This week in Medicare updates—4/21/2021

April 21, 2021
Medicare Insider

Updated List of Telehealth Services

On April 9, CMS published a Download Link to its updated list of telehealth services payable under the Physician Fee Schedule for 2021. The updated list includes 24 codes for audiology and speech-language pathology services that have been temporarily added due to the COVID-19 PHE. The additions are effective March 1, 2021.


Medicare Billing: Form CMS-1450 and the 837 Institutional

On April 12, CMS published a revised MLN Booklet regarding billing Medicare provider claims using Form CMS-1450 or the 837I. Updates include a new reference to the Medicare Secondary Payer Manual in the claims submission section as well as a new section on where to submit FFS claims. 


Updated Corporate Integrity Agreement Documents

On April 12, the OIG published information on a new Corporate Integrity Agreement with the following entity:

The OIG published information on the same date on closed cases with the following entities:

  • CF Watsonville East, LLC, and CF Watsonville West, LLC, of Buena Park, CA
  • The Female Pelvic Medicine Institute of Virginia, P.C., and Nathan Guerette, M.D., of North Chesterfield, VA
  • Hebrew Homes Health Network, Inc., of North Miami Beach, FL
  • Millennium Health, LLC, of San Diego, CA
  • Mobile Medical Inc. d/b/a OnHealthcare, of Troy, MI
  • U.S. Physical Therapy, Inc., and Old Towne Physical Therapy Limited Partnership, of Houston, TX
  • Fredericksburg Hospitalist Group, LLC, of Fredericksburg, VA
  • Health and Palliative Services of the Treasure Coast, Inc., and The Hospice of Martin and St. Lucie, Inc., and Hospice of the Treasure Coast, Inc., of Stuart, FL


Final Decision Memo for AlloMap® Molecular Expression Testing for Detection of Rejection of Cardiac Allografts

On April 13, CMS published a Final Decision Memo regarding coverage of AlloMap® Molecular Expression testing for detection of rejection of cardiac allografts. CMS is not issuing an NCD for coverage of this product, as it believes MACs are better suited for determining coverage for patients who may benefit from this test.


Decision Memo for Autologous Blood-Derived Products for Chronic Non-Healing Wounds

On April 13, CMS published a Decision Memo regarding coverage of autologous blood-derived products for chronic non-healing wounds under NCD 270.3. CMS will cover autologous platelet-rich plasma (PRP) for the treatment of chronic non-healing diabetic wounds for a duration of 20 weeks when prepared by devices whose FDA-cleared indications include management of exuding cutaneous wounds. When this treatment continues beyond 20 weeks, coverage will be determined by the MACs.


NCA for Transvenous (Catheter) Pulmonary Embolectomy

On April 13, CMS published a Tracking Sheet for a National Coverage Analysis (NCA) on removing NCD 240.6 for Transvenous Catheter Pulmonary Embolectomy, which is currently not covered under Medicare because it is experimental. By issuing a tracking sheet, CMS initiates a 30-day public comment period on this request. Comments are due by May 13.


Comment Request: Business Proposal Forms for Quality Improvement Organizations (QIO); Medicare/Medicaid Psychiatric Hospital Survey Data and Supporting Regulations; more

On April 13, CMS published a Comment Request in the Federal Register regarding the submission of the following information collections for OMB review:

  • Business Proposal Forms for Quality Improvement Organizations (QIO)
  • Medicare/Medicaid Psychiatric Hospital Survey Data and Supporting Regulations
  • Community Mental Health Center Cost Report
  • Request for Termination of Premium-Hospital and or Supplementary Medical Insurance

Comments are due to the OMB desk officer by May 13.


Comment Request: CLIA Collection of Information Requirements Related to SARS-CoV-2 Test Results Reporting Under the PRA

On April 13, CMS published a Comment Request in the Federal Register regarding an information collection titled “CLIA Collection of Information Requirements Related to SARS-CoV-2 Test Results Reporting Under the PRA.” 

Comments are due by June 14.


Chapter 15 of Pub. 100-08 Manual Redesign - Additional Release of Chapter 10 of Pub. 100-08, Modification of Timeliness Standards

On April 13, CMS published Medicare Program Integrity Transmittal 10727, which rescinds and replaces Transmittal 10353, dated September 11, 2020, to update business requirements 11865.2 and 11865.4 and revise section 10.5(C)(1) in chapter 10 of Pub. 100-08. The original transmittal was issued regarding the reorganization of manual instructions in chapter 15 and the modification of the timeliness standards for processing all initial and change of information CMS-855 applications, CMS-20134 applications, and opt-out affidavits. 

Effective date: February 1, 2021

Implementation date: February 1, 2021


Notice of New Interest Rate for Medicare Overpayments and Underpayments - 3rd Qtr Notification for FY 2021

On April 13, CMS published Medicare Financial Management Transmittal 10731 regarding the third quarter update to the interest rate on Medicare overpayments and underpayments. The Department of Treasury has changed the private consumer rate to 9.5%.

Effective date: April 19, 2021

Implementation date: April 19, 2021


Monoclonal Antibody COVID-19 Infusion Information

On April 14, CMS updated its Monoclonal Antibody COVID-19 Infusion webpage with updated information on bamlanivimab, an antibody therapy that was granted an EUA in November 9, 2020. Due to the prevalence of variants which are resistant to bamlanivimab administered alone, the federal government and Eli Lilly and Company have stopped distributing bamlanivimab alone. The therapy can be provided to patients when administered with etesivimab. This combination product received an EUA on February 9, 2021. Facilities may order etesivimab alone to pair with a current supply of bamlanivimab. An additional antibody treatment, casirivimab and imdevimab administered together, also remains in use.


CDC Health Alert

On April 14, the CDC published a Health Alert regarding the pause in the use of the Johnson & Johnson COVID-19 vaccine, which CMS also posted on its COVID-19 provider webpage. The health alert was issued in part to ensure the healthcare provider community is aware of the potential for adverse events from the vaccine and can provide proper management due to the unique treatment required for the type of blood clot that may be associated with the vaccine. The health alert includes specific recommendations for clinicians, such as not treating patients with heparin for this complication, reporting adverse events to VAERS, and more. 


Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance

On April 15, the OIG published a Notice reminding vaccine providers that the COVID-19 vaccine is being provided by the federal government and must be administered at no cost to recipients. Providers participating in the CDC’s COVID-19 vaccination program also must comply with the terms of that program. The OIG included a list of those terms in the notice and said it is aware of complaints by patients about charges from providers when receiving their vaccines. Providers who charged individuals fees for the COVID-19 vaccine or administration must refund those individuals. 


Updated OIG Work Plan

On April 15, the OIG updated its Work Plan with the following new items:


Revisions to State Operations Manual Appendix Z - Emergency Preparedness 

On April 16, CMS published State Operations Provider Certification Transmittal 204 regarding revisions to Appendix Z of the manual to account for revised requirements for providers and suppliers based on changes introduced by the Burden Reduction final rule, effective November 29, 2019. The updates also build on experiences during the COVID-19 PHE to include additional guidance on pandemic preparedness.

Effective date: April 16, 2021

Implementation date: April 16, 2021