This week in Medicare updates—6/1/2022

June 1, 2022
Medicare Insider

Updated EUA for Pfizer Vaccine

On May 23, CMS updated its COVID-19 Toolkit to note that the FDA revised the Emergency Use Authorization (EUA) for the Pfizer COVID-19 vaccine on May 17 to authorize a single booster pediatric dose for all patients ages 5-11 years old.  

CMS added information about payment rates for the pediatric booster dose to its Medicare COVID-19 Vaccine Shot Payment page. Payment remains the same ($40 per dose) for the pediatric booster as it does for other doses. CMS noted on its Billing for COVID-19 Vaccine Shot Administration page that providers should bill for these doses using the booster shot code 0074A.  


Revisions to NCD 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache

On May 23, CMS published Medicare National Coverage Determinations Transmittal 11429 and Medicare Claims Processing Transmittal 11429, which rescind and replace National Coverage Determinations Transmittal 11263 and Claims Processing Transmittal 11263, dated February 10, 2022, to extend the implementation date from June 14, 2022, to January 3, 2023. The original transmittals were published regarding changes to NCD 240.2 and the removal of NCD 240.2.2. 

CMS revised MLN Matters 12607 on the same date to accompany the transmittals. 

Effective date: September 27, 2021

Implementation date: January 3, 2023


Update to ‘J’ Drug Code List for Billing Home Infusion Therapy (HIT) Services 

On May 24, CMS published Medicare Claims Processing Transmittal 11430 regarding an update to guidance and claims processing systems changes necessary for implementing part of the 21st Century Cures Act regarding home infusion therapy services. It also updates the list of home infusion drugs to add J1551 to payment category 2. The corresponding G-codes for these drugs are G0069 or G0089. This transmittal is no longer sensitive and is being re-communicated.

Effective date: July 1, 2022

Implementation date: July 5, 2022


Advisory Opinion 22-11

On May 25, the OIG published an Advisory Opinion regarding whether a medical group practice’s proposal to employ an individual who is excluded from participation in federal health care programs would be grounds for the imposition of sanctions under civil monetary penalties. This individual would be employed to perform marketing tasks relating to workers’ compensation programs, none of which are federal health care programs. 

The OIG said that because of specific caveats the practice made to ensure the individual is not paid from any reimbursement received from federal health care programs and would not be involved in tasks involving federal health care programs, this arrangement would not implicate the civil monetary penalties. However, the OIG warned that the arrangement raises concerns from a compliance perspective, as the individual was excluded due to receiving illegal kickbacks in exchange for the referral of workers’ compensation patients and the role the individual would be serving in is designed to encourage workers’ compensation payors and attorneys to refer their clients to the requestor. 


Guidance Related to Emergency Preparedness - Exercise Exemption Based on a Facility’s Activation of their Emergency Plan

On May 26, CMS revised a Memorandum, originally published September 28, 2020, then revised on June 21, 2021, to state survey agency directors regarding clarifications on testing exercise requirements in light of the COVID-19 PHE. Due to the continued PHE and the number of facilities still operating under disaster/emergency conditions, CMS is exempting any inpatient or outpatient facility still operating under an activated emergency from the full-scale exercise requirement for specified 12-month cycles of testing exercises. Revisions add information for outpatient providers and revised the information on individual facility-based exercises and important reminders.

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


Program Integrity Manual, Chapter 5 Update - Planned Elimination of Certificates of Medical Necessity (CMN) and Durable Medical Equipment Information (DIF) Forms

On May 26, CMS published Medicare Program Integrity Transmittal 11431 regarding updates to Chapter 5 of the manual pertaining to the elimination of the CMN and DIF forms effective for claims with dates of service on or after January 1, 2023. 

Effective date: June 28, 2022

Implementation date: June 28, 2022


Transition of Enrollment and Certification Activities for Various Certified Provider and Supplier Types and Transactions

On May 26, CMS published Medicare Program Integrity Transmittal 11432 regarding the continued transition of certain administrative functions involving certified provider/supplier enrollment transactions from the CMS Survey & Operations Group (SOG) Locations to the MACs and CMS Provider Enrollment & Oversight Group. These latest enrollment transaction processing changes will affect ambulatory surgical centers, community mental health centers, comprehensive outpatient rehabilitation facilities, home health agencies, outpatient physical therapy/outpatient speech pathology, and portable x-ray suppliers. Also included is an instructional sheet for FQHC site enrollment.

Effective date: May 27, 2022

Implementation date: May 27, 2022


July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)

On May 26, CMS published Medicare Claims Processing Transmittal 11435 regarding the July 2022 updates to the OPPS. Updates include a new Level II HCPCS code for the over-the-counter COVID-19 test demonstration, four new procedures assigned to new technology APCs, and more. 

Effective date: July 1, 2022

Implementation date: July 5, 2022


July 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.2

On May 26, CMS published Medicare Claims Processing Transmittal 11434 regarding the July 2022 updates to the I/OCE.

Effective date: July 1, 2022

Implementation date: July 5, 2022


Comment Request: Hospital Notices: IM/DND; Medicare Outpatient Observation Notice (MOON); more

On May 26, CMS published a Comment Request in the Federal Register regarding the following information collections:

  • Hospital Notices: IM/DND
  • Medicare Outpatient Observation Notice (MOON)
  • Agent/Broker Data Collection in Federally-Facilitated Health Insurance Exchanges
  • Compliance with Individual and Group Market Reforms Under Title XXVII of the Public Health Services Act
  • Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment

Visit this website to view the proposed MOON. Visit this website to view the proposed IM/DND. 


Withdrawing Rule on Securing Updated and Necessary Statutory Evaluations Timely (SUNSET)

On May 27, CMS published a Final Rule Withdrawal in the Federal Register to announce it is withdrawing the SUNSET final rule, which was originally published in the Federal Register on January 19, 2021, by the previous administration. The rule was scheduled to take effect on March 22, 2021, but was delayed when a lawsuit was filed seeking to overturn it on March 9, 2021. In addition to the lawsuit, the Biden-Harris administration chose to review the rule internally and has now decided to withdraw the rule in its entirety.

Dates: As of July 26, 2022, the final rule is withdrawn.


Updates to Interim Final Rule, CMS-3401 IFC: Requirements and Enforcement Process for Reporting of COVID-19 Data Elements for Hospitals and Critical Access Hospitals (CAH)

On May 27, CMS revised a Memorandum to CMS locations, state agencies, hospitals, CAHs, and other stakeholders regarding COVID-19 data reporting requirements for CAHs and hospitals. CMS has revised the frequency for psychiatric and rehabilitation hospital reporting. Those facilities are required to report data elements described in the memo once annually and only have to include data for the previous week. CMS also revised information on enforcement.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the CMS Location training coordinators.