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CMS offers guidance in billing Medicare for COVID-19 antibody treatment

The agency is covering monoclonal antibody therapies at no cost for a broad range of providers and suppliers.  

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has posted updates to frequently asked questions and an infographic about coverage and payment for monoclonal antibodies to treat COVID-19. 

The FAQs include general payment and billing guidance on lab testing, hospital services and inpatient prospective payment system payments, including questions on different setting types. 

For instance, one FAQ asks: If a COVID-19 diagnostic laboratory test is performed prior to a procedure in a hospital outpatient department, ambulatory surgical center or office, is it included as part of the procedure? 

The answer is that, currently, under the hospital outpatient prospective payment system, all available COVID-19 clinical diagnostic laboratory tests are paid separately. If a COVID-19 clinical diagnostic laboratory test is performed prior to a procedure and billed separately, it is not bundled into the payment for the procedure.

However, with regard to the hospital setting, if the hospital is billing for specimen collection for the COVID-19 clinical diagnostic laboratory test along with another hospital service, the payment for the specimen collection would be packaged into that of the procedure. 

The infographic has facts about expected Medicare payment to providers and information about how Medicare beneficiaries can receive COVID-19 treatments with no cost-sharing during the public health emergency.

WHY THIS MATTERS

The information is provided by CMS to clear up any questions so that hospitals and physicians can correctly bill Medicare for administering these infusions. 

THE LARGER TREND

On November 10, CMS said it would cover monoclonal antibody therapies at no cost. This includes a broad range of providers and suppliers, including freestanding and hospital-based infusion centers, home health agencies, nursing homes, and entities that contract with nursing homes, to administer this treatment in accordance with the Food and Drug Administration's Emergency Use Authorization.

Currently, two monoclonal antibody therapies have received EUA's for treatment of COVID-19.
 
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com