Medicare DRG Increases for COVID-19 Treatment Services Under Coronavirus Aid, Relief, and Economic Security (Cares) Act
The Centers for Medicare & Medicaid Services (CMS) have released guidance for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. MeridianTotal (Medicare-Medicaid Plan) will be following this guidance as we adjudicate Medicare claims for applicable COVID-19 inpatient treatment services.
The CARES Act provides for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. The increase will be applied to claims that include the applicable COVID-19 ICD-10-CM diagnosis code and meet the date of service requirements, as follows:
- Discharges occurring on or after January 27 and on or before March 31:
- B97.29 – Other coronavirus as the cause of diseases classified elsewhere
- CDC coding guidance for cases discharging on March 31 and prior
- Discharges occurring on or after April 1:
- U07.1 – COVID-19
- CDC coding guidance for cases discharging on April 1 and after
For discharges with the diagnosis codes above, MeridianTotal will follow the Medicare billing guidance published by CMS. Inpatient claims for these COVID-19 discharges that have already been received will be automatically reprocessed to reflect the payment increase.
This guidance is in response to the COVID-19 pandemic and may be retired at a future date.
The Centers for Medicare and Medicaid (CMS)
The Centers for Disease Control (CDC)