2022 COVID Plan Reminders and Updates

COVID Vaccinations and Vaccine Administration Claims

As detailed by CMS: Coverage and Reimbursement for Administration of the Vaccine by Health Insurance Issuers

The vaccine itself will be paid for through funding authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but administration of the vaccine by a provider will be paid for by the payer (for example, the private insurance company, Medicare Advantage plan as of January 1, 2022, or the Provider Relief Fund). Issuers of non-grandfathered group or individual health insurance coverage are required to cover without cost sharing the vaccine and its administration when provided by a network provider, and during the COVID-19 PHE, are also required to cover without cost sharing the vaccine and its administration when provided by an out-of-network provider. Providers are prohibited by agreement with the U.S. Government from billing patients for the vaccine or its administration, including balance billing.

Medicare Advantage Coverage and Payment

• For Calendar Years (CYs) 2020 and 2021, Medicare payment for the COVID-19 vaccine (if providers do not receive it for free) and its administration for beneficiaries enrolled in Medicare Advantage plans will be made through the Original Medicare program.
• For CY 2022, Medicare payment for the COVID-19 vaccine (if providers do not receive it for free) and its administration for beneficiaries enrolled in a Medicare Advantage plan will be made by the beneficiary’s Medicare Advantage plan. Original Medicare won’t pay COVID-19 vaccine administration claims for Medicare Advantage beneficiaries vaccinated on or after January 1, 2022.

Sequestration
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a bill designed to provide financial support and resources to individuals and businesses affected by the COVID-19 pandemic, was signed into law on March 27, 2020 and extended on December 27, 2020.

Under the Act, the 2% sequestration of Medicare payments is suspended effective May 1, 2020, through March 31, 2022. Beginning April 1, 2022 through June 30, 2022 we will implement the 1% payment adjustment. Beginning July 1, 2022, the full 2% payment adjustment is effective.

HealthTeam Advantage will continue to follow CMS regulations and suspend the sequestration as outlined.

COVID At-Home Tests
While the Biden-Harris Administration is requiring private insurance companies, and group health plans to cover the cost of at-home COVID-19 tests effective January 15, 2022, this does not impact Medicare or Medicare Advantage plans at this time. HealthTeam Advantage does not cover, nor reimburse members for COVID-19 over-the-counter (OTC) at home tests purchased at retailers such as Wal-Mart, Amazon, CVS, etc. Please do not order, recommend or indicate to an HTA member that this is a covered benefit. Read here for more information, and answers to FAQ.

Remdesivir: Antiviral Medication
On January 7, 2022 CMS released a new HCPCS code, J0248, for VEKLURY™ (remdesivir) antiviral medication when administered in an outpatient setting. This code is available for use by all payers and is effective for dates of service on or after December 23, 2021:

• Long descriptor: Injection, remdesivir, 1 mg
• Short descriptor: Inj, remdesivir, 1 mg
  
  

HealthTeam Advantage does cover HCPCS code J0248 for VEKLURY™ (remdesivir) administered in an outpatient setting. Please read here for more information.