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2022-05-26-MLNC



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

Thursday, May 26, 2022

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

Compliance

 * Surgical Dressings: Medicare Requirements

Publications

 * Screening Pap Tests & Pelvic Exams — Revised

 


NEWS


COVID-19: NEW ADMINISTRATION CODE FOR PFIZER PEDIATRIC VACCINE BOOSTER DOSE

On May 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine emergency
use authorization (PDF) to authorize the use of a single booster pediatric dose
(orange cap) for all patients 5–11 years old. CMS issued a new code, effective
May 17, 2022, for the vaccine administration:

Code: 0074A

 * Long descriptor: Immunization administration by intramuscular injection of
   severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus
   disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10
   mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation
 * Short descriptor: ADM SARSCV2 10MCG TRS-SUCR B

For more information, visit the COVID-19 Provider Toolkit, and get the most
current list of billing codes, payment allowances, and effective dates. (Note:
you may need to refresh your browser if you recently visited these webpages).

 


BIOSIMILARS: INTERCHANGEABLE PRODUCTS MAY INCREASE PATIENT ACCESS

Depending on state pharmacy laws, you may substitute an interchangeable
biosimilar product at the pharmacy, much like substituting a generic for a
brand-name drug. This helps increase patient access to biologics and may reduce
patient costs. Learn more about Interchangeable Biological Products from the
FDA. Bookmark FDA’s Biosimilars webpage and materials for health care providers
and patients.

Additional FDA resources you may find helpful:

 * Overview of Biosimilar Products
 * Biosimilar Regulatory Review and Approval (PDF)

 


CRITICAL CARE EVALUATION & MANAGEMENT SERVICES: COMPARATIVE BILLING REPORT IN
MAY

In late May, CMS will issue a Comparative Billing Report (CBR) on Medicare Part
B claims for critical care evaluation and management services. Use the
data-driven report to compare your billing practices with those of peers in your
state and across the nation.

CBRs aren’t publicly available. Look for an email from
cbrpepper.noreply@religroupinc.com to access your report. Update your email
address in PECOS to make sure you get it.

More Information:

 * View a webinar recording
 * Visit the CBR website
 * Register for a live webinar on June 8 from 3–4 pm ET

 


COMPLIANCE


SURGICAL DRESSINGS: MEDICARE REQUIREMENTS

Medicare covers primary or secondary surgical dressings:

 * When used to protect or treat a wound
 * If needed after you debride a wound

You must:

 * Include clinical information in patients’ medical records that demonstrates a
   reasonable and necessary need for the type and quantity of surgical dressings
 * Evaluate the wound monthly and update the record, unless you document why you
   can't do a monthly evaluation and how you're monitoring the patient's ongoing
   use of dressings

For more information, see the Surgical Dressings – Policy Article.

 


PUBLICATIONS


SCREENING PAP TESTS & PELVIC EXAMS — REVISED

Learn about 3 new ICD-10 diagnosis codes for these screenings (PDF):

 * Z92.850 – Personal history of Chimeric Antigen Receptor T-cell therapy
 * Z92.858 – Personal history of other cellular therapy
 * Z92.86 – Personal history of gene therapy

 

--------------------------------------------------------------------------------

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