New COVID-19 Procedure Codes, Reimbursement

July 30, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) announced new procedure codes allowing Medicare and other insurers to identify use of the therapeutics remdesivir and convalescent plasma in treating COVID-19 inpatients. The new codes are effective Aug. 1, and enable CMS to conduct real-time surveillance and obtain real-world evidence on the effectiveness of these drugs in treating and protecting patients with COVID-19.

Additionally, CMS and the Centers for Disease Control and Prevention announced today that payment is available to physicians and healthcare providers who counsel patients, at the time of COVID-19 testing, on the importance of self-isolation after testing and prior to the onset of symptoms. Reimbursable counseling services include the discussion of immediate need for isolation, the importance of informing immediate household members of the necessity of testing for COVID-19, the review of COVID-19 signs and symptoms, and services available to patients to aid in isolating at home.

Should the patient test positive for COVID-19, providers should counsel patients that they need to wear a mask at all times, and that public health authorities will contact the patient for information relevant to contact tracing. CMS will use existing evaluation and management (E/M) payment codes to reimburse providers who are eligible to bill CMS for COVID-19 counseling services, regardless of where the COVID-19 test is administered. This includes doctor’s offices, urgent care clinics, hospitals and community drive-thru or pharmacy testing sites.

See CMS’ Medicare Learning Network article SE20011 and Counseling Check List for more information and resources.