Change Healthcare has been closely monitoring coding changes related to COVID-19 to provide general guidance specific to codes used within healthcare transactions involving patient diagnosis, care, or treatment. The following are ICD-10, HCPCS, and AMA code additions relative to COVID-19, along with actions required and links to additional information.
Through recent COBVA broadcasts, the Centers for Medicare & Medicaid Services (CMS) and Benefits Coordination & Recovery Center (BCRC) alerted all Coordination of Benefits Agreement (COBA) trading partners to upcoming systems changes that would be needed to ensure that 071x (Rural Health Clinic), 077x (Federally Qualified Health Clinic), and 85x (Critical Access Hospital) Type of Bill (TOB) claims correctly waived coinsurance amounts when a modifier “CS” was included on the claims. Earlier, we mentioned that the actions to correct this issue would not begin until July 1, 2020.
Latest Update: The CMS and BCRC COBA teams have been advised that the systems fix-tied to the above issue has been implemented and that associated mass adjustment/claims reprocessing actions will be starting, potentially as early as this week.
Certain Clinical Lab Tests Showing Coinsurance
Additionally, some of our COBA trading partners have provided examples of COVID-19-related testing codes (e.g., U0002 and 87635) where coinsurance had been applied in error. This issue now has been corrected at the Medicare Administrative Contractors (MACs). Additionally, the affected MACs have been adjusting the COVID-19-related clinical lab claims that incorrectly applied coinsurance amounts on them.
The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Agreement (COBA) wants to make all COBA trading partners aware of additional information regarding Medicare claims in relation to COVID-19 that was brought to the COBA team’s attention May 7, 2020. This additional information includes the following:
1) Not all services billed to Medicare result in the waiver of deductible and coinsurance amounts.
Some key examples covered in this documentation include, but are not limited to:
2) New Modifier Used in Certain Billing Situations
In a recent MLN Matters article, Medicare announced its acceptance of a new modifier in conjunction with certain COVID-19 billed services.
Action Required: Payers should ensure that their claims adjudication systems will accept the HCPCS/Modifier combination.
The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Agreement (COBA) team recently received corrected and updated information relating to the handling of Rural Health Clinic (RHC; type of bill (TOB) 071x), Critical Access Hospital (CAH; TOB 85x), and Federally Qualified Health Clinic (FQHC; TOB 077x) claims on which a modifier “CS” would apply.
This new information revises our previously-issued COBVA notice dated April 22, 2020.
The following portions of our April 22nd COBVA notice remain correct:
The following are corrections/additions to our April 22nd COBVA announcement:
This notice is for Coordination of Benefits Agreement (COBA) trading partner representatives from the CMS and Benefits Coordination & Recovery Center (BCRC) COBA teams regarding CMS MLN Matters Special Edition, released on March 18. Although this outreach information is targeted towards providers, it will also be useful to our COBA trading partners.
COBA trading partners may be seeing 837 institutional coordination of benefits (COB) claims containing a “DR” (disaster-related) condition code, and 837 professional COB claims containing a “CR” (catastrophe/disaster-related) modifier, for situations where Section 1812(f) waivers have been announced. Additionally, the publication includes useful information regarding Medicare’s coverage of telehealth/telemedicine in association with the COVID-19 pandemic.
For questions regarding this notification, please contact your designated BCRC COBA EDI representative using the following contact information:
Tel. # 646-458-6740
Fax # 646-458-6761
On February 20, 2020, the CDC released a notification for a new ICD-10 code for the 2019 Novel Coronavirus (COVID-19) for reporting that will be effective October 1, 2020. For more information read the CDC Announcement: New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), October 1, 2020.
New HCPCS Code Additions for COVID-19
There have been two HCPCS code announcements from the CMS related to COVID-19 additions, including:
For more information visit the CMS Fact Sheet: Coverage and Payment Related to COVID-19 Medicare.
New AMA CPT Code 87635 for COVID-19
On March 13, 2020, the AMA announced the addition of CPT code 87635 for laboratory testing services that detect the presence of COVID-19 effective immediately.
For more information visit the AMA Press Release: New CPT code announced to report novel coronavirus test.
Action Required: Please ensure your clinical and administrative provider software systems are updated to support these recent code set updates. Reach out to your software vendor(s) as applicable. New information is being published daily as a response to COVID-19; please continue to monitor CMS and your payer sites for the latest information. Refer to your MAC and payer guidelines to determine if services are covered.
Action Taken: Change Healthcare has obtained all code set updates specific to COVID-19 for immediate deployment across all Change Healthcare systems, solutions, and services. We continue to monitor this situation and will respond accordingly as conditions change.