Another emergency update: The glass half full version

Jan. 14, 2022 / By Rhonda Butler

In December I posted a blog on the “new and improved normal,” discussing the April 1 ICD-10-CM/PCS update added to the schedule beginning in 2022. Two updates a year instead of one is a welcome change according to many, including me. Although this year the April 1 update contains just a handful of new diagnosis and procedure codes, the precedent has been set, so hurrah for that, right?

Well, here’s the deal … this being an ongoing public health emergency, new and improved normal is relative. The Centers for Medicare and Medicaid Services (CMS) announced on Jan. 12, 2022, the addition of two more new ICD-10-PCS codes for April 1 implementation, to enable tracking of additional monoclonal antibody products approved for treatment of COVID-19.

The new codes are:

  • XW023X7 Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7
  • XW023Y7 Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7

The good news is, since the new codes are to be used for discharges on or after April 01, 2022, this time the industry won’t have to scramble to try to update systems on some random date, as with previous COVID-19 emergency updates. So, this is still a new and improved form of normal in my book.

The new codes and associated content are available for download on the CMS 2022 ICD-10 PCS page, in a single zip file entitled “ERRATA” and dated Jan. 12, 2022. The zip file includes the new codes, the additions to the index and definitions files, as well as a copy of the CMS website announcement.

The announcement contains information that may be confusing to those of us who don’t deal with the nuts and bolts of Medicare reimbursement. It discusses the fact that Medicare pays for COVID-19 vaccines for hospitalized patients using CPT® codes instead of the diagnosis-related group (DRG) rate. However, the paragraph doesn’t mention anything about payment for monoclonal antibodies. Then it directs readers to the vaccine administration webpage for more details. When I asked CMS about it, they referred me to a page I consider more useful, so I am sharing it here: the Monoclonal Antibody COVID-19 Infusion page.

Roughly two-thirds of the way down the page, just below the table that lists the monoclonal antibody products that have received Emergency Use Authorization (EUA) for COVID-19 treatment, there is a section titled, “Medicare Payment for Administering COVID-19 Monoclonal Antibody Products.” In that section it says, “CMS will continue to pay for COVID-19 monoclonal antibodies under the Medicare Part B vaccine benefit …” Mystery solved–monoclonal antibody treatment payment is paid as a vaccine benefit.

There is lots of other information on this page for those of you who would like to learn more. As for the amazing individuals who have to master the details of payment policy for COVID-19, you probably already have this page bookmarked. To all of you, best wishes for a happy and healthy 2022!

Rhonda Butler is a clinical research manager with 3M Health Information Systems.

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