CMS Revises COVID-19 Medicare Fee-for-Service Billing Guidance for Outpatient Hospital Care

On July 8, 2020, the Centers for Medicare & Medicaid Services (CMS) revised its MLN Matters Article SE20011 on “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)”.  One revision addresses services provided by the hospital in the patient’s home as a provider-based outpatient department when the patient is registered as a hospital outpatient to state as follows:

During the COVID-19 PHE, hospitals may furnish clinical staff services in the patient’s home as a provider-based outpatient department and bill and be paid for these services as Hospital Outpatient Department (HOPD) services when the patient is registered as a hospital outpatient. Hospitals should bill as if the services were furnished in the hospital, including appending the PO modifier for excepted items and services and the PN modifier for non-excepted services. The DR condition code should also be appended to these claims.

Another revision was to add a section on “Teaching Physicians and Residents” which expands the CPT Codes that may be billed with the GE modifier under 42 CFR 415.174 on and after March 1, 2020, for the duration of the public health emergency.  See MLN Matters Article SE20011 for additional information.

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