Reimbursement Approved for Counseling Patients to Self-Isolate During COVID-19 Testing

Counsel to self-isolateOn July 30, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention are announcing that payment is available to Medicare providers for counseling patients to self-isolate after they are tested and prior to the onset of symptoms.

Rationale for Counseling Patients to Self-Isolate

The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic and asymptomatic individuals. Providers are encouraged to emphasize the importance of self-isolation while waiting for testing results. The Centers for Disease Control and Prevention (CDC) models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise.

Medicare E/M Reimbursement  Codes to Use

CMS will use existing evaluation and management (E/M) payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals and community drive-thru or pharmacy testing sites.

Counseling Check List Developed by CMS

  1. Discuss the need for immediate isolation, even before the results of the test are available.
  2. Advise patients to inform their immediate household/contacts that they may wish to be tested and quarantine as well. Review locations and people they have been in contact with in the past two weeks.
  3. Review the signs and symptoms of COVID-19.
  4. Inform patients that if positive, they will likely be contacted by a public health worker and asked to provide a list of the people they’ve been with for contact tracing, encourage them to ‘answer the call’.
  5. Discuss services that might help the patient successfully isolate and quarantine at home.

Additional Resources

For a 1-page printout of the above checklist and resources, click here.  


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