If a health care professional bills a case rate on the same date of service as COVID-19 vaccine administration code for the same patient, UnitedHealthcare will deny the vaccine administration code; We will not adjust rates for payment on claims submitted before the April 15, 2021, date of service In addition to the requirements listed above, you must meet several other requirements to bill for the additional in-home payment amount for administering the COVID-19 vaccine to a Medicare patient: 1Includes a communal space in a group living situation2Could be an individual living unit or a communal space in a group living situation3You can only bill for 1 home add-on payment in this situation because you vaccinated 10 or more Medicare patients at the same group living location on the same date4In other words, each vaccine administered in a distinct individual living unit or communal space of a group living situation. Patients can get the COVID-19 vaccine, including additional doses and booster doses (includes bivalent or updated vaccine), without a physicians order or supervision, and they pay nothing for the vaccine and its administration. Explore reports on this topic from the Council on Medical Education presented during the AMA Interim and Annual Meetings. The vaccine isnt related to your patients terminal condition, The attending physician administered the vaccine, Your Medicare patients have other insurance, such as employer health insurance or coverage through a spouses employer health insurance. New CPT Codes for COVID-19 Vaccines and Administration . These CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. In this episode of Making the Rounds, learn about one resident's experience of not matching, offering insight on coping and how unmatched applicants can find a position. For dates of service on or after August 24, 2021, if fewer than 10 Medicare patients are vaccinated on the same day in the same group living location, report the HCPCS Level II code M0201 for each Medicare patient vaccinated in each home that day, and up to a maximum of 5 times when multiple Medicare patients are vaccinated in the same home unit or communal location, Bill for each dose administered using the appropriate CPT code for the product and dose-specific COVID-19 vaccine administration. New Current Procedural Terminology (CPT ) codes have been created that streamline the reporting of immunizations for the novel coronavirus (SARS-CoV-2, also known as COVID-19). These CPT codes, developed based on extensive collaboration with Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC), are unique for each of four coronavirus vaccines as well as administration codes unique to each such vaccine and dose. Officials and members gather to elect officers and address policy at the 2023 AMA Annual Meeting being held in Chicago, June 9-14, 2023. Official websites use .govA Access reports from the Council on Medical Education presented during the AMA Annual and Interim Meetings. Medicaid lock Before you submit a Medicare claim for administering COVID-19 vaccines, you must find out if: You must gather information both from patients with Original Medicare and those enrolled in Medicare Advantage plans. Learn more about, You canbill on single claims for administering the COVID-19 vaccine, or submit claims on a. Submit COVID-19 vaccine administration claims to the Medicare Advantage Plan. The AMA promotes the art and science of medicine and the betterment of public health. If you want to administer the vaccine for free, you dont have to submit a claim to Medicare, Medicaid, or another insurer. Get information about CPT codes created to streamline the novel coronavirus testing currently available on the U.S. market. Until the PHE ends, you should include modifier CR on your claim only if you administer the COVID-19 vaccine at a temporary location that isnt considered your actual practice location. Claims must contain both administration codes and vaccine codes to pay. TERMINOLOGY" (CPT), FOURTH EDITION End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American . Learn more with the AMA. Submit COVID-19 vaccine administration claims to the Medicare Advantage Plan. Official websites use .govA No, the large language model cannot deliver medical care. Mass immunizers may use a roster bill or submit a traditional claim form, such as a CMS-1500 form (PDF) or the 837P electronic format. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Medicare Billing for COVID-19 Vaccine Shot Administration, Enrollment for Administering COVID-19 Vaccine Shots, SNF: Enforcement Discretion Relating to Certain Pharmacy Billing, Beneficiary Incentives for COVID-19 Vaccine Shots, CMS Quality Reporting for COVID-19 Vaccine Shots, New COVID-19 Treatments Add-On Payment (NCTAP), Enrollment for Administering COVID-19 Vaccines, most current list of billing codes, payment allowances, and effective dates, Health Resources & Services Administration (HRSA) COVID-19 Coverage Assistance Fund, Health Insurance Claim Form (CMS-1500) (PDF), Between June 8, 2021, and August 24, 2021, $35 in-home additional payment + (2 x $40 for each COVID-19 vaccine dose) = $115, (2 x $35 in-home additional payment) + (2 x $40 for each COVID -19 vaccine dose) = $150, (5 x $35 in-home additional payment) + (9 x $40 for each COVID -19 vaccine dose) = $535, (12 x $35 in-home additional payment) + (12 x $40) = $900, (5 x each COVID -19 vaccine dose $35 in-home additional payment for the single communal space) + (3 x $35 in-home additional payment for each of the individual homes) + (8 x $40 for each COVID -19 vaccine dose) = $600, Administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine, Vaccinate everyone, including the uninsured, regardless of coverage or network status, Charge your patients for an office visit or other fee if COVID-19 vaccination is the only medical service given, Require additional medical or other services during the visit as a condition for getting a COVID-19 vaccination, You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. ** For hospitalized patients, Medicare pays for the COVID-19 vaccines separately from the Diagnosis-Related Group (DRG)rate. When you choose the Place of Service (POS) code for your Part B claims, carefully consider where you provided the vaccine. Providers administering the vaccine to people without health insurance were able to request reimbursement for the administration of the COVID-19 vaccine through the Health Resources & Services Administration (HRSA) COVID-19 Uninsured Program . Issue briefs summarize key health policy issues by providing concise and digestible content for both relevant stakeholders and those who may know little about the topic. This resource is designed to help you determine the appropriate CPT code combination for the type and dose of vaccine that you are using. iPhone or Qualitative approach was used; semi-structured interviews were undertaken using online communication tools via Google Meet platform and for data analysis Atlas.ti program was used for coding and . You may use roster billing format or submit individual claims using the CMS-1500 form (PDF) or the 837P electronic format. For more information, see "Note from the instructor: CMS provides additional information on billing and coding for COVID-19 vaccines and monoclonal antibodies" by Kimberly Hoy, JD, CPC. %%EOF
When 10 or more Medicare patients get a COVID-19 vaccine dose at a group living location on the same day, you can only bill forthe additional payment once per home (whether the home is an individual living unit or a communal space). If you administer additional vaccine doses on or after August 12, 2021, to immunocompromised Medicare patients, consistent with the FDAs updated emergency use authorizations (EUAs), acknowledge and document (e.g., in the medical record) your patients self-reported qualifying conditions for the additional dose and bill the appropriate billing code for administering an additional dose. Download the latest guides and resources for telehealth services.
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See, You were able torequest reimbursement through the, They only have Medicare Part A but not Part B coverage (or supplemental coverage for Part B services, like vaccine administration), Their insurance doesnt include the COVID-19 vaccine administration fees as a covered benefit (like Medicare Part A only), Their health insurance covers the COVID-19 vaccine administration but with cost sharing, If your patients dont have any health insurance, you were able torequest payment through the, If you have questions about billing or payment for administering the vaccine to patients with private insurance or Medicaid, contact the health plan or, Patients without health insurance can also get the COVID-19 vaccine and administration at no cost. CMS and the American Medical Association (AMA) collaborated on a new approach to report use of COVID-19 vaccines. The goal of the Reimagining Residency grant program is to transform residency training to best address the workplace needs of our current and future health care system. Beginning Aug. 11, 2022, for dates of service on or after July 13, 2022, reimbursement rates for COVID-19 vaccine administration procedure codes 0041A and 0042A will be implemented for Texas Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and the Family Planning Program (FPP). CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. Not every residency match is made to last, as more than 1,000 residents transfer programs each year. Table 3. You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine. Members will have no cost-sharing on vaccines from in- and out-of-network providers through Dec. 31, 2021. You may submit a single set of roster bills (one containing M0201 and another containing the appropriate CPT code) for multiple Medicare patients who get the COVID-19 vaccine in their individual units of a multi-unit living arrangement. 230 0 obj
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Codes for Administering the Vaccine in the Patient's Home Use HCPCS Level II code M0201 for the additional payment for administering the COVID-19 vaccine to certain Medicare patients in their homes. Verify the insurance information: You may use roster billing format, or submit individual claims. New Current Procedural Terminology (CPT) codes have been created that streamline the reporting of immunizations for the novel coronavirus (SARS-CoV-2, also known as COVID-19). You should only bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine. Issue briefs summarize key health policy issues by providing concise and digestible content for both relevant stakeholders and those who may know little about the topic. Download AMA Connect app for Visit the COVID-19 CPT vaccine and immunization codes page, Coronavirus (SARS-CoV-2): Long descriptors, Coronavirus (SARS-CoV-2): Medium descriptors, Coronavirus (SARS-CoV-2): Short descriptors, Download the Nov. 10, 2020 CPT Assistant guide, Download the Oct. 6, 2020 CPT Assistant guide, Download the Sept. 8, 2020 CPT Assistant guide, Download the Aug. 10, 2020 CPT Assistant guide, Download the June 25, 2020 CPT Assistant guide, Download the May 20, 2020 CPT Assistant guide, Download the April 10, 2020 CPT Assistant guide, Download the March 13, 2020 CPT Assistant guide, Quick reference flow chart for CPT reporting for COVID-19 testing, Coding scenarios and how to apply best coding practices, COVID-19 CPT vaccine and immunization codes, Connecting Promise and Practice: The Trajectory of Digitally Enabled Care, How the CPT code set can be used to help advance health equity, What doctors wish patients knew about long COVID-19 brain fog, Why Minnesota changed key query to promote physician well-being, Want to switch residency programs? Insurance accepted at local public health agencies Influenza vaccine for administration into muscle, 0.5ml dosage, preservative free 1 19-20 18.31 90657 Influenza vaccine for administration into muscle, 0.25ml dosage 1 0-2 0 90658 Influenza vaccine for administration into muscle, 0.5ml dosage 1 3 - 18 0 90658 HA Influenza vaccine for administration into muscle, 0.5ml dosage 1 19-20 16.82 If you participate in theCDC COVID-19 Vaccination Program, you must: Report any potential violations of these requirements to the HHS Office of Inspector General: View the infographic (English (PDF)) (Spanish (PDF)) for COVID-19 vaccine administration in the home. Providers are required to use the appropriate rate code for the COVID-19 vaccine dose administered. Access Tool 2023 by the American Hospital Association. Modifiers CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. Access reports from the Council on Medical Education presented during the AMA Annual and Interim Meetings. Download and use free PC-ACE billing software (PDF)to electronically submit professional claim roster billing directly to your MAC. iPhone or Original Medicare wont pay these claims. The site is secure. Medicine section of the CPT code set. Completing the Moderna or Pfizer COVID-19 monovalent vaccine primary series protects children aged 3-5 and 3-4, respectively, against symptomatic SARS-CoV-2, AHA is offering for hospitals and health systems a second social media toolkit for February with messages for promoting COVID-19 vaccination and boosters. Pre-exposure prophylaxis is one of the Affordable Care Act (ACA) preventive services at risk in federal court, says Stephen Parodi, MD. Starting August 24, 2021, Medicare pays the additional payment amount (approximately $35 per dose administered)for up to a maximum of 5 vaccine administration services per home unit or communal space within a single group living location. The report noted that 26 percent of "breakthrough" (post-vaccination) COVID hospitalizations and 24 percent of breakthrough COVID deaths were "asymptomatic or not related . website belongs to an official government organization in the United States. For dates of service on or after August 24, 2021, if fewer than 10 Medicare patients are vaccinated on the same day in the same group living location, report the HCPCS Level II code M0201 for each Medicare patient vaccinated in each home that day, and up to a maximum of 5 times when multiple Medicare patients are vaccinated in the same home unit or communal location, Bill for each dose administered using the appropriate CPT code for the product and dose-specific COVID-19 vaccine administration. (*) Please note that the CPT codes shown for each vaccine crosswalk are not mapped to the NDC codes, but are mapped to the CVX . Codes 90460 and 90461 or 90471-90474 may be reported in addition to codes for COVID-19 vaccine administration if other vaccine/toxoid products are administered on the same date. For Medicare Advantage patients, RHCs and FQHCs should submit COVID-19 vaccine administration claims to the Medicare Advantage Plan. If you administer additional vaccine doses on or after August 12, 2021, to immunocompromised Medicare patients, consistent with the FDAs updated emergency use authorizations (EUAs), acknowledge and document (e.g., in the medical record) your patients self-reported qualifying conditions for the additional dose and bill the appropriate billing code for administering an additional dose. 0
Get the latest news on CPT codes and content emailed directly to your inbox each month from the CPT authority. Sign up to get the latest information about your choice of CMS topics. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. Bill the HCPCS Level II code (M0201) only 1 time for the additional payment rateif the date of service is between June 8, 2021, and August 24, 2021. Six novice principals were each interviewed over the 2020-2021 school year, each interview lasting approximately forty-five minutes. Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code. CPT codes have been created for reporting of immunizations for the novel coronavirus (SARS-CoV-2, also known as COVID-19). A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. For hospice patients under Part B only, you must include the GW modifier on COVID-19 vaccine administration claims if either of these apply: For Original Medicare patients, Medicare paysRural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for administering COVID-19 vaccines at 100% of reasonable cost through the cost report. DISCLAIMER: The contents of this database lack the force and effect of law, except as NOTE: Each COVID-19 vaccine administration rate code above represents a distinct COVID-19 vaccine administration CPT code. COVID-19 CPT vaccine and immunization codes page. An endocrinologist shares necessary steps to take to protect your kidneys. Code. The vaccines are manufactured by are Pfizer and Moderna and require two doses You can bill for up to 5 vaccine administration services only when fewer than 10 Medicare patients get a COVID-19 vaccine dose on the same day at the same group living location. Learn more. Get the latest news on CPT codes and content emailed directly to your inbox each month from the CPT authority. Category I and Proprietary Laboratory Analyses (PLA). AMA SPS member Mary K. McCarthy, MD, discusses the activities and efforts of the Committee on Senior Physicians at the Oregon Medical Association. Labeler Name. Use 4 new CPT codes effective December 8, 2022: Code 91316 for Moderna COVID-19 Vaccine, Bivalent Product: Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein . The national payment rate for M0201 effective for DOS on or after June 8, 2021, is $35.50. In addition, hospitals don't bill vaccines on an 11X type of bill. %PDF-1.6
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There is no cost. COVID-19 Monoclonal Antibody Coding. On July 26, 2021, for example, the Centers for Disease Control and Prevention released a report on "COVID-19 Vaccine Breakthrough Case Investigation and Reporting.". If you vaccinate these patients, you were able torequest payment for administering the vaccine through the, Providers administering the vaccine to underinsured individuals were able torequest reimbursement for the administration of the COVID-19 vaccine through the, Their health insurance doesnt include the COVID-19 vaccine administration fees as a covered benefit (like Medicare Part A only), 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B, 72X, Independent and Hospital-based Renal Dialysis Facility, 75X, Comprehensive Outpatient Rehabilitation Facility. Washington State COVID-19 Vaccine Program * Vaccine is not available to order, but clinics may still have it in their inventory. means youve safely connected to the .gov website. This article contains the allowances for the administration of COVID-19 vaccines and monoclonal antibodies for 2021. Before you submit a Medicare claim for administering COVID-19 vaccines, you must find out if: You must gather information both from patients with Original Medicare and those enrolled in Medicare Advantage plans. AMA announces new CPT code for pediatric COVID-19 vaccine doses. COVID-19 Vaccines, Adult and Pediatric IIS Vaccine Name Trade Name Number NDC CPT Code CVX Manufacturer Name - Code COVID-19, mRNA, LNP-S, PF, 100mcg/0.5 ml dose or 50mcg/0.25 ml dose (Mod 12+, red) Moderna COVID-19 Moderna: all patients 6 months - 5 years old. Council on Long Range Planning & Development. CPT Codes reported are: 99393 - Preventive service 90649 - HPV vaccine 90460 - Administration first component (1 unit) 90715 - Tdap vaccine 90460 - Administration first component (1. administration CPT codes which the vaccines must be exclusively reported with. Access reports from the Council on Medical Education presented during the AMA Annual and Interim Meetings. 0636 pharmacy, drugs requiring detailed coding. U.S. Department of Health & Human Services iPhone or COVID-19 Diagnostic Test Specimen Collection Coding. Not every residency match is made to last, as more than 1,000 residents transfer programs each year. 1.7 8/20/2021 Added CPT codes for administration of third dose, updated document title 1.8 10/1/2021 Added CPT codes for Pfizer booster shot and additional COVID treatments; at-home vaccine administration rate increase 1.9 11/10/2021 Added new pediatric vaccine codes, reorganized vaccine service charts As such, the only immunization administration codes previously available for patients 19 years and older were codes that did not include vaccine counseling. do not require reporting currently. CPT code 96372: Injection of drug/substance For immunization administration other than COVID-19, codes. Learn more. The 2021 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2021. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service. Additionally, it is expected that additional CPT or HCPCS codes may be released as vaccination efforts proceed and potential new vaccines are approved. Therefore, when counseling was provided by a physician/QHP to a patient 19 years and older at the time of immunization administration, it was appropriate to separately report an E/M visit code for the vaccine counseling. You should only bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine. All rights reserved. 9/9/2021 12:42:58 PM . Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency: (DOS = Date of Service, TBD = To Be Determined) [1] Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date. Download the latest guides and resources for telehealth services. Residents and fellows deciding on a practice setting should be armed with all the relevant details. An official website of the United States government ) Collaborating and networking to advocate for patients and the medical profession. ICD-10 coding. Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021 COVID-19 Third Dose Vaccine - 08-23-2021 Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021 COVID-19 Vaccine Program Webinar - 6-24-2021 In this case, the appropriate E/M visit code would be reported with modifier 25 appended. Share sensitive information only on official, secure websites. Accepted addition of two codes (0173A, 91317). The goal of the Reimagining Residency grant program is to transform residency training to best address the workplace needs of our current and future health care system. Unspecified US COVID-19 Vaccine CVX Code; CVX Short Description CVX Code CVX Long Description Note Vaccine Status; SARS-COV-2 (COVID-19) vaccine, UNSPECIFIED The appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration, The HCPCS Level II code M0201 for the additional payment amount for administering the COVID-19 vaccine in the home. If you vaccinate these patients, you were able torequest payment for administering the vaccine through the, Providers administering the vaccine to underinsured individuals were able torequest reimbursement for the administration of the COVID-19 vaccine through the, Their health insurance doesnt include the COVID-19 vaccine administration fees as a covered benefit (like Medicare Part A only), 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & Inpatient Part B, 72X, Independent and Hospital-based Renal Dialysis Facility, 75X, Comprehensive Outpatient Rehabilitation Facility. Sign up to get the latest information about your choice of CMS topics. These CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. The new national rate for the first dose, second dose, and single dose vaccines will be $40.00 effective for DOS on or after March 15, 2021. Android, The best in medicine, delivered to your mailbox. Use the ICD-10 diagnosis code Z23 (encounter for immunization) on the claim. Secure .gov websites use HTTPSA But AI can play a positive role in medical education. Review and download the full CPT code descriptor release. CPT Short Descriptor. Further updates to these documents will only occur when there are additional modifications to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) codes other than vaccines. For more details on the codes, visit AMAs webpage. Entering incorrect codes will only compromise data . These 2021 ICD-10-PCS codes are to be used for discharges occurring . Think of the AMA as your ally while preparing for the USMLE and COMLEX-USA. Use this AMA tool to determine the appropriate CPT code combination for the type and dose of vaccine being used. All vaccine codes can be found at the CPT vaccine and immunization codes page. ) An official website of the United States government Roster billers should use POS code 60 regardless of your provider type, even if youre not a mass immunization roster biller (provider specialty type 73). For dates of service between June 8, 2021, and August 24, 2021, you should bill for the additional payment amount of approximately $35 only once per date of servicein that home regardless of how many Medicare patients get the vaccine. Additional Coding for Hospital Inpatient Claims. No, the large language model cannot deliver medical care. LTATB AFSU 01/11/2021; 02/05/2021; 03/04/2021; 03/30/2021; 08/19/2021; 10/20/2021 COVID-19 Vaccination Billing Resources for Local Health Departments October 20, 2021 Cost How much will the vaccines cost? New Current Procedural Terminology (CPT) codes have been created that streamline the novel coronavirus testing currently available on the United States market. Not every residency match is made to last, as more than 1,000 residents transfer programs each year. All rights reserved. The data is shocking. rates for the COVID-19 vaccine administration fees: Dates of service 12/14/2020 through 3/14/2021 Initial vaccine administration - $16.94 Second vaccine administration - $28.39 Single dose vaccine administration - $28.39 Dates of service 3/15/2021 through 8/8/2021 Initial vaccine administration - $40.00 91300; SARSCOV2 VAC 30MCG/0.3ML IM. CMS and the AMA developed this code structureto make claims processingfor COVID-19 vaccines and monoclonal antibody infusions that get FDA EUA or FDA approval more efficient. Administration Codes 0001A, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose AMA reported that the 2022 CPT code set incorporates 12 vaccine-specific codes that "are the model for efficiently reporting and tracking immunizations and administrative services against the coronavirus (SARS-CoV-2)." the COVID-19 vaccine administration fee. The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. Access a file with the new CPT codes for testing and vaccineproductsandvaccine administrations. Dont include the vaccine codes on the claim when the vaccines are free. Download the latest guides and resources for telehealth services. The American Medical Association Oct. 6 announced Current Procedural Terminology code set updates to now include vaccine and administration codes for pediatric doses of the Pfizer COVID-19 vaccine. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. The current CPT codes are not appropriate for COVID vaccination, and the 2021 codes may not be in the system. CPT codes have been created for reporting of immunizations for the novel coronavirus (SARS-CoV-2, also known as COVID-19). If you submit roster bills for administering the COVID-19 vaccine in the home, you must submit 2 roster bills: A roster bill containing the appropriate CPT code for the product- and dose-specific COVID-19 vaccine administration, A second roster bill containing the HCPCS Level II code (M0201) for the additional in-home payment amount.
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