Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.
CMS issued an Interim Final Rule with Comment Period that established the New COVID-19 Treatments Add-on Payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS). The NCTAP, designed to mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments, was effective from November 2, 2020, until September 30, 2023. The NCTAP described below ended on September 30, 2023.
NCTAP Before October 1, 2023
Through the NCTAP, Medicare provided an enhanced payment through September 30, 2023, for eligible inpatient cases that used certain new products with current FDA approval or emergency use authorization (EUA) to treat COVID-19, including the following:
- Convalescent plasma: On August 23, 2020, the FDA issued (latest update December 28, 2021) an EUA for the use of COVID-19 convalescent plasma for treating COVID-19 in hospitalized patients.
- GOHIBIC (vilobelimab): On April 4, 2023, the FDA issued (latest update April 12, 2023) an EUA for the use of GOHIBIC to treat certain hospitalized adult patients with severe COVID-19 illness.
- Kineret® (anakinra): On November 8, 2022, the FDA issued an EUA for Kineret injection for the treatment of COVID-19 in hospitalized adults with positive results of direct SARS-CoV-2 viral testing with pneumonia requiring supplemental oxygen (low- or high-flow oxygen) who are at risk of progressing to severe respiratory failure and likely to have an elevated plasma soluble urokinase plasminogen activator receptor (suPAR). Review the Fact Sheet for Healthcare Providers: EUA for Kineret for more information about the limits and conditions for pharmacists prescribing Kineret.
- Lagevrio (molnupiravir): On December 23, 2021, the FDA issued (latest update October 3, 2023) an EUA for molnupiravir for the treatment of mild-to-moderate COVID-19 in certain adults who are at high-risk for progression to severe COVID-19, including hospitalization or death.
- Olumiant® (baricitinib): On November 19, 2020, the FDA issued (latest update October 27, 2022) an EUA for the use of Olumiant for the treatment of suspected or laboratory confirmed COVID-19 in certain hospitalized patients.
- PAXLOVIDTM (nirmatrelvir co-packaged with ritonavir):
- On December 23, 2021, the FDA issued an EUA for PAXLOVID for the treatment of mild-to-moderate COVID-19 in certain adults and pediatric patients at high risk for progression to severe COVID-19, including hospitalization or death.
- On July 6, 2022, the FDA revised the EUA to let pharmacists prescribe and dispense PAXLOVID to eligible patients without seeing a doctor or other clinician. Review the Fact Sheet for Health Care Providers: EUA for PAXLOVID for more information about the limits and conditions for pharmacists prescribing PAXLOVID.
- On May 25, 2023, the FDA approved PAXLOVID to treat eligible adult patients. PAXLOVID remains available under the EUA to treat eligible pediatric patients.
- VEKLURY® (remdesivir): On January 21, 2022, the FDA approved a supplemental New Drug Application (NDA) for VEKLURY, which expanded its use from adults and pediatric patients (12 years of age and older and weighing at least 40 kg) for the treatment of COVID-19 requiring hospitalization to certain non-hospitalized adults and pediatric patients for the treatment of mild-to-moderate COVID-19 disease. See the Federal Register announcement for more information about the revoked EUA and NDA approval.
For eligible cases, the NCTAP was equal to the lesser of these:
- 65% of the operating outlier threshold for the claim
- 65% of the amount by which the costs of the case exceeded the standard Diagnosis-Related Group (DRG) payment (including the adjustment to the relative weight under Section 3710 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act))
Coding for NCTAP
NCTAP claims are those that were eligible for the 20% add-on payment under Section 3710 of the CARES Act. Eligible claims had an ICD-10-CM diagnosis code U07.1 (COVID-19) and 1 of the following:
- ICD-10-PCS codes for VEKLURY (remdesivir), COVID-19 convalescent plasma, or Olumiant (baricitinib)
- National Drug Codes (NDC) for PAXLOVID (nirmatrelvir co-packaged with ritonavir), Lagevrio (molnupiravir), Kineret, and GOHIBIC
Codes for COVID-19 Convalescent Plasma for Hospital Discharges On or After November 2, 2020
ICD-10-PCS Code | Description |
---|---|
XW13325 | Transfusion of convalescent plasma (nonautologous) into peripheral vein, percutaneous approach, new technology group 5 |
XW14325 | Transfusion of convalescent plasma (nonautologous) into central vein, percutaneous approach, new technology group 5 |
Codes for GOHIBIC for Hospital Discharges On or After April 4, 2023
National Drug Code | Description |
---|---|
08300011004 | GOHIBIC |
NDCs are listed as 11-digit codes for hospital institutional billing
Codes for Kineret for Hospital Discharges On or After November 8, 2022
National Drug Code | Description |
---|---|
06665823407 | Kineret (anakinra) |
NDCs are listed as 11-digit codes for hospital institutional billing
Codes for Lagevrio for Hospital Discharges On or After December 23, 2021
National Drug Code | Description |
---|---|
00006505506 | Lagevrio (molnupiravir) |
00006505507 | Lagevrio (molnupiravir) |
NDCs are listed as 11-digit codes for hospital institutional billing
Codes for Olumiant
ICD-10-PCS Code | Description |
---|---|
For Hospital Discharges between November 19, 2020 and December 31, 2020 | |
XW0DXF5 | Introduction of other new technology therapeutic substance into mouth and pharynx, external approach, new technology group 5 |
3E0G7GC | Introduction of other therapeutic substance into upper G.I. via natural or artificial opening |
3E0H7GC | Introduction of other therapeutic substance into lower G.I. via natural or artificial opening |
For Hospital Discharges On or After January 1, 2021 | |
XW0DXM6 | Introduction of baricitinib into mouth and pharynx, external approach, new technology group 6 |
XW0G7M6 | Introduction of baricitinib into upper GI, via natural or artificial opening, new technology group 6 |
XW0H7M6 | Introduction of baricitinib into lower GI, via natural or artificial opening, new technology group 6 |
Codes for PAXLOVID
National Drug Code | Description | Effective for Hospital Discharges On or After |
---|---|---|
00069108506 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | December 22, 2021 |
00069108530 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | December 22, 2021 |
00069110120 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | March 17, 2022 |
00069110104 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | March 17, 2022 |
00069034530 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | April 18, 2022 |
00069034506 | PAXLOVID (nirmatrelvir co-packaged with ritonavir) | April 18, 2022 |
NDCs are listed as 11-digit codes for hospital institutional billing
Codes for VEKLURY for Hospital Discharges On or After November 2, 2020
ICD-10-PCS Code | Description |
---|---|
XW033E5 | Introduction of VEKLURY anti-infective into peripheral vein, percutaneous approach, new technology group 5 |
XW043E5 | Introduction of VEKLURY anti-infective into central vein, percutaneous approach, new technology group 5 |
Hospitals should report the ICD-10-PCS code(s) or NDC(s) for all products administered during the stay, even if the hospital got the product for free. Hospitals shouldn’t report charges for products they got for free.
Note: |
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A hospital shouldn't seek additional payment on the claim for drugs or biologicals to treat patients with known or suspected COVID-19 that the government purchased or provided for free. See the CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 32, Section 67 (PDF). |
For more information on COVID-19 diagnosis and procedure codes, visit the “Latest News” section of the MS-DRG Classifications and Software webpage.
You can also review our COVID-19 FAQs (PDF), which include information on NCTAP and our implementation of Section 3710 of the CARES Act.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.