CMS announces two payment initiatives for COVID-19 drug treatment and counseling

The Centers for Medicare and Medicaid Services has announced two payment initiatives to track the effectiveness of COVID-19 therapeutics and to use counseling to help stop the spread of the virus.

CMS will make payment available to physicians and providers to counsel 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. 

CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS 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.

The agency is also implementing new procedure codes to allow Medicare and other insurers to identify the use of the therapeutics remdesivir and convalescent plasma for treating hospital inpatients with COVID-19. 

These new codes are being implemented into the International Classification of Diseases Procedure Coding System, ICD-10-PCS. They go into effect on August 1. 

WHY THIS MATTERS

The new procedure codes will enable CMS to conduct real-time surveillance and obtain data on the drugs' effectiveness. 

With the emergence of new treatments, it is critical to track their use and effectiveness in real-time, CMS said.

These codes can be reported to Medicare, and other insurers may also use the codes to identify the use of COVID-19 therapies to help facilitate monitoring and data collection on their use. 

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.

Patients should also be told to inform members of their immediate household that they too should be tested for COVID-19, CMS said. Providers should review the signs and symptoms and services available to patients in isolating at home.

In addition, if a patient tests positive, they should 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.

THE LARGER TREND

The implementation of the new procedure codes is part of the Trump Administration's ongoing efforts to protect the health and safety of COVID-19 patients across the country during the public health emergency, CMS said.

The counseling efforts have the goal of reducing the spread of the virus by having patients isolated before they get test results or have symptoms. 

The Centers for Disease Control and Prevention models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86% reduction in the transmission of the virus compared to a 40% decrease in viral transmission if the person isolates after symptoms arise.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com