CMS releases CARES Act payment update and instructions for COVID-19 codes

April 22, 2020

Medicare increased payments for patients diagnosed with the novel coronavirus (COVID-19). MLN Matters SE20015, released April 15, implements provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act for hospitals paid under the Inpatient Prospective Payment System (IPPS), long-term care hospitals (LTCH) PPS, and inpatient rehabilitation facilities (IRF) PPS.

The Medicare-Severity Diagnosis Related Group (MS-DRG) relative weight is increased by 20% for the following ICD-10-CM codes:

  • B97.29 (other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after January 27 and on or before March 31
  • U07.1 (COVID-19) for discharges occurring on or after April 1 through the duration of the COVID-19 public health emergency period


The adjustment factor will be applied by Medicare’s claims processing system.

In addition, CMS is waiving the requirement that IRF patients must receive at least 15 hours of therapy per week. The waiver supersedes the clarification in the Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency interim final rule.

CMS is also waiving some site-neutral payment provisions for LTCHs. For the duration of the public health emergency, all admissions will be counted in the numerator of the Discharge Payment Percentage calculation. They will count as discharges paid the LTCH PPS standard payment rate.