This week in Medicare updates—2/3/2021
Acute Hospital Care At Home Approved List
On January 25, CMS updated a List of approved hospitals participating in the Acute Care Hospital at Home program as of January 22, 2021. The program has expanded to add 14 additional hospital systems this month. That increases the number of total hospitals participating in the program to 92 hospitals across 24 states.
MAC COVID-19 Test Pricing
On January 25, CMS published a Fact Sheet regarding pricing for COVID-19 test pricing by MAC. The Fact Sheet contains a table with 17 different CPT codes for COVID-19 testing and each of their payment rates by MAC.
Medicare Updates Data on COVID-19 Impacts on Medicare Beneficiaries
On January 25, CMS updated a Data Snapshot regarding Medicare beneficiaries and COVID-19. The data provides information on Medicare beneficiaries based on encounters from January 1 to November 12, 2020. Some of the findings from this most recent release include:
- There are nearly 2 million total COVID-19 cases among Medicare beneficiaries and nearly 500,000 hospitalizations. The number of COVID-19 cases among Medicare beneficiaries is nearly double what it was (1 million cases) when the last snapshot was issued in October (which had collected data based on encounters through mid September).
- The average Medicare payment per fee-for-service Medicare COVID-19 hospitalization was $23,558, a slight decrease from the previous snapshot’s average of $24,582. Medicare fee-for-service payments totaled $7.4 billion for COVID-19 hospitalizations by November 12, up from $4.4 billion in the October snapshot.
- The top four chronic conditions prevalent among fee-for-service beneficiaries hospitalized due to COVID-19 include hypertension (79%), hyperlipidemia (61%), chronic kidney disease (49%), and diabetes (49%).
- According to discharge data, 19% of Medicare patients hospitalized with COVID-19 died, a decrease from deaths in 22% of Medicare patients hospitalized as of the October snapshot.
Medicare Billing for COVID-19 Vaccine Shot Administration
On January 27, CMS updated the Medicare Billing for COVID-19 Vaccine Shot Administration webpage. The page notes that when COVID-19 vaccines are provided by the government for free, providers should only bill for the COVID-19 shot administration. It also notes that providers should submit the COVID-19 vaccines to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021. The page also describes how to submit institutional claims, professional claims, and a centralized bill for these services.
New COVID-19 Treatments Add-On Payment (NCTAP)
On January 27, CMS updated a Webpage on coding and billing for NCTAP, which currently includes treatments such as convalescent plasma, remdesivir, and baricitinib. The page instructs hospitals to report the ICD-10-PCS codes for these products regardless of whether the hospital received the product at no cost, but hospitals should not report charges associated with the product received at no cost.
Drug Claims Rejected in Error
On January 28, CMS published a Note in MLN Connects regarding a claims processing issue with HCPCS codes J0897 (denosumab: Prolia or Xgeva), J3111 (romosozumab-aqqg) and J3590 (unclassified drugs). Claims with these codes had been rejected in error (with FISS Reason Code 32453) when the drugs were for treatment of conditions other than osteoporosis in the home health setting. MACs will be correcting this error and reprocessing these claims automatically over the next several weeks.