Services Only From Providers With Whom They Had an Established Relationship 

On October 20, the OIG published a Data Snapshot regarding the relationship between beneficiaries and providers of telehealth services during the COVID-19 pandemic. While telehealth services were significantly expanded during the PHE, there were concerns about the potential for fraud, waste, and abuse associated with expanded telehealth services. The OIG hopes the data can be used to inform decisions on future telehealth policy for how frequently in-person care may need to be paired with telehealth services. 

The OIG found that 84% of beneficiaries received telehealth services from providers with whom they already had an established relationship. Beneficiaries tended to see their providers in person about four months on average before their first telehealth service. The most common types of services beneficiaries received from providers with whom they already had an established relationship included e-visits, virtual check-ins, telephone evaluation and management, office visits, preventive services, and assisted living visits.


Correction Notice: FY 2022 Inpatient Prospective Payment System (IPPS) Final Rule

On October 20, CMS published a Correction Notice in the Federal Register to correct technical and typographical errors from the 2022 IPPS Final Rule, which was published in the Federal Register on August 13. Corrections include adding in inadvertently omitted ICD-10-CM codes, fixing typos in MS-DRGs, correcting missing references to revised language regarding cost reporting forms and teaching hospitals, and more. Note that some errors mentioned in the “Summary of Errors in the Preamble” do not appear to be addressed in the “Correction of Errors in the Preamble,” including the error in the maximum new technology add-on payment for Aprevo Intervertebral Body Fusion Device and omitted ICD-10-CM codes used to identify cases involving the use of INTERCEPT Fibrinogen Complex eligible for new technology add-on payment.

Effective date: October 19, 2021

Applicability date: Discharges occurring on or after October 1, 2021


NCD 90.2, Next Generation Sequencing (NGS)

On October 21, CMS published One-Time Notification Transmittal 11055 regarding updates to ICD-10 diagnosis codes for clinical diagnostic lab tests related to the NGS policy.

Effective date: July 1, 2020

Implementation date: November 23, 2021


ICD-10 and Other Coding Revisions to NCDs - April 2022 (CR 1 of 2)

On October 21, CMS published One-Time Notification Transmittal 11068 regarding maintenance updates of ICD-10 conversions and other coding updates for NCDs. 

Effective date: April 1, 2022 - unless otherwise specified in individual requirements

Implementation date: November 23, 2021 - MACs; April 4, 2022 - Shared System Maintainers


Manual Updates for Clarification on the Election Statement Addendum and Extension of the Hospice Cap Calculation Methodology

On October 21, CMS published Medicare Benefit Policy Transmittal 11056 regarding updates to the manual to clarify certain aspects of the hospice election statement addendum, such as timeframes on furnishing the addendum and signature requirements, as finalized in the FY 2022 hospice final rule. The updates also include changes to the hospice cap calculation methodology in accordance with policies from the Consolidated Appropriations Act of 2021. 

Effective date: October 1, 2021

Implementation date: December 22, 2021


Intravenous Immune Globulin (IVIG) Demonstration Update for a New Drug Code J1554 - ASCENIV

On October 21, CMS published Demonstrations Transmittal 11067 regarding a new approved J code (J1554 - ASCENIV) for the treatment of Primary Immune Deficiency Diseases (PIDD) in the home for the IVIG Demonstration. 

Effective date: April 1, 2021

Implementation date: April 4, 2021


April 2022 Update to the Medicare Code Editor (MCE) for New Edit 20 - Unspecified Code Edit

On October 21, CMS published Medicare Claims Processing Transmittal 11059 regarding updates to the Medicare Code Editor, including new edit 20 - unspecified code. It also provides a mechanism to systematically bypass the new edit when a specific billing note is present in the claim remarks field to indicate the primary reason why laterality could not be determined. 

On October 22, CMS published MLN Matters 12471 to accompany the transmittal.

Effective date: April 1, 2022 - Effective for discharges occurring on or after April 1, 2022

Implementation date: April 4, 2022


CMS Publishes Moderna and Johnson & Johnson COVID-19 Booster Shot Information

On October 22, CMS updated its Medicare COVID-19 Vaccine Shot Payment webpage to note that the FDA updated the Moderna and Johnson & Johnson COVID-19 vaccine EUAs to allow for booster shots for both vaccines. Medicare payment rates for these vaccines will remain at $40 per dose. CMS updated its COVID-19 Vaccines and Monoclonal Antibodies billing and coding webpage and Medicare Billing for COVID-19 Vaccine Shot Administration webpage to reflect the revised EUAs for both brands of the vaccine as well.