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 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg
M0249 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose
M0250 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose
The FDA EUA limits the administration of Actemra to intravenous infusion only. Actemra is supplied in individual single-dose vials. See the EUA for more details.
These codes are effective June 24, 2021, and the EUA is effective until further notice.
COVID-19 Vaccine Reimbursement for HHAs
Effective June 8, 2021, Medicare will pay an additional $35 per dose for administering the COVID-19 vaccine for certain Medicare patients who have difficulties leaving their homes or are hard to reach. This is reported with HCPCS Level II code M0201 Covid-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient’s home. This is in addition to the standard administration amount Medicare pays for the vaccine (approximately $40 per dose).
The Centers for Medicare & Medicaid Services (CMS) has published “Medicare Payment for COVID-19 Vaccination Administration in the Home,” which outlines requirements.
Commercial payers are generally following suit. Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN), for example, are following CMS guidelines, with the exception of implementation dates: The expansion of COVID-19 vaccine coverage is effective on or after June 8, 2021, for patients with Medicare. BCBSM and BCN implemented coverage as of July 1, 2021, according to The Record (August 2021).
CMS Updates Modifiers 59 and X{EPSU} Guidelines
CMS clarifies, “Use of modifiers 59 or -X{EPSU} does not require a different diagnosis for each HCPCS/CPT coded procedure. Conversely, different diagnoses are not adequate criteria for use of modifiers -59 or -X{EPSU}.”
CMS also reiterates that these modifiers are not to be used with evaluation and management codes, and not with CPT code 77427 Radiation treatment management, 5 treatments.
Reference:
https://www.aapc.com/blog/81020-take-5-medicare-news-you-can-use-july-2021/