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Industry Insights

Medicare clarifies billing rules for second run Covid-19 variant tests

When re-testing Covid-19 specimens to check for variants, Medicare has indicated you may bill U0004 for the second-run of a high-throughput test.

For example, if a specimen tests positive, you may run the sample again to check for variants and bill U0004 (or the same code as the initial test) with a quantity of two. The accompanying diagnosis code must be for a positive Covid-19 result (e.g.: U07.1).

The variant test would only need to be run once for a positive sample. If the patient remains positive when they are later retested, that sample would not need to be re-tested for variants since the previous test determined whether a variant existed or not.

If you have additional questions surrounding billing for Covid-19 variant testing, feel free to reach out to us directly for a free consultation.

Please keep in mind that this information was gathered through a conversation with a representative from our client’s Medicare Administrative Contractor (MAC). Although we have not seen this policy formally documented, we encourage you to follow up with your MAC to confirm their preferred method for billing second-run tests.


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