Short Takes: New Preventive Vaccines, High-Dollar Facility Claims, & MID Program Changes

CDC Adds Meningitis and Monkeypox Vaccines to 2024 Preventive Schedule

The Centers for Disease Control and Prevention (CDC) recently approved new vaccines for meningitis and monkeypox (now called mpox) for the 2024 Preventive Schedule effective Jan. 1, 2024. For procedure codes and more information, click here.

Acute Care Facilities: Itemized Bills Required for Local and Host Claims Starting at $50,000

Providers will be required to submit itemized bills for high-dollar, inpatient care (costing $50,000 or more) at acute care facilities, effective Feb. 6, 2024, for both local and host (out of area) claims. This new requirement — the previous threshold was $100,000 — is part of an initiative by Highmark to reduce billing and/or payment errors on high-dollar claims that occur both in-network (IN) and out-of-network (OON). For more information, click here.

MID Program Changes: Mandatory Drug Category to Be Eliminated

Effective Feb. 1, 2024, professional providers will be able to buy and bill all drugs listed in the Medical Injectable Drug (MID) Program, as the mandatory category — which includes 36 drugs — will be eliminated. Starting Feb. 1, 2024, all drugs in the MID program will be considered voluntary across all regions, for all lines of business. To read the Special Bulletin, click here.