CMS Guidelines for Coronavirus Billing

The Centers for Medicare & Medicaid Services (CMS) is proactively taking steps to ensure that patients, healthcare facilities and clinical laboratories are prepared to respond to the COVID-19, a disease caused by the novel coronavirus. CMS has released several fact sheets in recent weeks on billing and coding to provide guidance for healthcare organizations on testing and treating patients for COVID-19.

Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. This month CMS announced the second HCPCS billing code (U0002), which allows laboratories to bill for non-CDC laboratory testing for COVID-19, to help increase the testing and improve tracking of this virus.

Healthcare Common Procedure Coding System (HCPCS) is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner.

Medicare claims processing systems will be able to accept the U0001 and U0002 codes starting April 1, 2020, for dates of service on or after February 4, 2020. 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 until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them.

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

If you are facing any billing and coding challenges or simply don’t have enough time in the day to manage your revenue cycle effectively, give us a call today to receive expert and dedicated support.

By: Tej Gill, VP – Healthcare Solutions, TriumpHealth