Medicare DRG Increase for COVID-19 Treatment Services Under CARES Act
The Coronavirus Aid, Relief and Economic Security (CARES) Act requires a 20% increase to the Inpatient Prospective Payment System (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. Superior HealthPlan is following this guidance in the adjudication of Allwell from Superior HealthPlan Medicare Advantage (HMO and HMO SNP) claims for applicable coronavirus inpatient treatment services, for inpatient claims with a discharge date on or after January 27, 2020. No action is required from facility providers to receive the increased DRG reimbursement.
Please note: This reimbursement increase is not applicable for Texas Medicaid inpatient claims.
The increase is being applied to claims that include the applicable COVID-19 ICD-10-CM diagnosis code and meet the date of service requirements, as follows:
- Discharges occurring on or after January 27 and on or before March 31:
- B97.29 – Other coronavirus as the cause of diseases classified elsewhere.
- To view Centers for Diease Control and Prevention (CDC) coding guidance for cases discharging on March 31 and prior, please see ICD-10-CM Official Coding Guidelines (PDF).
- Discharges occurring on or after April 1:
- U07.1 – COVID-19
- To view CDC coding guidance for cases discharging on April 1 and after, please see ICD-10-CM Official Coding and Reporting Guidelines.
Please note: This guidance is in response to the COVID-19 pandemic and may be retired at a future date.
For more information regarding these updates, please visit the links below.
- Centers for Disease Control and Prevention (CDC)
- Centers for Medicare and Medicaid (CMS)
- New Waivers for Inpatient Prospective Payment System (IPPS), Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act (PDF)
- July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer (PDF)