CMS Announces Medicare Payment Policy for COVID-19 Convalescent Plasma

October 30, 2020

The Department of Health and Human Services released an interim final rule with comment period (IFC) on Wednesday in which the Centers for Medicare & Medicaid Services (CMS) sets forth the Medicare payment policies for COVID-19 convalescent plasma (CCP) provided in the hospital inpatient and outpatient settings of care. Additionally, the interim final rule implements a price transparency requirement for COVID-19 diagnostic tests.

The interim final rule includes the following: 

  • Medicare Hospital Inpatient Payment Policy: CMS established a new add-on payment, the new COVID-19 treatments add-on payment (NCTAP), that will be available for certain novel COVID-19 treatments provided to hospital inpatients for the remainder of the public health emergency. CMS specified that only two treatments currently qualify for the NCTAP: CCP and remdesivir (Veklury, Gilead). However, as new therapies receive an emergency use authorization or approval to treat COVID-19, they may qualify for the NCTAP. Importantly, the Agency noted that hospitals should not seek additional payment on the claim for a drug or biological procured or provided by a government entity to a provider at no cost to the provider to diagnose or treat patients with known or suspected COVID-19. Therefore, if CCP has been paid for by the Biomedical Advanced Research and Development Authority and is provided to a hospital at no cost, the hospital should not seek payment using the NCTAP.
     
  • Medicare Hospital Outpatient Payment Policy: CMS indicated the Agency will make available separate payments for new drugs and biologicals, including blood products, used to treat COVID-19 in the hospital outpatient setting. Payments for these treatments will not be bundled. CMS anticipates adding new codes describing the treatments as soon as practicable once they are available.
     
  • Price Transparency for COVID-19 Diagnostic Tests: The interim final rule implements a requirement from the CARES Act that providers of diagnostic tests for COVID-19 make public their cash price for such tests on the internet. CMS is enforcing this requirement by establishing civil-monetary penalties equal to $300 per day for non-compliance. AABB is working to clarify the scope of the price transparency requirements, and their potential impact on AABB members.

Additional information on these provisions in the interim final rule is available in AABB’s summary.