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COVID-19 Catch Up for J15 Providers Ask-the-Contractor Teleconference (ACT)

View the handoutPDF for the March 4, 2021, COVID-19 Catch Up for J15 Providers Ask-the-Contractor Teleconference (ACT).

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  1. If a Medicare Advantage (MA) member receives a monoclonal antibody during an emergency department (ED) visit, would we bill CGS for the monoclonal antibody and the MA plan for all other charges?

    • Correct. The antibody charge would come to CGS, all other charges to the MA plan.

      Published: 03.18.21

  2. The March 4, 2021 PDF listed in the handouts is not working.

    • Here are the links to the webpage and PDF for the MLN Connects:

      Published: 03.18.21

  3. For audio only Annual Wellness Visit (AWV), if the patient refuses to provide vitals, can we still bill for the AWV?

    • You will need to document what was not completed for the AWV. Documentation requirements have not been waived during the PHE.

      Published: 03.18.21

  4. Codes G2061 – G2063 were replaced with a physician only account. Are there other CPT codes to report on the facility side?
  5. Regarding modifier CS, for patients that are having lingering health issues related to COVID is it appropriate to attach that modifier to the claim?
  6. Can you provide the Contractor Medical Director (CMD) email address again, please?
  7. Question about Postpayment service specific review: the letters state we can submit via fax, mail or ESMD. Will there be an option to submit via myCGS? If so, can this please be included on future letters?

    • Postpayment review ADRs are not available in myCGS at this time. We apologize for the inconvenience this causes you.

      Published: 03.18.21

  8. Can we have clarification on the correct use of Modifier CR with examples? 

    • Please refer to slide 35 of the presentation/handout. CMS also issued the following special edition article that discusses appropriate utilization of Modifier CR, https://www.cms.gov/files/document/se20011.pdf.

      Published: 03.18.21

  9. The CR/DR chart is not clear.
  10. Does an urgent care facility bill COVID testing with a CR or CS modifier?

    • The HCPCs modifier "CR" (catastrophe/disaster related) modifier for Part B billing, both institutional and non-institutional, i.e., claims submitted using the ASC X12 837 professional claim format or paper Form CMS-1500 or, for pharmacies, in the NCPDP format. The HCPCS modifier CS went into effect March 18, 2020 this modifier identifies when Medicare Part B to cover beneficiary cost-sharing for provider visits when a COVID-19 diagnostic test is administered or ordered.

      For additional guidance on the usage of the CR modifier please refer to the CMS Coronavirus Waivers and Flexibilities webpage,

      CMS updated the list of codes (ZIP) that physicians and non-physician practitioners can use with the Cost-Sharing (CS) modifier.

      Published: 03.18.21

  11. For an advantage plan the administration charges goes to Medicare, what about the vaccine charge? Does that mean administration is going to one place and vaccine charge to another?

    • Vaccine codes should not be included in the claim since they are currently provided at no charge.

      Published: 03.18.21

  12.  Is there no reimbursement to the skilled nursing facility (SNF) for the actual COVID-19 vaccine? Only the administration?

    • Correct. The vaccine codes should not be billed and are not reimbursed since they are currently being provided at no cost.

      Published: 03.18.21

  13. Should we be including the A6 code on the administration billing?

    • Yes, condition code A6 is required on institutional claims for the COVID-19 vaccines and the monoclonal antibody infusion.

      Published: 03.18.21

  14. Is this webinar being recorded so staff whom did not attend can listen?

    • Yes, the recording, presentation and Q&A document will be posted on our website. The following URLs will take you to the recorded webinar pages for each line of business.

      Published: 03.18.21

  15. The code 0031A is not the typical code; I bill as a Part B provider and we use HCPCS level II codes which usually begin with a letter. Is there another code for the administration?

    • No, this is the code assigned to the Janssen Covid-19 Vaccine Administration.

      Published: 03.18.21

  16. When billing the Bamlanivimab, is there a requirement for diagnosis Z23? If yes, is there written guidance for providers?

    • This is a requirement for institutional claims. This will be addressed in the presentation and guidance may be found on the CGS COVID-19 page (select COVID-19 tab from navigation menu) and the CMS COVID-19 FAQs referenced in the March 4th edition of the CMS MLN Connects newsletter. The link below will take you to CMS's webpage dedicated to information regarding monoclonal antibodies. There is a section that addresses all billing requirements and coding guidance, https://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusionExternal Website.

      Published: 03.18.21

  17. How do you bill for those who have an HMO plan on a roster bill. I was told condition code 78 was required. Where does it go?

    • You will need to use the patient's MBI to submit the claim to CGS. If you do not have the MBI, use the myCGS MBI Lookup Tool: /parta/pubs/news/2018/05/cope7584.html. For Part A (including HHH) claims only, you will need to use Condition Code 78 – New coverage not implemented by Medicare Advantage (if the beneficiary is enrolled in a MA plan) in addition to Condition Code A6 – 100% payment. Condition Codes are placed on the 1450 (UB-04) Form in form locators 18 – 28 and the electronic equivalent being Loop 2300, segment HI. Please reference the CGS Part A COVID-19 Vaccine Billing Job Aid at, /parta/pubs/news/2021/02/cope20503.html.

      Published: 03.18.21

  18. Can you provide scenarios for when it's appropriate to use and not use the Modifier CR in the outpatient setting?

    • CMS revised MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) to clarify when you must use modifier CR (catastrophe/disaster related) when submitting claims to Medicare. This update includes a chart of blanket waivers and flexibilities that require the modifier and can be found at https://www.cms.gov/files/document/se20011.pdf.

      Published: 03.18.21

  19. Can a Federally Qualified Health Center (FQHC) bill the administration fee for the COVID vaccine to Part B if there's not face to face? Patient is seen for vaccine admin only.

    • If the vaccine administration is the only service given on that day, no claim is filed, the patient coinsurance is waived, and the administration cost is included in the cost report.

      Published: 03.18.21

  20. Can you please address billing guidelines as it relates to COVID vaccine/mAb tx given in ESRD facilities?
  21. For 1500 professionals, how to bill Medicare for Advantage plans when the patient files the claim to bill the Medicare Advantage Plan?
  22. There is a question we have regarding how to bill Bamlanivimab administration as an emergency. Rev code 0260 or 0771, Diagnosis code?

    • For part A claims, revenue code 0771 and diagnosis codes Z23 – Encounter for immunization and U071 – COVID-19 (monoclonal antibody infusion only) will be used. Please reference the CGS Part A COVID-19 Vaccine Billing Job Aid at, /parta/pubs/news/2021/02/cope20503.html.

      Published: 03.18.21

  23. Please advise of the billing for route of administration when patient supplies the medication.

    • Drug Administration Reminder – As a reminder, in order to be processed for consideration, the drug or biological must meet all the general requirements for coverage under the incident-to provision; an FDA approved drug or biological must:

      Be of a form that is not usually self-administered;

      • Must be furnished by a physician; and
      • Must be administered by the physician, or by auxiliary personnel employed by the physician and under the physician's personal supervision.

      The charge, if any, for the drug or biological must be included in the physician's bill, and the cost of the drug or biological must represent an expense to the physician.

      If a medication is determined not to be reasonable and necessary for diagnosis or treatment of an illness or injury, CGS will deny coverage for both the drug and its' administration. Also, CGS will deny any charges for other services (i.e. office visit) rendered for the purpose of administering a non-covered injection.

      NOTE: If the provider has received a drug at no-cost or the patient brings in the drug, the drug may be submitted with a nominal fee of $0.01 (one cent), with the appropriate administration code.

      References: Medicare Claims Processing Manual, 100-02, Chapter 15, Sections 50.3 and 50.4.3External PDF

      Published: 03.18.21

  24. Is a modifier required on office visit charge when billing with a COVID test?
  25. How do I obtain Medicare numbers for patients that are on a Medicare Advantage plan?

    • You will need to use the patient's Medicare Beneficiary Identifier (MBI) to submit the claim to CGS. If you do not have the MBI, use the myCGS MBI Lookup Tool.

      Published: 03.18.21

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