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The American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes for pediatric doses of the Pfizer COVID-19 vaccine. In September 2021, Pfizer and BioNTech shared the results of a Phase 2/3 clinical trial in which two doses of the vaccine elicited a strong immune response in children ages 5 to 11. Following the trial, the … Read more
Make sure claims and documentation support medical necessity. Healthcare providers have been given the go-ahead to provide an additional dose of the COVID-19 vaccine to certain patients. Here’s what you need to know for Medicare claims. The U.S. Food and Drug Administration (FDA) amended the emergency use authorization for both the Pfizer BioNTech COVID-19 vaccine … Read more
New HCPCS Codes for COVID-19 Treatments On June 24, the Food and Drug Administration (FDA) released an Emergency Use Authorization for tocilizumab (Actemra), a monoclonal antibody product used for the treatment of COVID-19. Providers should use the following new HCPCS Level II codes when billing this product: Q0249 Injection, tocilizumab, for hospitalized adults and pediatric patients (2 … Read more
Deciding which code to use starts with determining each payer’s policy. The Healthcare Common Procedure Coding System (HCPCS) has two principal subsystems, referred to as Level I and Level II. Knowing when to use HCPCS Level I codes versus HCPCS Level II codes can be confusing, mainly because many services are described by both code … Read more
The AMA released a series of codes that would be eligible for reporting a COVID-19 vaccine under development by Novavax Inc. While the Novavax vaccine has yet to gain clearance from the U.S. Food and Drug Administration, the Gaithersburg, Md.-based biotechnology company has accelerated its testing and development and plans to ship hundreds of millions of products to the … Read more
Providers will find 205 proposed ICD-10-CM code changes in the FY 2022 version of the code set, slated to take effect Oct. 1, 2021. The proposed updates include 153 new diagnosis codes, 22 revised codes and 30 invalidated codes. The changes were issued in the proposed Inpatient Prospective Payment System (IPPS) payment rule for acute and long-term care hospitals, released … Read more
ICD-10 may be moving to biannual updates —April 1, in addition to October 1—depending on public comment . CMS and CDC jointly announced that the possibility of a regular April 1 update to ICD-10 is under consideration. CMS is taking the lead in the discussion and collection of public comment. By law, the current use … Read more
The U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab and etesevimab, administered together, for the treatment of mildto-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Bamlanivimab and etesevimab, administered … Read more
The American Medical Association (AMA) today announced that the Current Procedural Terminology (CPT®) code set is being updated by the CPT Editorial Panel to include vaccine and administration codes that are unique to the COVID-19 vaccine candidate under development by Janssen Pharmaceutica, a division of Johnson & Johnson. The new CPT codes will be effective for use … Read more
In response to the national emergency declared for the COVID-19 pandemic, the CDC has implemented six new ICD-10-CM diagnosis codes and CMS has implemented 21 new ICD-10-PCS procedure codes for COVID-19, as well as an updated MS-DRGs Version 38.1, all effective January 1, 2021. The six new diagnosis codes are: J12.82 Pneumonia due to coronavirus … Read more