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CMS Issues Enhanced Payments for New COVID-19 Treatments

The Centers for Medicare and Medicaid Services (CMS) announced new inpatient and outpatient payment provisions related to COVID-19 treatments delivered in those settings.

For COVID-19 treatments administered during the COVID-19 Public Health Emergency (PHE), Medicare will provide an enhanced payment for eligible inpatient cases using certain new products authorized or approved to treat COVID-19. The enhanced payment will be equal to the lesser of: (1) 65 percent of the operating outlier threshold for the claim; or (2) 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment (including the 20 percent add-on payment under section 3710 of the CARES Act) for eligible cases.

In outpatient settings, Medicare will exclude Food and Drug Administration (FDA) authorized or approved drugs and biologicals for the treatment of COVID-19 from being packaged into the Ambulatory Payment Classification payment when those treatments are billed on the same claim as a primary service. Medicare will pay for those drugs and biologicals separately during the PHE.

These changes are part of the fourth COVID-19 interim final rule with comment (IFC) period published by CMS. The IFC was released on October 28, 2020 and addressed multiple areas within Medicare and Medicaid. The IFC is effective immediately and is scheduled to be published on November 6 in the Federal Register with a 30 day public comment period.

A fact sheet regarding the IFC is available on the CMS website.

The full text of the IFC is available on the Federal Register website.

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