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CMS clarifies rules on coverage, payment for COVID-19-related services

March 12, 2020


Last week the Centers for Medicare & Medicaid Services (CMS) released a COVID-19 fact sheet to inform health care professionals and others about important Medicare coverage and payment information related to diagnosing and treating patients affected by the novel coronavirus virus.

The fact sheet indicates that:

  • Medicare Part B covers diagnostic laboratory tests when ordered by a physician without patient cost-sharing. There are two new HCPCS codes for lab tests to detect COVID-19: code for U0001 for the Centers for Disease Control (CDC) test panel and code U0002 for other tests.
  • Medicare Part B covers medically necessary imaging tests, such as CT scans, as needed for lung infection treatment purposes, but not for screening asymptomatic patients. Patient cost-sharing applies to imaging tests.
  • Medicare Part B covers certain preventive vaccines (flu, pneumonia, Hepatitis B) with no cost-sharing. Under current law, if a vaccine is developed for COVID-19, CMS indicates that the vaccine will be covered under Part D and will be required to be covered by all Part D plans.
  • Medicare Part A covers inpatient hospital care. There is a deductible of $1,408.
  • If a patient needs to be quarantined in a hospital, the hospital cannot charge the patient for a private room if the private room is medically necessary, nor is there an additional hospital deductible if a patient has been discharged from an inpatient stay but must remain in the hospital under quarantine.
  • The Medicare physician payment schedule covers online digital evaluation and management services for patients, which may be billed using Current Procedural Terminology (CPT®) codes 99241-99243. These services are for established patients only, and the fact sheet indicates they must be initiated by the patient, but practices can educate patients about the availability of these services prior to patients initiating them. (Medicare also pays for "virtual check-ins" using HCPCS code G2012, which may include telephone calls.)
  • Patients living in rural areas may use communication technology to have visits with their physicians at sites of service known as telehealth originating sites that use real-time audio and video.
  • Medicare covers ground ambulance transportation to a hospital or skilled nursing facility when transportation in any other vehicle could endanger the patient's health.
  • For patients with Medicare Advantage, the Medicare Advantage plan must cover all medically necessary Part A and B services covered under original Medicare.

Since CMS issued this fact sheet, Congress provided broad authority for CMS to waive the current Medicare telehealth restrictions. The California Medical Association (CMA) expects further guidance from CMS on telehealth soon. 

To empower surveillance and laboratory testing in response to the spread of the novel coronavirus, the American Medical Association is fast tracking code development of a unique CPT code for reporting novel coronavirus tests. It will be considered at a special CPT Editorial Panel meeting this week.

To keep up to date with what CMS is doing in response to COVID-19, please visit the CMS current emergencies website.

CMA has also set up a COVID-19 resource page, where you will find links to the latest news, research and developments on the COVID-19 outbreak for physicians and other health care providers.

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