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:

For eligible cases, the NCTAP is 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 exceed 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 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

*In accordance with the EUA, providers should administer baricitinib with remdesivir. Claims should also include the code for remdesivir (XW033E5 or XW043E5).

*In accordance with the EUA, providers should administer baricitinib with remdesivir. Claims should also include the code for remdesivir (XW033E5 or XW043E5).

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