Positive COVID Test Required for Medicare Add-On Payment

Aug. 19, 2020

On Monday, the Centers for Medicare & Medicaid Services (CMS) updated guidance regarding the 20% add-on payment to Inpatient Prospective Payment System (IPPS) operating payments for COVID-19 related discharges. Beginning with admissions occurring on or after Sept. 1, claims eligible for the 20% increase in the IPPS operating payment amount must have a positive COVID-19 laboratory test documented in the patient’s medical record. Positive tests must be the result of viral testing (i.e., molecular or antigen), and may be performed either during or prior to the hospital admission. For more information, see a CMS Medicare Learning Network (MLN) Matters article.