CMS, CDC Announce Reimbursement Options for Counseling COVID-19 Patients

As maintaining the decline in COVID-19 cases remains a priority, the Centers for Medicare. & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have announced that physicians and health care providers who counsel patients on the importance of self-isolation, are eligible for added reimbursement.

“The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic and asymptomatic individuals emphasizing the importance of education on self-isolation as the spread of the virus can be reduced significantly by having patients isolated earlier, while waiting for test results or symptom onset,” explained the agencies in a press release.

When a patient is actively being tested for COVID-19, a provider’s consult should include a discussion of the immediate need for isolation, even before results are returned. Per the CDC models, “there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise.”

In addition, the agencies expect providers to discuss the importance of informing immediate household members and encourage them to review signs and symptoms.

If a patient tests positive, providers will offer more guidance and counseling, including contact from local public health authorities to provide data for contact tracing purposes.

CMS provided a counseling checklist for providers via their website, CMS.gov.

As for the actual coding, “CMS will use existing evaluation and management (E/M) payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.” —Edan Stanley