Medicare CARES Act DRG Increase for COVID-19 Inpatient Treatment
The Centers for Medicare & Medicaid Services (CMS) have released guidance (PDF) for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. WellCare 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, WellCare will follow the Medicare billing guidance published by CMS. (PDF) 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)
- New Waivers for Inpatient Prospective Payment System (PDF)
- July 2020 Quarterly Update to the Inpatient Prospective Payment System (PDF)
The Centers for Disease Control (CDC)
- ICD-10-CM Official Coding and Reporting Guidelines April through September 2020 (PDF)
- ICD-10-CM Official Coding Guidelines Supplement Coding Encounters related to COVID-19 (PDF)