New COVID-19 Treatments Add-On Payment (NCTAP)
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, is effective from November 2, 2020, until the end of the COVID-19 public health emergency (PHE).
Through the NCTAP, the Medicare Program will provide an enhanced payment for eligible inpatient cases that use certain new products with current FDA approval or emergency use authorization (EUA) to treat COVID-19, including the following:
- On August 23, 2020, the FDA issued (reissued on November 30, 2020, and revised on March 9, 2021) an EUA for the use of COVID-19 convalescent plasma for treating COVID-19 in hospitalized patients
- On October 22, 2020, the FDA approved remdesivir (Veklury) for the treatment of COVID-19 for adults and certain pediatric patients requiring hospitalization
- On November 19, 2020, the FDA issued an EUA for the use of baricitinib (Olumiant), in combination with remdesivir (Veklury), for the treatment of suspected or laboratory confirmed COVID-19 in certain hospitalized patients
For eligible cases, the NCTAP is equal to the lesser of these:
Coding for NCTAP
NCTAP claims are those that are eligible for the 20% add-on payment under Section 3710 of the CARES Act. Eligible claims have both of the following:
- ICD-10-CM diagnosis code U07.1 (COVID-19)
- ICD-10-PCS codes for remdesivir (Veklury), COVID-19 convalescent plasma, or baricitinib (Olumiant) in combination with remdesivir, as described below
Codes for Remdesivir or COVID-19 Convalescent Plasma for Hospital Discharges on or after November 2, 2020
| ICD-10-PCS Code |
Description |
|---|
| XW033E5 |
Introduction of remdesivir anti-infective into peripheral vein, percutaneous approach, new technology group 5 |
| XW043E5 |
Introduction of remdesivir anti-infective into central vein, percutaneous approach, new technology group 5 |
| 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 Baricitinib for Hospital Discharges between November 19, 2020 and December 31, 2020*
| ICD-10-PCS Code |
Description |
|---|
| 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 |
*In accordance with the EUA, providers should administer baricitinib with remdesivir. Claims should also include the code for remdesivir (XW033E5 or XW043E5).
Codes for Baricitinib for Hospital Discharges on or after January 01, 2021 through the End of the COVID-19 PHE*
| ICD-10-PCS Code |
Description |
|---|
| 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 |
*In accordance with the EUA, providers should administer baricitinib with remdesivir. Claims should also include the code for remdesivir (XW033E5 or XW043E5).
|
