Update to Vaccine Services Editing

MLN Matters Number: MM11975
Related CR Release Date: November 13, 2020
Related CR Transmittal Number: R10456CP
Related Change Request (CR) Number: 11975
Effective Date: For claims received on or after April 1, 2021
Implementation Date: April 5, 2021

CR 11975:

  • Allows an inpatient SNF claim that contains a “From” Date of Service (DOS) that overlaps only the “Through” date of a vaccine or telehealth outpatient claim for the same beneficiary
  • Instructs MACs to pay HCPCS codes G0008, G0009, and G0010 claims with a DOS in Calendar Year (CY) 2020 based on the CY 2019 national payment amounts for immunization administration services
  • Modifies current editing to allow vaccines and their administration when they are the only services on a 12x claim where the service date is equal to the discharge date of an inpatient claim for the same provider and the service date is equal to the "From" date of another inpatient claim with condition code B4 for the same provider

Please make sure your billing staffs are aware of these changes.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11975.


            Last Updated Wed, 18 Nov 2020 17:34:36 +0000