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Federal – Coverage, Payment, and Coding

COVID-19 Policies under CARES Act
MLN Matters SE20015: New COVID-19 Policies for IPPS Hospitals, LTCHS, and IRFs due to Provisions of the CARES Act (Revised 9/11/20)

Alternate Care Sites: Payment
CMS Fact Sheet for State and Local Governments, CMS Programs & Payment for Care in Hospital Alternate Care Sites

1135 Waivers: Guidance re Medicare FFS Billing
MLN Matters SE20011: Revised Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus (Revised 8/20/20)

Medicare Billing FAQ
COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (8/7/20)

CMS Innovation Model Adjustments
CMS Innovation Center Models COVID-19 Related Adjustments (6/3/20)

COVID-19 Diagnostic Testing: Price Transparency

COVID-19 Diagnostic Testing: Test Pricing
Medicare Administrative Contractor (MAC) COVID-19 Test Pricing (5/19/20)

Medicaid Managed Care
Medicaid Managed Care Options in Responding to COVID-19 (5/14/20)

Medicaid & CHIP
COVID-19 FAQs for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies (5/5/20)

Lab Billing for COVID-19 Testing
MLN Article MM11765 – Addition of the QW modifier to HCPCS code U0002 and 87635 (4/24/20)

Medicare Advantage
Information to Medicare Advantage Organizations Related to COVID-19 (4/21/20)

COVID-19 Medicare Add-On Payment
CMS information regarding implementation section 3710 of the CARES Act (applying a 20% adjustment factor to inpatient prospective payment system (IPPS) payments for COVID-19 cases) (4/15/20)

Medicaid COVID-19 Testing Coverage Expansion
Families First Coronavirus Response Act (FFCRA) and CARES Act FAQs (4/13/20)

Diagnosis Codes
MS-DRG Assignment for New COVID-19 Diagnosis Code Effective April 1, 2020 (3/23/20)

Catastrophic Coverage
FAQs on Catastrophic Plan Coverage (3/18/20)

Medicare & COVID-19 Testing
CMS Medicare Administrative Contractor (MAC) COVID-19 Test Pricing (3/12/20)

Exchanges and Insurers
CMS FAQs on Essential Health Benefit Coverage and COVID-19 (3/12/20)

Medicare
CMS Fact Sheet re Coverage and Payment Related to COVID-19 – Medicare (3/5/20)

Medicaid & CHIP
CMS Fact Sheet re Coverage and Payment Related to COVID-19 – Medicaid and CHIP (3/5/20)

Insurance
CMS Fact Sheet re Coverage and Payment Related to COVID-19 – Individual and Small Group Market Insurance Coverage (3/5/20)
> FAQs on Issuer Flexibilities for Utilization Management and Prior Authorization

Diagnosis Coding
CDC ICD-10-CM Official Coding Guidelines (Effective 2/20/20)