Medicare AdvantageBilling CodesHigh impact
22-259m Medicare Billing Changes for 2022
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Effective January 1, 2022, Medicare Advantage COVID-19 vaccine billing shifted from direct CMS reimbursement to delegated provider groups (HMO) or Health Net (PPO). New telehealth place of service codes were introduced, with POS 10 for home telehealth becoming available April 4, 2022.
Action Required
Immediately: Update billing workflows to submit Medicare Advantage COVID-19 vaccine claims to delegated provider groups (HMO) or Health Net (PPO) instead of Medicare fee-for-service. By April 4, 2022: Update billing system to use POS 10 for telehealth services provided in patient's home and POS 02 for telehealth outside patient's home. Home health agencies must submit NOA with TOB 32A within first 5 calendar days of care period to avoid penalties, followed by claims with TOB 329.