Facility Billing After The PHE

Background

During the COVID-19 Public Health Emergency (PHE), hospitals and practitioners were granted certain ?flexibilities?to meet the healthcare needs of the country under waivers issued by the federal government. In addition, some healthcare services related to COVID vaccinations, screening for COVID, and treating COVID-positive patients were given special coverage by Medicare and Congress to protect the patient from incurring financial liability This paper offers concise guidance on coding and coverage changes which apply to hospitals following the end of the Public Health Emergency on May 11, 2023.

COVID PCR and Ant igen Test Orders

After the PHE, Medicare will require all COVID-19 and related testing that is performed by a laboratory to be ordered by a physician or non-physician practitioner.

COVID Ant ibody (serology) Test s

May be covered at the discretion of the Medicare Administrative Contractor. Commercial plan coverage may vary

COVID Specim en Collect ion

Nasal swab specimen collection for COVID testing will no longer be eligible for separate reimbursement. While reporting HCPCSC9803 (HOSPITAL OUTPATIENT CLINICVISIT SPECIMEN COLLECTION FORSEVEREACUTERESPIRATORYSYNDROMECORONAVIRUS2 (SARS-COV-2) (CORONAVIRUSDISEASE[COVID-19]), ANYSPECIMEN SOURCE) is not expected to cause claim rejections, it will not be reimbursed after 5/11/2023.

Out pat ient COVID Treat m ent w it h Veklury (rem desivir)

Will continue to be covered, but the cost will carry patient liability for the usual Medicare deductible and coinsurance Commercial plan coverage may vary (There are currently no COVID-19 monoclonal antibodies approved or authorized for use against the dominant strains of COVID-19 in the United States.)