This week in Medicare updates—7/8/2020
2021 Release of ICD-10-CM Codes
On June 30, the CDC published the 2021 ICD-10-CM Code Set files. There are 490 new codes, 47 revised codes, and 58 deleted codes. Changes include a new chapter, Chapter 22 (Codes for special purposes), which will be used for provisional assignment of new diseases of uncertain etiology or emergency use. In 2021, this chapter will consist of two codes, U07.0 (vaping-related disorder) and U07.1 (COVID-19). The 2021 code set will go into effect October 1, 2020, and will be used through September 30, 2021.
Proposed Decision Memo for Transcatheter Mitral Valve Repair
On June 30, CMS published a Proposed Decision Memo regarding expanded coverage of the transcatheter edge-to-edge repair (TEER) of the mitral valve for patients with functional mitral regurgitation (MR). The current NCD covers TEER of the mitral valve only for Medicare patients with significant symptomatic degenerative MR under coverage with evidence development (CED). In addition to expanded coverage to patients with functional MR, CMS proposes to remove the CED designation and will allow MACs discretion to cover TEER of the mitral valve for patients with degenerative MR.
CMS published a Press Release on the policy on the same date. Comments on the proposed decision memo are due by July 30.
Providing Mental Health and Substance Use Disorder Resources During the COVID-19 Public Health Emergency
On July 1, CMS published a Document for healthcare providers and health insurance issuers to remind them of ways to ensure access to mental health and substance use disorder resources during the COVID-19 pandemic. The document reviews expanded telehealth options and discusses where providers and issuers can find guidance to ensure they are practicing within the bounds of the laws and waivers currently in effect. It also discusses community resources and mobile apps providers can use to connect patients with resources during the pandemic.
Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19
On July 1, CMS updated a Fact Sheet on flexibilities for SNFs in the fight against COVID-19 to change information on staffing data submission, which was reinstated on June 25 after having been waived previously in the year. Staffing data must be submitted through the Payroll Based Journal system. New information is marked with double asterisks.
OIG Advisory Opinion No. 20-03
On July 1, the OIG published an Advisory Opinion regarding whether an arrangement in which a discount medical plan organization (DMPO) pays chiropractors and chiropractic clinics a fee for each new DMPO member referred by the chiropractor/chiropractic clinic would constitute grounds for the imposition of sanctions under the anti-kickback statute. The OIG determined that although this arrangement could potentially generate prohibited remuneration under the anti-kickback statute, it would not impose sanctions in this case. The OIG reasoned that the discounted rates apply only to services not covered by Medicare; membership in the DMPO does not require members to use a particular chiropractor; the DMPO services are marketed toward chiropractors rather than patients; and the DMPO is merely an intermediary and does not provide health care items/services, bill federal health care programs, receive any payment from federal health care programs, or recommend any particular items or services.
Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus
On July 1, CMS revised Special Edition MLN Matters 20011, originally dated March 16, 2020, to revise billing instructions on page 12 to include instructions to readmit the beneficiary on day 101 to start the SNF benefit period waiver. The original article was issued regarding information on waivers for providers and suppliers in the wake of the COVID-19 national emergency declaration on March 13.
Quarterly HCPCS Drug/Biological Code Changes - July 2020 Update
On July 1, CMS published Medicare Claims Processing Transmittal 10196 regarding updates to the HCPCS code set for drugs and biologicals. The update adds two codes, Q5119 (injection, rituximab-pvvr, biosimilar [Ruxience] 10 mg) and Q5120 (injection, pegfilgrastin-bmez, biosimilar [Ziextenzo] 0.5 mg), to the code set.
CMS published MLN Matters 11769 on the same date to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: July 6, 2020
New Point of Origin Code for Transfer From a Designated Disaster Alternate Care Site
On July 1, CMS published One-Time Notification Transmittal 10205, which rescinds and replaces Transmittal 10205, dated June 12, 2020, to change the implementation date. The original transmittal was issued regarding the creation of a new Point of Origin (PoO) code, “G”, which will be defined as “transfer from a designated disaster alternate care site” and is effective on July 1, 2020. The code was created relative to the COVID-19 PHE.
On July 2, CMS revised MLN Matters 11836 to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: August 3, 2020
Updated OIG Work Plan
On July 2, the OIG updated its Work Plan with the following new item:
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2021
On July 2, CMS published Medicare Claims Processing Transmittal 10202 regarding the annual update to the payment rates for the SNF PPS. These rates will be published in the Federal Register.
On July 6, CMS published MLN Matters 11859 to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020
July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On July 2, CMS published Medicare Claims Processing Transmittal 10207, which rescinds and replaces Transmittal 10166, dated June 5, 2020, to correct numerous errors or omissions from the previous transmittal. Changes include a new CPT code, 99458, for remote physiologic monitoring; a corrected APC assignment for HCPCS code C9760 (APC 1589); a note about the inadvertent deletion of CPT code 0126T from the July I/OCE update; the addition of a new PLA COVID-19 code, 0202U; and more. The original transmittal was issued regarding the July 2020 update of the OPPS. Changes include new status indicators for certain virtual services, 25 new CPT Category III codes, multiple COVID-19 related changes, and more.
CMS revised MLN Matters 11814 on the same date to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: July 6, 2020