COVID-19 Claims payment to healthcare providers for Testing and Treatment of Uninsured
Since the beginning of this terrible pandemic,
healthcare providers have been risking their lives and money to save the country from the modern beast – novel coronavirus COVID-19. Every healthcare professional involved in the saga of saving the people from the virus is a superhero who needs to be rewarded. Luckily, the government is here for our
Here are some FAQs on this support plan.
Who can receive the new payment?
Health care providers of any specialty who, starting with 02/04/2020, perform COVID-19 testing to uninsured individuals or treatment to uninsured individuals with a confirmed diagnosis of COVID-19, considering it was the primary reason for treatment.
Is this a loan? Would healthcare providers have to return the money?
No. These are claims reimbursements, which do not need to be repaid. However, the administering entity may request a refund after the payment when it was determined to be paid in error (when the program guidelines were not met).
Are the funds provided separately from the money paid by the patient? If so, can I still collect money from the uninsured?
No, the providers must not collect money from the patients. This program issues the only payment for the services.
Can I submit claims for uninsured patients, who are undocumented?
It is not required for providers to confirm immigration status before submitting claims for reimbursement, hence claims for undocumented individuals may be submitted and paid as far as all other guidelines are met.
Which providers are ineligible to get funds?
Providers who are in the OIG Excluded List and/or those whose Medicare enrollment has been revoked cannot be part of this program.
Which services can be paid for?
- Specimen collection, diagnostic, and antibody testing.
- Testing-related visits (including office, urgent care, or emergency room, or telehealth.)
- Treatment, including office visits (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, home health, DME (e.g., oxygen, ventilator), etc.
- FDA-approved vaccine, when available.
The full list is available here.
How should I code the services rendered?
Diagnosis codes for diagnostic testing and testing-related services:
- Z03.818- Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
- Z20.828- Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
- Z11.59- Encounter for screening for other viral diseases (asymptomatic)
- COVID-19 tests: U0001, U0002, U0003, U0004, 87635
- Antibody tests: 86318, 86328, 86769
- Specimen collection: G2023, G2024
For services related to treatment, claims must meet the following criteria:
- The primary diagnosis code on the claim must be the COVID-19 diagnosis code. (The only exception is for pregnancy (O98.5-) when the COVID-19 code may be listed as secondary.)
COVID-19 diagnosis code for dates of service before April 1, 2020:
- B97.29 -Other coronavirus as the cause of diseases classified elsewhere COVID-19 diagnosis codes. (Review CMS guidance for more information).
COVID-19 diagnosis code for dates of service on or after April 1, 2020:
- U07.1- 2019-nCoV acute respiratory disease.
Procedural coding for services is based on standard billing practices.
More information is available here.
What services cannot be paid for?
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Treatment without a COVID-19 diagnosis listed as primary, except for pregnancy (see above).
- Hospice services.
- Outpatient prescription drugs.
What’s the claim’s timely filing limit?
One year from the date of service.
How much would I earn?
The payment amount will be based on the current year Medicare fee schedule except where otherwise noted.
Finally, do I need to do anything to receive funds, or they would be transferred automatically? How do I send claims?
Healthcare providers are required to register and attest that they:
- Have checked the patients’ insurance coverage and confirmed they are, in fact, uninsured, i.e., do not have any Federal, State, or commercial healthcare coverage. This is compulsory since you will not receive the payment for patients already having coverage, even when they may not be aware of it.
- Accept the program reimbursement as payment in full
- Agree not to balance bill the patients
- Agree to the program terms and condition (testing terms and conditions and treatment terms and conditions)
Registration includes several steps and may take overall up to 20 business days. More information can be found here.
There are no options to send claims on paper or submit corrected claims either on paper or electronically.
*At the time of services, please obtain the patient's SSN and state of residence, or state identification/driver's license. This information is required for claims submission.
Hooray, you can now receive funds for uninsured patients!
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