CMS Updates COVID-19 Billing FAQs for Outpatient Remdesivir Administration

Outpatient use of remdesivir is considered off-label.

A version of this article was first published March 17, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS’ latest round of updates to its COVID-19 billing FAQs addresses coverage and payment for remdesivir administered to outpatients, practitioners eligible to administer COVID-19 vaccines, as well as information related to ACOs and shared savings programs.

Outpatient remdesivir billing

According to the FDA, remdesivir is only approved for use in a hospital or a facility capable of providing care comparable to inpatient hospital care. In Section BB. Drugs and Vaccines Under Part B, CMS states that it expects that remdesivir infusions will generally be provided in inpatient settings. This includes traditional hospitals as well as settings designated as alternate care sites under a waiver.

Outpatient use of remdesivir is considered off-label. If remdesivir is administered at a hospital outpatient department or in a physician’s office to an individual who is not an inpatient, the organization should contact their MAC for billing instructions.

Vaccine administration

COVID-19 vaccines may be administered by individuals authorized under applicable state scope of practice and licensure requirements, CMS said in Section BB. Drugs and Vaccines Under Part B. A list of provider types eligible to bill Medicare for COVID-19 vaccine administration is included in CMS’ provider toolkit.

ACOs

CMS added a number of new questions to Section U. Medicare Shared Savings Program—Accountable Care Organizations (ACO). Newly added questions include scenarios involving reporting or not reporting quality and interoperability data under the Merit-based Incentive Payment System delaying proactive beneficiary notifications, participation in and termination of various cost-sharing programs, using diagnoses from telehealth services in risk scores, and more.