SPECIAL EDITION – Coronavirus (COVID-19)
Craneware® Insights Regulatory Updates – CWI1208 (16 March 2020)
SPECIAL EDITION – Coronavirus (COVID-19)
Craneware is providing a summary of actions taken by CMS to address the 2019-Novel Coronavirus (COVID-19). Where applicable, Craneware is providing links to various CMS documents in which billing, coding, and other guidance is provided.
Provider Types Affected
Critical Access Hospitals
Provider-Based Rural Health Clinics
Compliance / Revenue Integrity
Laboratory – General
What You Need to Know
On March 11, 2020, President Trump addressed the nation regarding efforts to combat the coronavirus outbreak. In addition to previously issued warnings regarding travel to other countries where the coronavirus had spread, new travel restrictions are being implemented as of March 13, 2020. Travel from Europe to the United States is suspended for the next 30 days. This restriction does not currently apply to the United Kingdom.
In addition to travel restrictions, it is anticipated that the health insurance industry will extend insurance coverage and waive co-payments for coronavirus treatments. President Trump has allocated $8.3 billion to fund the CDC and other government agencies to fight the virus, support vaccines, treatments and the distribution of medical supplies.
The Centers for Medicare & Medicaid Services (CMS) has issued several memos and press releases addressing healthcare facilities and clinical laboratories preparedness strategies to combat this virus. A summary of the communications is as follows:
- February 6, 2020: CMS released a memorandum (Memo #: 20-09-ALL) to State Survey Agency Directors in which healthcare facility expectations for infection control prevention and control policies and practices are reviewed. CMS expects every Medicare participating facility in the nation’s healthcare system to adhere to standards for infection prevention and control.
- February 6, 2020: CMS posted a memorandum (Memo #: 2020-02-06) to State Survey Agency Directors regarding the authorization for emergency use of the Centers for Disease Control (CDC)’s 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel assay in CDC qualified and CLIA certified to perform high complexity tests.
- February 13, 2020: CMS issued a press release regarding billing and payment for the Coronavirus lab test. The press release announced the development of a new HCPCS code for testing patients for SARS-CoV-2. The use of the new HCPCS code will allow CMS to better track this particular strain of the Coronavirus.
HCPCS code U0001 has been created to describe the Centers for Disease Control and Prevention’s (CDC) 2019-nCoV Real-Time RT-PCR Diagnostic Panel. This test is intended for use with upper and lower respiratory specimens collected from persons who meet CDC criteria for COVID-19 testing. As of February 4, 2020, the test can be used at laboratories designated by CDC as qualified and, in the U.S., certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity tests.
This code is effective for dates of service on or after February 4, 2020. Medicare’s claims processing system will accept the new code on April 1, 2020.
- March 4, 2020: CMS posted a press release regarding a directive for State Survey Agencies and Accrediting Organizations to focus facility inspections exclusive to infection control and other serious health and safety threats. This approach will allow inspectors to focus on addressing the spread of COVID-19.
- March 5, 2020: CMS posted a press release in which details are provided regarding expanded coverage for the 2019-Novel Coronavirus (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as other health insurers that choose to adopt this new code. HCPCS code U0002 generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types, or subtypes (includes all targets).
The Medicare claims processing system will accept HCPCS code U0002 starting on April 1, 2020 for dates of service on or after February 4, 2020. The Medicare Administrative Contractors (MACs) are responsible for developing payment amounts for these new HCPCS codes until Medicare establishes national payment rates. Additionally, there is no beneficiary cost sharing applicable to these codes.
- March 5, 2020: CMS released a Fact Sheet entitled “Coverage and Payment Related to COVID-19 Medicare”. The Fact Sheet includes information on HCPCS code U0001 and U0002, Medicare’s policy on vaccines, inpatient hospital services, inpatient hospital quarantines, ambulatory services, telehealth services, and prescription refills.
- March 6, 2020: CMS posted a frequently asked questions (FAQs) document for healthcare providers regarding Medicare billing and payment for laboratory tests and other services related to the 2019-Novel Coronavirus (COVID-19). Information is provided for billing COVID-19 lab tests, evaluation and management services provided by a physician or non-physician practitioner, home care, telehealth, “alternative care sites” (such as a school gymnasium), isolation/quarantined private room(s), drugs and vaccines under Medicare Part B, and other miscellaneous services. Generally, current Medicare Part A and Part B payment policies will apply to medically reasonable and necessary services required to diagnose and treat the Coronavirus.
Lastly, CMS has created a homepage entitled “Current emergencies”, which provides links to the CDC, CMS memos and press releases, billing and coding guidance, and coverage guidelines, etc. pertaining to the Coronavirus: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
Facilities and providers need to become familiar with Medicare’s billing and coverage guidelines for diagnosing and treating patients with Coronavirus. Hospitals and physician offices may want to consider providing patients with the CMS fact sheet(s) and CMS FAQ document, when appropriate.
Hospital and provider offices need to add the new HCPCS codes for Coronavirus testing into their chargemaster(s) and charge capture tools. Laboratory staff and personnel responsible for order entry need to be informed of the new HCPCS codes.
Attention should be paid to Craneware Insights articles that may contain information on billing and coverage guidelines for the Coronavirus. Additionally, key personnel should periodically access the CMS “Current emergencies” homepage for real-time, up-to-date information.
04 February 2020
No references are applicable to this Insight.
CPT Codes © 2020 American Medical Association, use of this site denotes acceptance of below terms and conditions
CPT codes, descriptions, and material only are copyright 2020 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained here in. CPT is a trademark of the American Medical Association.
The responsibility for the content of any ‘National Correct Coding Policy’ included in this product is with Centers for Medicare and Medicaid Services, formerly known as Health Care Financing Administration, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Applicable FARS/DFARS Restrictions Apply to Government Use.
Current Dental Terminology copyright © 2020 American Dental Association. All rights reserved.
NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipient(s) and not to be shared with other facilities or vendors outside of Craneware. Craneware Inc, 3340 Peachtree Road, N.E., Suite 850, Atlanta, GA 30326, Tel: 404-364-2032 email: firstname.lastname@example.org