CMS
Develops Additional Code for Coronavirus Lab Tests
Agency Issues Fact Sheets Detailing Coverage under Programs
On March 6, CMS took additional actions to ensure
America’s patients, healthcare facilities and clinical laboratories are
prepared to respond to the 2019-Novel Coronavirus (COVID-19).
CMS has developed a second Healthcare Common
Procedure Coding System (HCPCS) code that can be used by laboratories to bill
for certain COVID-19 diagnostic tests to help increase testing and track new
cases. In addition, CMS released new fact sheets that explain Medicare,
Medicaid, Children’s Health Insurance Program, and Individual and Small Group
Market Private Insurance coverage for services to help patients prepare as
well.
“CMS continues to leverage every tool at our
disposal in responding to COVID-19,” said CMS Administrator Seema Verma. “Our
new code will help encourage doctors and laboratories to use these essential
tests for patients who need them. At the same time, we are providing critical
information to our 130 million beneficiaries, many of whom are understandably
wondering what will be covered when it comes to this virus. CMS will continue
to devote every available resource to this effort, as we cooperate with other
government agencies to keep the American people safe.”
HCPCS is a standardized coding system that
Medicare and other health insurers use to submit claims for services provided
to patients. 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. The second
HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory
tests for SARS-CoV-2/2019-nCoV (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. This second
HCPCS code may be used for tests developed by these additional laboratories
when submitting claims to Medicare or health insurers. CMS expects that
having specific codes for these tests will encourage testing and improve
tracking.
The Medicare claims processing systems will
be able to accept these codes starting on April 1, 2020, for dates of service
on or after February 4, 2020. Local Medicare Administrative Contractors
(MACs) are 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. As
with other laboratory tests, there is generally no beneficiary cost sharing
under Original Medicare.
To ensure the public has clear information on
coverage and benefits under CMS programs, the agency also released three fact
sheets that cover diagnostic laboratory tests, immunizations and vaccines,
telemedicine, drugs, and cost-sharing policies.
Medicare Fact Sheet
Highlights: In addition to the diagnostic tests
described above, Medicare covers all medically necessary hospitalizations, as
well as brief “virtual check-ins,” which allows patients and their doctors to
connect by phone or video chat.
Medicaid and Children’s
Health Insurance Program (CHIP) Fact Sheet Highlights: Testing and
diagnostic services are commonly covered services, and laboratory and x-ray
services are a mandatory benefit covered and reimbursed in all states. States
are required to provide both inpatient and outpatient hospital services to
beneficiaries. All states provide coverage of hospital care for children and
pregnant women enrolled in CHIP. Specific questions on covered benefits
should be directed to the respective state Medicaid and CHIP agency.
Individual and Small
Group Market Insurance Coverage: Existing federal
rules governing health insurance coverage, including with respect to viral
infections, apply to the diagnosis and treatment of with Coronavirus
(COVID-19). This includes plans purchased through HealthCare.gov. Patients
should contact their insurer to determine specific benefits and coverage
policies. Benefit and coverage details may vary by state and by plan. States
may choose to work with plans and issuers to determine the coverage and
cost-sharing parameters for COVID-19 related diagnoses, treatments,
equipment, telehealth and home health services, and other related costs.
Summary of CMS Public Health Action on
COVID-19 to date:
On March 4, 2020, CMS issued a call to action
to healthcare providers nationwide to ensure they are implementing longstanding
infection control procedures and issued important guidance to help State
Survey Agencies and Accrediting Organizations prioritize their inspections of
healthcare facilities to focus exclusively on issues related to infection
control and other serious health and safety threats. For more information on
CMS actions to prepare for and respond to COVID-19, visit: CMS Announces Actions to Address Spread of Coronavirus.
On February 13, 2020, CMS issued a new HCPCS
code for healthcare providers and laboratories to test patients for COVID-19
using the CDC-developed test. For more information about this code: Public Health News Alert: CMS Develops New Code for
Coronavirus Lab Test.
On February 6, 2020, CMS issued a memo to help the nation’s healthcare
facilities take critical steps to prepare for COVID19.
On February 6, 2020, CMS also gave
CLIA-certified laboratories information about how they can test for
SARS-CoV-2. Read more: Suspension of Survey Activities memorandum
For the updated information on the range of
CMS activities to address COVID-19, visit the Current Emergencies webpage.
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Friday, March 6, 2020
CMS Develops Additional Code for Coronavirus Lab Tests
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