COVID-19 Update: Reimbursement issues – Who is picking up the tab for coronavirus testing?

Insurance coverage
In a statement on March 6, 2020, the Board of Directors for America’s Health Insurance Plans (AHIP) announced that insurers are voluntarily covering the diagnostic testing of COVID-19 (coronavirus) when ordered by a physician. AHIP said that health insurers are taking action to ease network referral and prior authorization requirements and/or waiving patient cost-sharing. Additionally, AHIP is working with state and federal policymakers to provide more guidance and flexibility for preventive services and treatment options. CIGNA has said that its customers will have access to COVID-19 testing, when prescribed, and the company will waive all co-pays or cost-shares. Aetna/CVS Health said it is providing COVID-19 testing and telemedicine visits with no out-of-pocket costs or cost sharing for its members.

HCPCS code
In order for non-CDC labs and providers to get reimbursed for COVID-19 testing, the Centers for Medicare and Medicaid Services (CMS) has developed a second Healthcare Common Procedure Coding System (HCPCS) code (U0002) that can be used to bill for non-CDC laboratory COVID-19 diagnostic tests. CDC testing laboratories use a different HCPCS code (U0001) to bill for tests and track new cases of the virus. The Medicare claims-processing systems will be able to accept these codes starting on April 1 for dates of service on or after February 4.

Telehealth restrictions waived
A provision to waive telehealth services restrictions for Medicare beneficiaries was included in an emergency funding measure passed by the Senate on March 5, 2020, and signed by President Trump on March 6, 2020. Telehealth is likely to play an important role in the treatment of patients with COVID-19 given the current utilization of self-quarantine and home care procedures. The waiver was a necessary act of Congress to allow Medicare to cover telehealth services, as current rules generally restrict such coverage to rural areas.