Medicare covers certain COVID-19 laboratory tests, which can be billed by health care facilities and laboratories.
The below HCPCS codes are covered for dates of service on or after February 4, 2020.
- U0001 – “CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel”
- U0002 – “2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC.”
Fees are based on the locality, and approximately U0001 - $ 36.00, U0002- $ 51.00
The CPT code, 87635 is covered for dates of service on or after March 13, 2020.
- 87635 –“Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.”
Fees are based on the locality, and approximately 87635- $ 51.00
CMS also has created two new HCPCS codes, effective for dates of service on or after April 14, 2020, specifically for Laboratory Tests of high throughput technologies.
These new codes are:
- U0003- “Infectious agent detection by nucleic acid (DNA or RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R”
- U0004 – “2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.”
The above codes were assigned a rate of $100.00.
More information is available at CMS-2020-1-R, https://www.cms.gov/files/document/cms-2020-01-r.pdf.
Antibody Tests
For services performed on or after April 10, 2020, two new CPT codes were added to report blood tests that detect antibodies for COVID-19.
These two codes are:
- 86328 – “Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19].”
- 86769 – “Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).”
Fees are based on the locality, and approximately 86328 - $ 45.00, 86769- $ 42.00
CLIA certificate is required!
Some of the tests can be used by facilities with a current CLIA certificate of waiver.
However, most of the tests require Laboratories to be certified under the CLIA that allows to perform high and/or moderate complexity tests.
More information is available at https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization
Specimen Collection
Effective March 1, 2020, Independent labs may use one of the below HCPCS for the specimen collection for further COVID-19 testing.
These HCPCS codes are:
- G2023 – “Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source”
- G2024 – “Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.”
Practitioners can be paid for assessment and specimen collection for COVID-19 testing using the level 1 evaluation and management code CPT code 99211. Medicare allows this code to be billed for all patients, new and established. Because physicians and other non-physician practitioners will be using the 99211 code to report testing related visits, there will NOT be any cost-sharing.
Medicare Does Not Require an Order During the Public Health Emergency Period!
Medicare also has relaxed ordering/referring requirements for specific diagnostic laboratory tests.
List of these tests can be found at https://www.cms.gov/files/document/covid-ifc-2-flu-rsv-codes.pdf
Any provider authorized under state law may order these tests. However, Medicare does not require a written order from the treating or other provider:
- If an order is not written, no need to include the NPI of the ordering/referring provider on the claim;
- If an order is written, include the NPI of the ordering/referring provider.
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Source:
https://www.cms.gov/files/document/admin-info-20-06-clia.pdf
https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
https://www.cms.gov/files/document/covid-19-laboratories.pdf
https://www.cms.gov/files/document/mm11765.pdf
