Coding, Coverage and Reimbursement Changes for COVID-19

Published: March 12, 2020; Last Updated: May 11, 2020

Evolent continues to closely monitor the outbreak and spread of Coronavirus Disease 2019 (COVID-19). COVID-19 has been declared a national public health emergency by the U.S. Department of Health and Human Services (HHS), a global pandemic by the World Health Organization, and a national emergency under the Stafford Act. The health of the public, patients, physicians and other clinical and administrative staff is of the utmost importance. This Resource Center provides links to several key resources from federal agencies to support your efforts. We encourage you to frequently check these resources to ensure you have the most up-to-date guidance. You should also be aware of announcements, legal requirements and guidance issued by your state and locality, as they may vary.

CMS Details Support For Clinicians

CMS has posted a letter to clinicians that outlines actions it has taken to ensure they have maximum flexibility to reduce unnecessary barriers to providing patient care during the COVID-19 pandemic. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information.

Coding and Reimbursement Resources

On March 5 and February 13, 2020, CMS announced new Healthcare Common Procedure Coding System (HCPCS) codes for health care providers and laboratories to test patients for COVID-19. These codes are in effect as of April 1, 2020, for services occurring after February 4, 2020. Medicare Administrative Contractors (MACs) have published payment rates for these codes here. Information on increased CMS payment for high-production coronavirus lab tests is available here.

As of April 1, 2020, new ICD-10 coding guidance related to COVID-19 is also in effect. See the CDC ICD-10 webpage for these updates.

CMS announced it will pay for covered telehealth services at the same rates as in-person services occurring March 1, 2020 through the end of the national public health emergency. For more information, see the “Site of Service Differential for Medicare Telehealth Services” section on pages 13-15 of CMS’s March interim final rule [CMS-1744-IFC]. Furthermore, CMS has expanded the list of services that can be provided using audio-only telephone communication, with higher payment rates for some services.See the “Payment for Audio-Only Telephone Evaluation and Management Services” section on pages 137-141 of CMS’s April interim final rule [CMS-5531-IFC] and the full list of telehealth codes (last updated on April 30, 2020) here.

CMS has released a comprehensive, 53-page FAQ document on Medicare fee-for-service billing related to COVID-19.

Plan Design Flexibility

On April 30, 2020, CMS issued an updated fact sheet for Medicare Advantage organizations and Part D plan sponsors on COVID-19 requirements and flexibilities, including paperwork reductions, changes to Star ratings methodologies and appeals processes.

Other Coverage Resources

CMS has published information about what is covered during this public health emergency, including diagnostic laboratory tests, immunizations and vaccines, telemedicine and drugs. See the coverage-related resources for:

In addition, the National Association of Insurance Commissioners has established a web page to help the public and insurance professionals understand private health insurance coverage issues related to COVID-19.

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