CMS Announces Reimbursement for Patient Counseling on Self-Isolation at Time of COVID-19 Testing

King & Spalding

On July 30, 2020, CMS and the CDC announced that health care providers can be reimbursed for counseling patients regarding the importance of self-isolation prior to the onset of symptoms at the time of COVID-19 testing.

As the transmission of COVID-19 occurs from symptomatic, pre-symptomatic, and asymptomatic individuals, the new emphasis on self-isolation education and patient counseling can help reduce the spread of the virus. CDC models show that there is an 86 percent reduction in the transmission of COVID-19 when individuals practice self-isolation and quarantine while waiting for test results or prior to symptom onset, compared to a 40 percent reduction in viral transmission if individuals wait to isolate until after symptoms arise.

CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS for counseling services, regardless of where the test is administrated, including doctor’s offices, urgent care clinics, hospitals and community drive-thru or pharmacy testing sites.

Counseling services shall include discussions regarding the need for patient self-isolation prior to test results or symptoms, the importance of informing household members that they should be tested, the signs and symptoms of COVID-19, and various services that can help patients isolate at home. Moreover, patients will be counseled that if they test positive, to wear a mask at all times, to inform their immediate family and contacts in case those individuals need to be tested and self-isolate, and that they will be contacted by public health authorities to provide information for contact tracing.

A copy of the CMS press release can be found here, and further information and resource links can be found here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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