CMS and Washington Health Plans Provide Information on COVID-19 Outbreak Related Billing

March 25, 2020

WSHA Help. WSHA wants to provide help to our members with questions and issues related to billing and payment.  If you have questions, please send them to Andrew Busz at or Claudia Sanders at  WSHA has assembled a small new group to help surface and address issues hospitals are experiencing related to billing and payment and will be tracking down answers as needed.


Washington State Health Plans.  WSHA is working with the state health plans to get answers needed on billing and payment.  Much work has already been done on some of the most common issues.  The current list of questions and answers is posted on the OneHealthPort website at  Click on Administrative Direction document.  See the paragraph above on WSHA Help if you have additional questions you want to make sure are addressed and WSHA will get them entered into the process.

Telemedicine. The Centers for Medicare and Medicaid Services (CMS) released a fact sheet and set of Frequently Asked Questions regarding provision and billing for telemedicine services during the COVID-19 outbreak. Note the Medicare definition and payment criteria are different than Medicaid. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The temporary changes expand the methods, locations, and circumstances under which telemedicine can be billed for Medicare enrollees, including removal of the current geographic restrictions.


MS-DRG update. CMS has also modified inpatient MS-DRG payment for COVID  to recognize the new ICD-10-CM diagnosis code, U07.1, for COVID-19. The initial MS-DRG assignment would have resulted in significant reimbursement reductions for hospitals. The ICD-10 MS-DRG Grouper assigns each case into an MS-DRG based on the reported diagnosis and procedure codes and demographic information (age, sex and discharge status). The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.


Noridian Administrative Services, the Medicare administrative contractor (MAC) for our region, provided codes and allowed amounts for COVID-19 tests performed by the Centers for Disease Control and Prevention (CDC) or by non-CDC laboratories.

Billing under emergency waivers. The Centers for Medicare and Medicaid Services provided information related to billing services under various emergency waivers. This includes waiver of the 25-bed limit and 96-hour rule for critical access hospitals, and waivers regarding movement of patients among hospital units needed to maximize capacity due to the COVID-19 outbreak.

WSHA will continue to advocate for hospitals and providers and be a resource of information. For more information and resources, see WSHA’s  Hospital Response to Coronavirus (COVID-19) webpage. (Andrew Busz,


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