CMS Replaces Instructions to Correct Payment Basis for Hospice Vaccines
Vaccines Billed on 8X1/8X2 TOB will be paid on Reasonable Cost Basis
October 10, 2016 02:26 PM
Effective October 1, 2016, hospices may bill vaccines and their administration on an institutional claim (8X1, 8X2). Prior to this change, hospices wishing to bill for preventive vaccines and their administration were required to enroll as suppliers and bill the appropriate Medicare Administrative Contractor (MAC). The National Association for Home Care & Hospice (NAHC) and members of its Forum of State Associations (FSA) sought this administrative simplification on behalf of hospice providers (see NAHC Report,April 8, 2014).
While the Centers for Medicare & Medicaid Services (CMS) issues instructions on the new option for hospice billing of vaccines and their administration earlier this year (see NAHC Report, May 1, 2016) with an effective date of October 1, 2016, the agency recently issued a correction to specify that the vaccines will be reimbursed at the “reasonable cost” rate rather than the “MPFS (Medicare Physician Fee Schedule)” rate, as was previously indicated in Change Request 9052/Transmittal 3540. In issuing the correction CMS rescinded the June issuance of CR 9052 and reissued it on October 7, 2016. As was indicated in previous issuances of CR 9052, the administration of these vaccines by hospice providers will be paid according to the MPFS. Payment made through the MPFS is based on geographic locality, and is at the assigned rate. Therefore, payments vary based on the geographic locality where the service was performed.
In related news, CMS recently issued Change Request 9793/Transmittal 3617, which provides instructions for payment and edits for the common working file (CWF) to include influenza virus vaccine code 90674 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) for claims with dates of service on or after August 1, 2016, processed on or after January 3, 2017.