COVID-19 Medicare patient visits

Coding for Coronavirus: Medical Coding & Billing Tips for Medicare Patient Visits

YES HIM Consulting

The Centers for Medicare & Medicaid Services (CMS) has provided tips on how to code and bill all Medicare patient visits related to COVID-19 (CMS, 2020).

Here are the latest COVID-19 coding and billing updates for Medicare patients:

  • HCPCS code U0001 will track tests and emerging cases for services on February 4 and after (CMS, 2020).
  • HCPCS code U0002 covers non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVID-19) for services on February 4 and after (CMS, 2020).
  • Until a national rate is established by Medicare, payment for U0001 and U0002 claims will be determined by Medicare Administrative Contractors (MAC) for their local jurisdictions (CMS, 2020).
  • Medicare will pay for any cost outliers and the diagnosis-related group rate while the Medicare beneficiary is in quarantine as a medical necessity – even if he or she does not require acute inpatient care. (The National Law Review, 2020).
  • No additional deductible will be required if a patient wants to remain in the hospital under quarantine, even if he or she would have otherwise been discharged (CMS, 2020).
  • The American Medical Association (AMA) has released a new CPT code to streamline COVID-19 tests from providers (AMA, 2020). CPT code 87635 has short, medium, and long descriptors that can be found on the AMA website. Two additional CPT codes, 86328 and 86769, were released for COVID-19 antibody tests (AMA, 2020).
  • CMS has revised the list of telemedicine services payable under the Medicare Physician Fee Schedule (2020).

If you need more guidance for how to code COVID-19, enroll in our COVID-19 Coding Webinar that outlines the ICD-10-CM COVID-19 codes and guidelines, as well as provides coding scenarios for COVID-19 patient encounters.

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