In an MLN Matters article (SE20011),[1] CMS listed three CPT and HCPCS codes for COVID-19 testing that trigger the use of the CS modifier, but there are now seven COVID-19 tests,[2] said Chris Anusbigian, a specialist senior manager with Deloitte & Touche in Detroit. “I’m not sure if CMS has updated its edits,” she said. Hospitals are holding their claims pending clarification. The newer codes are HCPCS codes U0003 and U0004 and CPT codes 86328 and 86769. Contact her at canusbigian@deloitte.com.
Coding & Billing - COVID-19 Testing
Providers billing for COVID-19 testing should use the following HCPCS/CPT codes and guidelines (as of 4/16/2020).
Code |
Description |
Effective Date |
---|---|---|
U0001 |
CDC 2019 novel coronavirus (2019 ncov) real time rt pcr diagnostic panel |
4/1/2020i |
U0002 |
Non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19) |
4/1/2020i |
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 |
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 |
ADDITIONAL NOTES
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Providers should work with their commercial payers to determine the appropriate coding requirements.
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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.
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
Endnotes
i HCPCS codes are effective as of 4/1/2020 but can be retroactively billed for services beginning on 2/4/2020.