This week in Medicare updates—2/17/2021

February 17, 2021
Medicare Insider

COVID-19 FAQs on Medicare Fee-for-Service Billing 

On February 8, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included guidance on data collection and reporting requirements for the Medicare ground ambulance data collection system.   

CMS continues to update this document on a regular basis. Providers should review frequently for new information.


Emergency Use Authorization (EUA) of Bamlanivimab and Etesevimab

On February 9, CMS published Payment and Coding Information for an additional type of COVID-19 monoclonal antibody combination treatment of bamlanivimab and etesevimab, which received an EUA granted by the FDA on February 9. The EUA applies to the use of these two products administered together for treatment of mild-to-moderate COVID-19 in adults and pediatric patients ages 12 and older who weigh at least 40kg. The products are not to be used for patients who are hospitalized with COVID-19, require oxygen therapy due to COVID-19, or who require an increase in baseline oxygen flow due to COVID-19 while on chronic oxygen therapy for a separate, unrelated condition. Providers should report code Q0245 for the combination product and M0245 for the administration of the product. Payment rates are the same for this treatment as they are for the other two monoclonal antibody treatments currently under an EUA.  

CMS published an Authorization Letter and Fact Sheet about the product on the same date.


Visitation at Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs) - COVID-19

On February 10, CMS published a Memorandum to state survey agency directors regarding new guidance for visitation in ICF/IIDs and PRTFs during the PHE. While CMS acknowledges it is important to handle visitation carefully to prevent the spread of COVID-19, it also notes that social isolation may negatively affect patients in these facilities. The memo provides guidelines and recommendations on how to facilitate visitation safely in both indoor and outdoor settings. It also addresses testing for staff, clients/residents, and visitors; communal activities; survey considerations; legal requirements, and more. 

Effective date: Immediately. This policy should be communicated to all survey and certification staff, their managers, and the state/regional office training coordinators immediately.


Claims Processing Issues for Type of Bill 072X

On February 11, CMS published a Note in MLN Connects regarding two claims processing issues for TOB 072X for dates of service in 2021. CMS is aware of an issue where the ESRD network reduction was deducted twice from payments. It is also aware of an issue with claims with HCPCS codes J0604 and/or J0606, which may have received reason code 36226 claiming the AX modifier had to be appended to the line, which is not actually required. CMS and MACs will be correcting these errors and adjusting claims automatically.