CMS Guidance on COVID-19 Medicare FFS and
Medicare Advantage Plans
Medicare FFS COVID-19 Testing Reimbursement
Medicare Part B covers medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. CMS developed two Healthcare Common Procedure Coding System (HCPCS) codes to bill Medicare Part B for COVID-19 testing:
U0001 and U0002
. Medicare claims processing systems will accept both codes beginning April 1, 2020, for dates of service on or after February 4, 2020.
It is important to note that 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.
Click here
to read a longer discussion of Medicare FFS COVID-19 reimbursement.
CMS Guidance to Medicare Advantage Plans
- Plans may offer access to Medicare Part B services via telehealth in any geographic location and from a variety of places including a beneficiaries' home.
- Plans may choose to waive plan prior authorization requirements that otherwise would apply to test or services related to COVID-19 at any time.
The CMS memo also reviews the special
requirements
MA plans must adhere to in a disaster or emergency, including:
- Cover plan benefits furnished at non-contracted facilities (e.g. out-of-network providers);
- Waive, in full, requirements for gatekeeper referrals where applicable;
- Provide same cost sharing for the enrollee as if services were received in a contracted facility; and
- Make changes that benefit the beneficiary without the 30-day notification requirement (such changes could include reductions in cost).
Lastly, CMS reminded MA plans that under a specific emergency waiver authority (known as a
Katrina Waiver
), the agency may authorize MACs to pay for Part C covered services furnished to beneficiaries enrolled in MA plans and retrospectively seek reimbursement from the MA plan for those services. Providers should check with their participating MA plans to understand which flexibilities the plan offers.
