CMS expands COVID-19 testing options and makes other temporary changes

May 1, 2020

The Centers for Medicare & Medicaid Services (CMS) issued regulatory waivers and rule changes to expand testing options for COVID-19 testing, home care and telehealth services and to allow healthcare providers to set up temporary treatment sites, the agency announced.

To expand access to testing, CMS will no longer require an order from a physician or other provider for Medicare beneficiaries to get COVID-19 tests, as well as other laboratory tests, such as an influenza test, that are required as part of a COVID-19 diagnosis.

To allow Medicare beneficiaries to go to COVID-19 drive-thru sites operated by pharmacies, CMS said pharmacists can work with a physician or other provider to provide symptom assessment and specimen collection services, and the physician can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law.

CMS also will pay hospitals’ outpatient departments and providers to evaluate Medicare beneficiaries’ symptoms and collect laboratory samples for COVID-19 tests, and the agency will make a separate payment when that is the only service the patient receives. Providers should bill Medicare under the existing level 1 evaluation and management code CPT code 99211, while hospital outpatient departments should use a new Healthcare Common Procedure Coding System code, C9803.

CMS said this rule is designed to expand on a previous announcement in which it said it would pay laboratories when technicians collect specimens for COVID-19 tests from homebound beneficiaries.

For both Medicare and Medicaid, CMS said it will cover antibody tests to detect if a patient has been infected with SARS-CoV-2. Medicare and Medicaid will cover laboratory processing of FDA-authorized tests that beneficiaries self-collect at home.

In addition to changes in lab testing rules, CMS also announced other changes, including that it is: 

·         Increasing the payment rate for audio-only telephone consultations between beneficiaries and their physicians or other providers from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

·         Allowing freestanding inpatient rehabilitation facilities to accept acute-care patients from hospitals facing a surge of COVID-19 patients.

·         Not decreasing payment rates to hospitals’ outpatient departments when they set up temporary sites for such services as wound care, medication administration and behavioral health services. CMS will still pay them at the higher rates under the Outpatient Prospective Payment System—rather than under the physician fee schedule.

·         Allowing nurse practitioners, clinical nurse specialists and physician assistants to order and oversee home health services. Previously, Medicare and Medicaid home health beneficiaries could only receive home health services with the certification of a physician.

·         Allowing physical therapists, occupational therapists and speech language pathologists to deliver services using telehealth platforms. 

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