CMS approves additional payment for new COVID-19 treatments, adds price transparency requirements for diagnostic testing

Wednesday, November 18, 2020

The New COVID-19 Treatments Add-on Payment (NCTAP) will allow additional Medicare payment for eligible hospital inpatient and outpatient cases that involve certain new products or treatments authorized or approved for COVID-19, according to CMS’ Fourth COVID-19 Interim Final Rule with Comment Period (IFC-4).

For hospital inpatient discharges occurring on or after November 2, the enhanced payment is the lesser of:

  • 65% of the operating outlier threshold for the claim
  • 65% of the cost of a COVID-19 stay beyond the operating Medicare payment, including the 20% add-on payment under section 3710 of the CARES Act

 The NCTAP will not be included in the operating outlier payment calculation, Revenue Cycle Advisor reported.

For hospital outpatient encounters, Medicare will pay separately for drugs and biologicals authorized or approved by the FDA to treat COVID-19 when billed on the same claim as a primary C-APC service. Although CMS expects such situations to be rare, it opted to exclude these treatments from being packaged in C-APC payments to avoid discouraging their use.

IFC-4 also requires organizations to publicize the cash price for COVID-19 diagnostic tests, including molecular, antigen, and serological test. IFC-4 defines the cash price as the “charge that applies to an individual who pays in cash (or cash equivalent) for a COVID-19 diagnostic test.” The cash price must be published on the organization’s website in a conspicuous location. If an organization does not have a website, it must prominently post the cash price information on signage at the location testing is performed.

Comments on IFC-4 are due by 5 p.m. Eastern on January 4, 2021.

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