Medicare Clinical Laboratory Fee Schedule Private Payor Data Reporting – Delayed until 2023
The Protecting Medicare and American Farmers from Sequester Cuts Act delayed the Clinical Laboratory Fee Schedule private payor reporting requirement:
- Next data reporting period is January 1 – March 31, 2023
- Reporting is based on the original data collection period, January 1 – June 30, 2019
The Act also extended the statutory phase-in of payment reductions resulting from private payor rate implementation:
- No payment reductions for Calendar Years (CYs) 2021 and 2022
- Payment won’t be reduced by more than 15% for CYs 2023 through 2025
COVID-19 Vaccine & Monoclonal Antibodies : Changes for MA Plans Starting January 1, 2022
If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.
Pneumococcal Conjugate Vaccine, 15 Valent
Medicare began covering pneumococcal conjugate vaccine,15 valent on July 16. CMS suggests submitting separate claims for this vaccine (HCPCS code 90671).
- Part A and B Medicare Administrative Contractors will hold claims for vaccines provided after December 31 until pricing is set
- CMS will deny claims for vaccines provided before July 16
Average Sales Price Files: January 2022
CMS posted the January 2022 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2022 ASP Drug Pricing Files webpage.
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims. The 2% sequestration cut that would apply to all Medicare rates beginning January 1, 2022 is postponed until April 1, 2022:
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1 – June 30, 2022
- 2% payment adjustment beginning July 1, 2022
New Telehealth POS codes
The Centers for Medicare & Medicaid Services (CMS) has published new guidance on the reporting of telehealth/telemedicine Place of Service (POS) codes.
For reporting Medicare telehealth services, CMS had recommended reporting the POS code that would have been reported if the service had been furnished in person. This recommendation was intended to allow CMS to make appropriate payments for services furnished via Medicare telehealth at the same rate as in-person services.
The POS code listed on a claim provides information on the location or setting for the services rendered. This information is necessary to pay claims correctly.
To meet the widespread use of telehealth during the public health emergency, CMS is now updating the 2022 POS code set by revising the description of existing POS code 02, Telehealth Provided Other than in Patient’s Home, and adding new POS code 10, Telehealth Provided in Patient’s Home. According to CMS’ October MLN Matters, the POS changes will go into effect on Jan. 1, 2022, and will be implemented on April 4, 2022.
POS 02: Telehealth Provided Other than in Patient’s Home
The location where health services and health-related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health-related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home
The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.