Non-Emergent, Elective Medical Services, and Treatment Recommendations 

To aggressively address COVID-19, CMS recognizes that conservation of critical healthcare resources 

is essential, in addition to limiting exposure of patients and staff to the virus that causes COVID-19. 

CMS also recognizes the importance of reducing burdens on the existing health system and 

maintaining services while keeping patients and providers safe. CMS, in collaboration with medical 

societies and associations, recently created recommendations to postpone non-essential surgeries 

and other procedures. This document provides recommendations to limit those medical services 

that could be deferred, such as non-emergent, elective treatment, and preventive medical services 

for patients of all ages. 

A tiered framework is recommended to prioritize services and care to those who require emergent 

or urgent attention to save a life, manage severe disease, or avoid further harms from an 

underlying condition. Decisions remain the responsibility of local healthcare delivery systems, 

including state and local health officials, and those clinicians who have direct responsibility for their 

patients. In providing in-person care to patients during the pandemic, particularly prenatal and 

maternity care, healthcare providers should continue to direct patients to accredited facilities and 

ambulatory care sites. However, in analyzing the risk and benefit of any medical treatment or 

service, the clinical situation must be assessed to ensure conservation of resources. These 

recommendations are meant to be refined over the duration of the crisis, based on feedback from 

subject matter experts. Professional societies are also developing resources for their specialties. 

Given this, CMS urges healthcare facilities and clinicians to consider the following tiered approach 

to curtailing non-emergent, elective medical services and treatment. Additionally, healthcare 

facilities and clinicians may wish to consider expanding capacity to manage a surge of patients 

seeking care. We anticipate there is likely to be a significant rise in patients with COVID-19 in the 

upcoming weeks. 

Key considerations: 

* Clinicians should continue to work with their local and state health departments to coordinate testing

through public health laboratories. See CDC guidance regarding Criteria to Guide Evaluation and

Laboratory Testing for COVID-19

• Current and projected COVID-19 cases in the community and region

• Ability to implement telehealth, virtual check-ins, and/or remote monitoring

• Supply of personal protective equipment available at the practice location and in the region

• Staffing availability

• Medical office/ambulatory service location capacity

• Testing capability in the local community*

• Health and age of each individual patient and their risk for severe disease

• Urgency of the treatment or service

04/07/2020
*Federally Qualified Health Care/ Rural Health Clinics

**Hospital Outpatient Department

***If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritize newborn care and

vaccination of infants and young children (through 24 months of age) when possible (see also CDC guidance for further

information: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html)

Tiers Definition Locations Examples Action 

Tier 1 Low acuity 

treatment or 

service 

• Medical office

• FQHC/RHC*

• HOPD**

• Ambulatory

care sites

• Routine primary or

specialty care

• Preventive care

visit/screening

• Annual Wellness or

Welcome to Medicare

Initial Preventive Visit

• Supervised exercise

therapy

• Acupuncture

Consider postponing service 

Consider follow-up using 

telehealth, virtual check-in, 

or remote monitoring

Tier 2 Intermediate 

acuity treatment or 

service 

Not providing the 

service has the 

potential for 

increasing 

morbidity or 

mortality 

• Medical office

• FQHC/RHC

• HOPD

• Ambulatory

care sites

• Pediatric vaccinations

• Newborn/early

childhood care***

• Follow-up visit for

management of

existing medical or

mental/behavioral

health condition

• Evaluation of new

symptoms in an

established patient

• Evaluation of nonurgent symptoms

consistent with

COVID-19

Consider initial evaluation 

via telehealth; triage to 

appropriate sites of care as 

necessary 

If no current symptoms of 

concern, consider follow-up 

with virtual check-in

Tier 3 High acuity 

treatment or 

service 

Lack of in-person 

treatment or 

service would 

result in patient 

harm 

• Medical office

• FQHC/RHC

• HOPD

• Ambulatory

care sites

• Emergency

department

• Evaluation of new

symptoms in a new

patient

• Evaluation of

symptoms consistent

with COVID-19, with

warning signs including

shortness of breath,

altered mental status,

or other indications of

severe disease

We would not recommend 

postponing in-person 

evaluation; consider triage 

to appropriate facility/level 

of care as necessary