2022 Comprehensive Covid-19 Guide
Condition Codes during the PHE Condition Code A6 – During the PHE, Medicare will cover monoclonal infusions and COVID-19 vaccines at no expense to the beneficiary under the COVID-19 vaccine program. Report Condition code A6 for 100% payment from Medicare. Per UB-04 Manual: "This code identifies that pneumococcal pneumonia and influenza vaccine services are reimbursed under special Medicare program provisions and Medicare deductible and coinsurance requirements do not apply."
Condition Code DR – The Disaster Related (DR) Condition code is an informational billing indicator to assist Medicare in collecting information on when services were permissible due to a waiver. While CMS will not reject a claim that falls outside of their revised instructions, on November 9, 2020, CMS provided a table to clarify when a provider should include condition code DR on an institutional claim. The MLN Matters publication link and an excerpt are provided below: https://www.cms.gov/files/document/se20011.pdf
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