COVID-19 Articles and Resources

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 Coronavirus & Telehealth Coding Page


News and Important Information

ALERT: As of November 1, 2023, there is only a single vaccine administration code (90480) and there are new product codes 91318-91322 for COVID vaccinations. Many other vaccine codes were eliminated so be sure to visit our COVID/Telehealth page to see the changes.

On January 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. Read here for New Waivers and Flexibilities announced by CMS

Feb 02, 2023- CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (Unless otherwise noted, these waivers will terminate at the end of the COVID-19 public health emergency (PHE).)

Articles and Support Pages for COVID

Current Codes: CMS- Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates.

 

Resources

Select the title to see a summary and a link to the full article.  some articles require a subscription to view.

Dec 12th, 2023

Changes to COVID-19 Vaccines Strike Again

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Oct 26th, 2023

COVID Vaccine Coding Changes as of November 1, 2023

by  Wyn Staheli, Director of Content - innoviHealth

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
May 4th, 2023

What’s Going on with the COVID Vaccines Now?

by  Wyn Staheli, Director of Content - innoviHealth

Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride and we now have two new twists to this exciting ride. Buckle up and let’s look at how this changes things.
Mar 16th, 2023

It is True the COVID-19 PHE is Expiring

by  Raquel Shumway

The COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.
Feb 7th, 2023

Is the End Really Near?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

What happens once the COVID-19 emergency declarations have ended?
Jan 5th, 2023

Covid-19 Vaccines for children 6 months to 5 years- 4 NEW CPT codes effective Dec 08, 22.

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The FDA amended the emergency use authorizations to include Pfizer-BioNTech and Moderna COVID-19 vaccines to include use in children down to 6 months old.
Oct 31st, 2022

CMS Updates COVID Vaccine Requirements for Staff

by  Wyn Staheli, Director of Content - innoviHealth

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements. This new memorandum replaces memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised.
Oct 24th, 2022

End-Stage Renal Disease Risk Model Updates for 2023

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?
Oct 24th, 2022

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.
Aug 21st, 2022

CMS Encourages Medicaid MCOs and CHIP to Employ Section Waivers to Improve SDoH and Reduce Healthcare Costs

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?
Aug 9th, 2022

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
Jul 19th, 2022

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.
Jul 14th, 2022

HHS Leaders Urge States to Maximize Efforts to Support Children’s Mental Health

by  SAMSHA Newsroom

Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.
Jul 7th, 2022

New Audio-Only Telehealth Guidance to Meet HIPAA Rules

by  U.S. Department of Health & Human Services

Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.
Jun 16th, 2022

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

by  CMS - MLNConnects

News - 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 - -...
Jun 7th, 2022

Do You Know What Code is Used to Report Long-Haul COVID-19 Conditions?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

A new code was added to the ICD-10-CM official code set with an effective date of October 1, 2022 for reporting post-COVID-19 sequela. We have all heard about people having odd conditions following COVID-19, well now there is a code available for reporting all of these anomalies, but are you familiar with the code and the rules for reporting it?
Apr 25th, 2022

CMS Creates New Code for Over-the-Counter COVID-19 Test

by  Raquel Shumway

COVID-19 testing coverage is expanding with a new code which became effective on April 4, 2022. From that date until the end of the COVID-19 public health emergency (PHE), Medicare is conducting a COVID-19 Test demonstration “to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.”
Apr 14th, 2022

Telehealth: The Current PHE Status and What to Expect

by  Terry Fletcher, CPC CCC CEMC CCS CCS-P CMC CMSCS CMCS ACS-CA SCP-CA QMGC QMCRC

Coming soon is the possible end of the PHE. Will it be extended? How does the Consolidated Appropriations Act of 2022 impact the PHE, and where does telehealth fit into all of this? The COVID-19 public health emergency (PHE) is slated to end this week on Thursday, April...
Apr 12th, 2022

Monitoring Changes to Telehealth in 2022

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

SUMMARY: Did you realize telehealth services increased by 11,000% between 2019-2020? Once again the newest CPT and HCPCS updates address telehealth changes for 2022 with new modifiers and guidelines for reporting. With such an increase in usage, the OIG has also identified significant fraud.
Mar 24th, 2022

Audit News Exacerbates Healthcare Crisis

by  Ronald Hirsch, MD FACP CHCQM CHRI

No good news is not good news. Last week brought some news that may have significant financial consequences for many providers. The Health Resources and Services Administration (HRSA) program that funded care for uninsured patients with COVID-19 will run out of money and stop accepting claims on March...

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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

May 11th, 2023

Post-Public Health Emergency (PHE) | Changes to Telehealth Services 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Thursday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 PM EST The official end of the COVID Public Health Emergency (PHE) is approaching, with May 11, 2023, marking its conclusion. Certain waivers and flexibilities will end on that date, while others will continue into 2024 or beyond (e.g., some telehealth-eligible services.) To stay informed about these changes, click here to register for our free, 30-minute webinar, on May 11, 2023.
Jul 7th, 2022

Dealing with the Little Coding Conundrums 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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