CMS Guidelines for Coronavirus Billing

Key Updates on COVID-19 Testing Codes and Reimbursement Policies

Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new virus cases. This code applies specifically to CDC testing laboratories that test patients for SARS-CoV-2. This month, CMS introduced a second HCPCS billing code (U0002). This new code allows laboratories to bill for non-CDC laboratory testing for COVID-19, increasing testing capacity and improving virus tracking.

The Healthcare Common Procedure Coding System (HCPCS) is a standardized code system. It helps medical providers submit healthcare claims to Medicare and other health insurers consistently and orderly.

Beginning April 1, 2020, Medicare will accept U0001 and U0002 codes for services after February 4, 2020. Local Medicare Administrative Contractors (MACs) will develop payment amounts for these newly created HCPCS codes in their jurisdictions. Until Medicare establishes national payment rates, laboratories can seek guidance from their MAC on payments for these tests before billing.

Medicare Payments for Quarantined Patients

According to CMS, when Medicare patients with COVID-19 no longer require acute inpatient care but remain quarantined in a hospital, Medicare will pay the diagnosis-related group rate and any cost outliers until the patient is discharged.

Call us today if you face billing and coding challenges or lack the time to manage your revenue cycle effectively. We provide expert and dedicated support.

Source: CMS COVID-19 Response News Alert

By: Tej Gill, VP – Healthcare Solutions, TriumpHealth