Updated CMS Guidelines For COVID-19 Tests And Booster Shot

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Updated CMS Guidelines For COVID-19 Tests And
Booster Shot
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Updated CMS Guidelines For COVID-19 Tests And
Booster Shot
Billing and coding guidelines for various medical
specialities are constantly getting updated due
different COVID-19 variants. Before delivering
services, providers are really not sure about
insurance coverage for that specific procedure.
As Public Health Emergency (PHE) has extended
beyond 16th April 2022 by 90 days, various
waivers are continued, making no change in
billing guidelines in pandemic. In fact,
concerned authority extended the current COVID-19
pandemic telehealth waivers for five months
beyond the end of the public health emergency. In
month of April 2022, CMS also announced couple of
important billing update for COVID-19 tests and
booster dose. We shared billing update for free
COVID-19 tests and second free booster dose in
detail in this article. Medicare to Cover
Over-the-Counter COVID-19 Tests On 4th April
2022, CMS announced that more than 59 million
Americans with Medicare Part B, including those
enrolled in a Medicare Advantage plan, now have
access to Food and Drug Administration (FDA)
approved, authorized, or cleared over-the-counter
COVID-19 tests at no cost. People with Medicare
can get up to eight tests per calendar month from
participating pharmacies and health care
providers for the duration of the COVID-19 public
health emergency. If beneficiary is in a Medicare
Advantage plan, the tests covered under this
initiative will be covered outside of existing
plans coverage, and in addition to any
over-the-counter tests that may be covered under
the plan as a supplemental benefit. Medicare
wont cover over-the-counter COVID-19 tests for
Medicare Part A (Hospital Insurance) coverage,
but beneficiary may be able to get free tests
through other programs.
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Updated CMS Guidelines For COVID-19 Tests And
Booster Shot
This is the first time that Medicare has covered
an over-the-counter self-administered test at no
cost to beneficiaries. This new initiative
enables payment from Medicare directly to
participating eligible pharmacies and other
health care providers to allow Medicare
beneficiaries to receive tests at no cost, in
addition to the two sets of four free at-home
COVID-19 tests. National pharmacy chains are
participating in this initiative, including
Albertsons Companies, Inc., Costco Pharmacy, CVS,
Food Lion, Giant Food, The Giant Company,
Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee
Pharmacy, Kroger Family of Pharmacies, Rite Aid
Corp., Shop Stop, Walgreens and
Walmart. Providers and suppliers eligible to
participate include certain types of pharmacies
and other health care providers who are enrolled
in Medicare and able to furnish ambulatory health
care services such as preventive vaccines,
COVID-19 testing and regular medical visits. To
ensure that people with Medicare have access to
these tests, Medicare is not requiring
participating eligible pharmacies and health care
providers go through any new Medicare enrollment
processes. If a health care provider currently
provides ambulatory health care services such as
vaccines, lab tests or other clinic type visits
to people with Medicare, then they are eligible
to participate in this initiative. Second
COVID-19 Booster Shot at No Cost On 4th April
2022, the Centers for Medicare Medicaid
Services (CMS) announced it will pay for a second
COVID-19 booster shot of either the
Pfizer-BioNTech or Moderna COVID-19 vaccines
without cost sharing as it continues to provide
coverage for this critical protection from the
virus.
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Updated CMS Guidelines For COVID-19 Tests And
Booster Shot
People with Medicare pay nothing to receive a
COVID-19 vaccine and there is no applicable
co-payment, coinsurance or deductible. People
with Medicaid coverage can also get COVID-19
vaccines, including boosters, at no cost. The
Centers for Disease Control and Prevention (CDC)
recently updated its recommendations regarding
COVID-19 vaccinations. Certain immunocompromised
individuals and people ages 50 years and older
who received an initial booster dose at least
four months ago are eligible for another booster
to increase their protection against severe
disease from COVID-19. Additionally, the CDC
recommends that adults who received a primary
vaccine and booster dose of Johnson Johnsons
Janssen COVID-19 vaccine at least four months ago
can receive a second booster dose of a
Pfizer-BioNTech or Moderna COVID-19 vaccine. We
shared updated CMS guidelines for COVID-19 tests
and booster shot for reference purpose only, you
can visit below mentioned CMS links for more
detailed understanding. Medisys Data Solutions is
a leading medical billing company providing
billing and coding services for various medical
billing specialities. If you need any assistance
in medical billing for your practice, contact us
at info_at_medisysdata.com/ 302-261-9187
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