Coding and billing COVID-19: A step-by-step guide

April 22, 2020

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.

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