COVID-19 regulatory updates from the last week include a CMS/CDC reimbursement for counseling patients to self-isolate, new therapeutic procedure codes, and a new FAQ from the Office of the Inspector General on regulatory flexibility.
On July 30, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) recently announced payment for physicians and health care providers to counsel patients, at the time of COVID-19 testing, about the importance of self-isolation after they are tested and prior to the onset of symptoms. CMS will use existing evaluation and management (E/M) payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites
CMS is implementing new ICD-10-PCS procedure codes to allow Medicare and other insurers to identify the use of the therapeutics Remdesivir and convalescent plasma for treating hospital inpatients with COVID-19. These new codes will take effect August 1, and enable CMS to conduct real-time surveillance and obtain real-world evidence in how these drugs are working, and provide critical information on their effectiveness and how they can protect patients. These codes can be reported to Medicare and other insurers may also use the codes to identify the use of COVID-19 therapies and help facilitate monitoring and data collection on their use.
The Office of Inspector General (OIG) has updated frequently asked questions (FAQs) related to administrative enforcement authorities, including the Federal anti-kickback statute and civil monetary penalty (CMP) provision prohibiting inducements to Medicare patients during the COVID-19 public health emergency (PHE).
CMS has added a new CPT code to the list of clinical laboratory tests required for a COVID-19 diagnosis that does not require a written order from the treating physician or other practitioner during the PHE. Any health care professional authorized under state law may order CPT 87426 (Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]). Medicare will pay for the test without a written order.
The Department of Health and Human Services (HHS), through the Assistant Secretary for Planning and Evaluation (ASPE), released a new report showing the dramatic utilization trends of telehealth services for primary care delivery in Fee-for-Service (FFS) Medicare in the early days of the coronavirus disease 2019 (COVID-19) pandemic. The report analyzes claims data from January through early June. The report underscores how telehealth flexibilities address care delivery disruptions caused by the pandemic, which helped to spur and maintain Medicare beneficiaries’ access to their primary care providers.
CMS also released its first monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. For the first time, the snapshot includes data for American Indian/Alaskan Native Medicare beneficiaries. The new data indicate that American Indian/Alaskan Native beneficiaries have the second-highest rate of hospitalization for COVID-19 among racial/ethnic groups after Blacks. The updated data confirm that the COVID-19 public health emergency is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities.