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 (and amended on December 20, 2021) an EUA for the use of baricitinib (Olumiant) for the treatment of suspected or laboratory confirmed COVID-19 in certain hospitalized patients
  • On December 22, 2021, the FDA issued 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.
  • On December 23, 2021, the FDA issued an EUA for PAXLOVID (nirmatrelvir co-packaged with ritonavir) 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.

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 an ICD-10-CM diagnosis code U07.1 (COVID-19) and one of the following:

  • ICD-10-PCS codes for remdesivir (Veklury), COVID-19 convalescent plasma, or baricitinib (Olumiant)
  • National Drug Codes (NDC) for PAXLOVID (nirmatrelvir co-packaged with ritonavir) and molnupiravir

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

 

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

 

Codes for PAXLOVID™ (nirmatrelvir co-packaged with ritonavir) for Hospital Discharges on or after December 23, 2021

National Drug Code

Description

00069108506

PAXLOVID (nirmatrelvir co-packaged with ritonavir)

00069108530

PAXLOVID (nirmatrelvir co-packaged with ritonavir)
NDCs are listed as 11-digit codes for hospital institutional billing


Codes for molnupiravir for Hospital Discharges on or after December 22, 2021

National Drug Code

Description

00006505506

molnupiravir

00006505507

molnupiravir

NDCs are listed as 11-digit codes for hospital institutional billing

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:
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.

Page Last Modified:
07/20/2022 04:28 PM