Category: Business
CPT code for Janssen CoVid-19 Booster
October 27, 2021
The new CPT code for the booster dose of the Janssen COVID-19 vaccine joins unique CPT codes previously issued to COVID-19 vaccine booster doses from Moderna and Pfizer.
For quick reference, the new code assigned to the Janssen booster for the COVID-19 vaccine is:
0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5 mL dosage; booster dose
UHC Policy Updates November 2021
Community Plan
Reimbursement Policy Update Bulletin: November 2021
Medicare Advantage
Reimbursement Policy Update Bulletin: November 2021
Commercial
Medical Policy Update Bulletin: November 2021
Community Plan
Medical Policy Update Bulletin: November 2021
Medicare Advantage
Coverage Summary Update Bulletin: November 2021
UHC Link Down at this time
Medicare Advantage
Policy Guideline Update Bulletin: November 2021
UHC Link Down at this time
Two New Files Added
PHE Extended, Again
Department of Health and Human Services (HHS) Secretary Xavier Becerra has once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days. Unless it is further extended, the current determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days’ notice prior to allowing the PHE to lapse.
Attention: Codes deleted from ICD-10
ATTENTION!
Please Read!
Thirty-nine codes were deleted from the 2022 ICD-10 code set effective October 1, 2021.
Three of these 39 codes are billed by PCPs quite frequently:
M54.5 (low back pain)
R05 (cough)
R63.3 (feeding difficulties)
POET has been told, “Cigna Medicare is denying the whole claim as “inappropriate diagnosis code” when billed with one of these deleted codes. “
Texas Prepares to Inplement “GOLD CARD”
HAD YOUR FILL OF BURDENSOME PRIOR AUTHORIZATIONS?
For the Nitty Gritty of how House Bill 3459 is supposed to make your life easier follow this link to the TMA article by Joey Berlin.
Biden Vaccine Mandate Plan
Earlier this month, President Joe Biden introduced a six-point plan that mandates COVID-19 vaccines for millions of Americans.
Many details of the plan are still being developed as specific regulations are written, but at least one aspect of the plan is clear: The vaccination mandate for “over 17 million health care workers at Medicare and Medicaid-participating hospitals and other health care settings,” largely does not apply to small physician practices, according to Texas Medical Association analysis
HAVING UHC CLAIMS ISSUES?
If You Are Having UHC OON
Claims Issues,
Please Read This!
POET is working with the TMA regarding UHC OON issues. They have confirmed the following:
If you are billing with a GROUP TIN:
You will not utilize the group NPI# in box 33a – if you do, it will process OON. Only the individual physician’s NPI# should be listed here since your physicians has an individual contract with UHC, not a group contract.
For those claims processing OON, if timely filing limits have not passed you should file corrected claims with the individual NPI in box 33a.
When verifying whether a physician is in or out of network, you should not provide the group NPI#.
This only reflects physicians who are in the POET All Products contract. If you have a direct, POET is unable to direct you in this matter.
Recent Comments