• Innovation in Action

Mar 16, 2020

COVID-19 Medicare Coverage and Payment Guidance for Health Care Providers


The Centers for Medicare & Medicaid Services (CMS) provided guidance to health care providers on Medicare coverage and payment related to COVID-19, including diagnostic testing, telehealth services and prescription refills.

  1. Medicare Part B covers medically necessary doctor’s visits and clinical diagnostic laboratory tests, as well as medically necessary imaging tests as needed for treatment of lung infections. CMS developed two new HCPCS codes for health care providers who need to test patients for COVID-19. HCPCS code U0001 should be used by health care providers who need to test patients using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. HCPCS code U0002 should be used by labs and health care facilities to bill Medicare as well as other insurers who may choose to use the code for these tests.
  2. CMS reminds providers that telehealth coding options are available for people with Medicare and Medicaid. These options are a lifeline for high-risk populations who need access to their doctors if they feel sick or have questions. Providers may contact their established patients via telephone or captured video or image, as well as through their patient portal. View the CMS MLN Booklet on Telehealth Services for additional telehealth coding options and information.
  3. For Medicare Part B drugs, Medicare and Medicare Administrative Contractors (MACs) will consider payment for more than a 30-day supply of drugs on a case-by-case basis. Decisions will be based on the patient’s diagnosis, disruptions to the supply chain and other relevant factors.
  4. The CDC issued guidance to clinicians on how to appropriately diagnose patients suspected of contracting COVID-19, as well ICD-10 coding guidance.

For more information about CMS’ response to COVID-19 and the latest program guidance, please visit: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page