Here are codes for COVID-19 lab tests and specimen collection, with some tips, and guidance on when to use the QW modifier,[1] said Chris Anusbigian, a specialist senior manager with Deloitte & Touche in Detroit. Contact her at canusbigian@deloitte.com.
Coding & Billing – COVID-19 Testing Lab Services
Providers billing for COVID-19 testing should use the following HCPCS/CPT codes and guidelines during the public health emergency
|
Code |
Description |
Effective Date |
|---|---|---|
|
Antigen/Molecular Tests | ||
|
U0001 |
Centers for Disease Control and Prevention (CDC) 2019 novel coronavirus (2019-nCoV) real-time RT-PCR diagnostic panel |
4/1/2020[2] |
|
U0002 |
Non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19) |
4/1/20202 |
|
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 |
3/13/2020 |
|
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 |
3/18/2020 |
|
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 |
3/18/2020 |
|
Antibody Tests | ||
|
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]) |
4/10/2020 |
|
86769 |
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (multistep method) |
4/10/2020 |
|
Specimen Collection | ||
|
G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source (Billable only by clinical diagnostic laboratories) |
3/1/2020 |
|
G2024 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source (Billable only by clinical diagnostic laboratories) |
3/1/2020 |
|
99211 |
Specimen is collected during a visit where the face-to-face interaction only involves clinical staff of the billing professional for the purpose of a COVID-19 assessment and specimen collection, new and established patients |
3/1/2020 |
|
C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source |
3/1/2020 |
ADDITIONAL NOTES
Providers should work with their commercial payers to determine the appropriate coding requirements.
Providers should add above codes to their chargemaster, update associated clinical systems, and monitor revenue and usage of these services as well as associated reimbursement.
During the COVID-19 public health emergency, COVID-19 tests may be covered when ordered by any health care professional authorized to do so under state law (normally must be based on the order of a treating physician or nonphysician practitioner per 42 C.F.R. § 410.32 [a])
Sources
https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf
https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf
https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf
https://www.cms.gov/files/document/cms-2020-01-r.pdf
https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf
