CMS Announces New Payment Allocation for COVID-19 Patient Counseling

Patient Counseling

CMS will leverage existing evaluation and management (E&M) payment codes to reimburse eligible providers for the coronavirus counseling services.

 The Centers for Medicare & Medicaid Services (CMS) will make payment available to physicians and providers for counseling patients at the time of COVID-19 testing about the importance of self-isolation after they are tested and prior to the onset of symptoms.

A CMS announcement released late last week, in collaboration with the Centers for Disease Control and Prevention (CDC), said CMS will leverage existing evaluation and management (E&M) payment codes to reimburse eligible providers for the coronavirus counseling services, including telling patients about self-isolation and the benefits of wearing a mask at all times if they test positive.

Again, CMS will use existing evaluation and management payment codes to reimburse providers that are eligible to bill Medicare for counseling services, no matter where a test is administered – whether it’s a doctor’s office, urgent care clinic, hospital, community drive-through, or pharmacy testing site. Eligible providers include MDs, DOs, NPs, PAs, and CNSs. It is not clear whether a pharmacist is an eligible provider, as they are not permitted to report E&M services under Medicare Part D or Part B.

The provider counseling payments will give clinicians the opportunity to discuss with patients, at the time of their COVID-19 testing, the immediate need to self-isolate, even before results are available.

In addition, if a patient tests positive, the CDC instructs that the patient be told to wear a mask at all times, and told they will be contacted by the public health authority and asked to “provide information for contact tracing and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well,” the agency stated.

By making reimbursement available to providers, CMS and CDC hope to stop the spread of COVID-19.

CMS also provided a “checklist” of what would be required to document these visits. It did not say how much providers will get paid for the services, but I would guess that this would be a lower-level E&M office visit code: 99201 or 99212-99213.

The checklist is as follows:

Discuss the need for immediate isolation, even before results of the test are available.
Advise patients to inform their immediate household/contacts that they may wish to be tested and quarantine as well. Review locations they have visited and people they have been in contact with in the past two weeks.
Review the signs and symptoms of COVID-19.
Inform patients that if positive, they will likely be contacted by a public health worker and asked to provide a list of the people they’ve been with for contact tracing; encourage them to “answer the call.”
Discuss services that might help the patient successfully isolate and quarantine at home.

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