by CMS - MLNConnects
June 16th, 2022
- COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose
- Biosimilars: Interchangeable Products May Increase Patient Access
- Critical Care Evaluation & Management Services: Comparative Billing Report in May
On May 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization (PDF) to authorize the use of a single booster pediatric dose (orange cap) for all patients 5–11 years old. CMS issued a new code, effective May 17, 2022, for the vaccine administration:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation
- Short descriptor: ADM SARSCV2 10MCG TRS-SUCR B
For more information, visit the COVID-19 Provider Toolkit, and get the most current list of billing codes, payment allowances, and effective dates. (Note: you may need to refresh your browser if you recently visited these webpages).
Depending on state pharmacy laws, you may substitute an interchangeable biosimilar product at the pharmacy, much like substituting a generic for a brand-name drug. This helps increase patient access to biologics and may reduce patient costs. Learn more about Interchangeable Biological Products from the FDA. Bookmark FDA’s Biosimilars webpage and materials for health care providers and patients.
Additional FDA resources you may find helpful:
In late May, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for critical care evaluation and management services. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.
CBRs aren’t publicly available. Look for an email from firstname.lastname@example.org to access your report. Update your email address in PECOS to make sure you get it.
Medicare covers primary or secondary surgical dressings:
- When used to protect or treat a wound
- If needed after you debride a wound
- Include clinical information in patients’ medical records that demonstrates a reasonable and necessary need for the type and quantity of surgical dressings
- Evaluate the wound monthly and update the record, unless you document why you can't do a monthly evaluation and how you're monitoring the patient's ongoing use of dressings
For more information, see the Surgical Dressings – Policy Article.
- Z92.850 – Personal history of Chimeric Antigen Receptor T-cell therapy
- Z92.858 – Personal history of other cellular therapy
- Z92.86 – Personal history of gene therapy
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