NCMS Morning Rounds 1-10-22

Happy Monday! Enjoy your NCMS Morning Rounds

January 10, 2022


COVID-19: New HCPCS Code for Remdesivir Antiviral Medication

Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding therapies for the COVID-19 Omicron variant, CMS created 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

Medicare Administrative Contractors (MACs) determine Medicare coverage when there is no national coverage determination, including in cases when providers use FDA-approved drugs for indications other than what is on the approved label. The MACs consider the major drug compendia, authoritative medical literature and accepted standards of medical practice to determine medical necessity when considering coverage. Therefore, the MACs will determine Medicare coverage for HCPCS code J0248 for VEKLURY™ (remdesivir) administered in an outpatient setting.

Your MAC will share coverage and claims processing information for J0248. Contact your MAC if you have questions about coverage.

How to Conduct a Rapid Community Assessment

Rapid community assessment (RCA) is a process for quickly collecting community insights about a public health issue to inform program design. The assessment involves reviewing existing data and conducting community-based interviews, listening sessions, observations, social listening, and surveys.

The Centers for Disease Control and Prevention (CDC) shares an assessment guide and tools for those who wish to better understand their community’s needs regarding COVID-19 vaccine acceptance and uptake among adults, adolescents, and children. View the CDC Resources Page here.

COVID-19 Vaccine & Monoclonal Antibody Products: Changes for MA Plan Claims Started January 1

If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.

More Information:

In the News

Provocative new findings suggest a surprising cause of Down syndrome: cells linked to aging, STAT, 1-6-22

Learning Opportunity 

Measuring Impact for Health Equity, January 25, 2022, from 2-5 pm ET and January 26, 2022, from 12-2 pm ET

The National Academy of Medicine’s Culture of Health Program will hold this virtual meeting to examine key considerations for measuring, evaluating, and communicating the impact of efforts to accelerate health equity. This meeting will also highlight existing approaches, including gaps and opportunities, to measuring and evaluating health equity strategies in various sectors, as well as elevate promising strategies to measure impact of efforts to sustain and advance health equity outcomes.

Learn more and register here. 


If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!


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