PROVIDER ALERT: CMS Issues Guidance Related to Payment for Services Related to COVID-19

On March 6, 2020 the Centers for Medicare & Medicaid Services (CMS) issued frequently asked questions (FAQs) and answers for healthcare providers and supplemented a February Public Health News Alert regarding Medicare payment for laboratory tests related to the 2019-Novel Coronavirus (“COVID-19”).  The FAQs also addressed payment for other related services. Highlights include:

Laboratory Testing

  • Starting in April, providers and laboratories performing the test for SARS-CoV-2can bill Medicare and other health insurers for services that occurred after February 4, 2020, using the following codes:
    • For tests developed by the CDC: HCPCS code (U0001).
    • For non-CDC laboratory tests: HCPCS code (U0002).

Local Medicare Administrative Contractors (MACs) will be responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for these tests.

Physicians’ Services

  • Medicare pays for evaluation and management (E/M) and other services furnished in a beneficiary’s home by a physician or non-physician practitioner, and also pays for certain non-face-to-face services used to assess and manage a beneficiary’s conditions, such as care management services, remote patient monitoring services, and communication technology-based services.
  • Medicare pays for brief communications between beneficiaries and practitioners for specific purposes, furnished via a number of different communication technology modalities. For example:
    • HCPCS code G2012 (virtual check-in) can be furnished using synchronous technology such as a telephone call.
    • HCPCS code G2010 (Remote evaluation of recorded video and/or images submitted by an established patient) can be furnished using asynchronous technology such as e-mail.
    • CPT codes 99421 – 99423 (patient-initiated digital communication) and HCPCS codes G2061-G2063 (online assessment) can be furnished using an online patient portal.

Drugs & Vaccines Under Part B

  • Medicare Part B pays for preventive Hepatitis B vaccinations for high-and intermediate-risk beneficiaries and also for influenza and pneumococcal vaccinations for all Medicare beneficiaries. Medicare Part B will also pay for medically reasonable and necessary vaccinations of beneficiaries against a microbial agent or its derivatives (e.g., tetanus toxin, Hepatitis A) following likely exposure in accordance with normal Medicare coverage rules. Under current law, once a vaccine becomes available for COVID-19, Medicare will cover the vaccine under Part D. All Part D plans will be required to cover the vaccine.
  • New drugs that are created to treat COVID-19 covered under Medicare Part B, including new antiviral drugs, can be paid by the MACs until they receive a code and are on the pricing files. New drugs that are covered under Medicare Part D can be billed to the beneficiary’s Part D plan.

 

For more information, contact Frier Levitt to speak with an attorney.

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