As CMS and the AMA continue to develop new codes for performing and billing COVID-19 testing, we will work to update you with the latest information to ensure you’re being reimbursed properly during the ongoing public health emergency.
Here’s a quick rundown of the key items to know when performing and billing for these tests:
Coding:
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.
U0001 – Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel.
- CMS reimbursement: $36
U0002 – 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc.
- CMS reimbursement: $51
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.
U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
- CMS reimbursement: $100
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.
U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
- CMS reimbursement: $100
Antibodies (Serological Antibodies Testing)
Revised: 86318 — Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (ie. reagent strip).
New: 86328 — Severe acute respiratory syndrome coronavirus (SARS-CoV-2) Coronavirus disease (COVID-19), single-step immunoassay. For antibody testing using the multi-step method, use 86769.
New: 86769 — Antibody; Severe acute respiratory syndrome coronavirus (SARS-CoV-2) Coronavirus disease (COVID-19). For detection of antibodies other than those to infectious agents, see specific antibody or specific method.
Collection
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.
CS Modifier
Cost-sharing waiver.
Lab billing scenarios:
If you have a laboratory that is performing the actual COVID-19 test, please use the following preferred codes for the applicable scenarios:
Laboratory Scenario:
- Laboratory receives physician order and patient specimen for testing
- Laboratory performs testing and reports test results
Step-by-step billing:
- Step 1: Use CPT code 87635.
- Step 2: Use ICD Dx provided on physician order. ICD DX: Z03.818 – Suspected exposure to COVID-19 or ICD Dx: Z20.828 – Exposure to confirmed case of COVID-19.
If a laboratory is performing the actual COVID-19 test, the following HCPCS codes will also be accepted by most commercial payers for the applicable scenarios:
HCPCS U0001: This code is used for the laboratory test developed by the CDC.
HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC, in accordance with CDC guidelines.
Note – see above for high-throughput testing.
Interested in learning more about coding audits or improving your overall revenue cycle management? Contact us today for a free consultation.