Updated FAQ clarifies COVID-19 test coding

CMS released an update to its FAQ on coding and billing for the novel coronavirus (COVID-19) on March 23. The FAQ clarifies the use of HCPCS and CPT® codes for diagnostic laboratory services.

Laboratories may bill for COVID-19 diagnostic tests using one of three codes. For the CDC test kit, laboratories must use HCPCS code U0001 (CDC 2019-nCoV real-time RT-PCR diagnostic panel). For non-CDC test kits, laboratories must use either:

• HCPCS code U0002 (2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes [includes all targets], non-CDC); or
• CPT code 87635 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19), amplified probe technique)

Both HCPCS codes are effective February 4 and will be in the Medicare claims processing system April 1. Laboratories can begin billing for these codes immediately, according to the FAQ. MACs have been instructed to hold claims for these tests until the first week of April. The CPT code will also be available on the HCPCS and Clinical Laboratory Fee Schedule files starting April 1 and is effective for dates of service on or after March 13.

If a laboratory uses a non-CDC test that uses the method specified by CPT code 87635 but has not yet been able to implement the code in the billing system, the laboratory may use HCPCS code U0002.

If new tests are created, laboratories should use HCPCS code U0002. CMS will continue to monitor the types of testing available and will adjust codes as necessary.

MACs are responsible for developing the payment amounts for the HCPCS codes until Medicare establishes national payment rates via the clinical laboratory public meeting this summer. CMS published a table displaying the contractor rates on March 12. While the contractor payment amounts differ by a few cents between MACs, they are generally approximately $35.91 for U0001 and $51.31 for U0002.

The FAQ also responds to questions about the use of telehealth for home health services, billing for hospital services that are subject to the waivers announced on March 16, and more.

Editor’s note: This article was originally featured on Revenue Cycle Advisor. 

NAHRI members can share information and ask questions about COVID-19-related revenue integrity concerns on our dedicated COVID-19 forum. Nonmembers may use HCPro’s COVID-19 forum by registering free of charge. Visit our Coronavirus Resource Center for additional guidance and education. Email NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com with requests for additional COVID-19 resources and news.