Member Article

The focus on the response to the Coronavirus (COVID-19) has primarily centered around prevention and containment but the government and commercial payors have also addressed healthcare operational matters that encourage prompt diagnosis, treatment and monitoring through billing and reimbursement modifications and expansion of telehealth services.

CMS and commercial payors have provided an avenue for reimbursement of services offered by hospitals, physician practices and other practitioners in diagnosing, treating and monitoring patients for the Coronavirus (COVID-19). Diagnostic lab and imaging tests will be reimbursed under Medicare Part B as well as by private insurers. CMS has established reimbursement for Coronavirus lab tests. The BCBS Association has waived pre-authorization and cost-sharing for testing consistent with CDC guidance and expanded access to telehealth service, and other commercial payers have followed suit.

The CDC released interim coding guidance to support coding of encounters related to the Coronavirus COVID-19 and notes that codes for conditions unrelated to the coronavirus may be needed to fully code scenarios in accordance with the current ICD-10-CM coding classification. The CDC guidance identifies several potential illnesses that may arise based on confirmed COVID-19 infections The list includes pneumonia, acute chronic bronchitis, lower respiratory infection, and acute respiratory distress syndrome (ARDS). Guidance is also provided to code for encounters for observation both when the exposure results in positive or negative confirmation and for treatment of symptoms when there is no definitive diagnosis, such as for cough, shortness of breath and fever.

Starting April 1, CMS will begin accepting new HCPCS codes for laboratory tests performed on or after February 4 on patients to diagnose COVID-19. HCPCS Code U0001 is for CDC testing labs to test for SARS-CoV-2. The additional new code, HCPCS Code U0002, allows labs to bill for non-CDC lab tests for COVID-19. Local MACs will set pricing for these new codes.

CMS reimbursement guidance released on March 6 was not limited to diagnostic testing, but includes reimbursement for an in-patient stay, in-patient quarantine and monitoring, ambulatory, home or other alternative site treatment and monitoring, extended supply coverage, emergency ambulance transport, items or services paid for by federal, state or local government agencies, and new anti-viral drugs and preventative vaccines.

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