COVID-19 billing and coding primer

March 27, 2020

As part of a developing response to the COVID-19 pandemic, CMS and the American Medical Association have each issued billing codes for reporting COVID-19 related lab tests. Here’s a quick rundown of the key items to know when performing and billing for these tests.

CMS Guidelines:

Codes: (U0001) CDC’s 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel

(U0002) Non-CDC Tests

  • Starting April 1, laboratories performing the tests developed by the Centers for Disease Control and Prevention (CDC) can bill Medicare and other health insurers for services that occurred after Feb. 4, 2020, using the newly created HCPCS code (U0001). Laboratories performing non-CDC lab tests for COVID-19 can bill for them using a different HCPCS code (U0002).
  • CMS said in a press release that having specific codes for these tests will encourage testing and improve tracking.
  • Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates.
  • Currently most MACs payment rate for U0001 is $35.91, while most pay $51.33 for U0002.

AMA Guidelines for Commercial Payers:

Code: CPT 87635

  • Short description: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) (Coronavirus disease [COVID-19]), amplified probe technique
  • Effective March 13, this code is to be used for reporting COVID-19 testing to commercial payers unless the policy directs otherwise.

Diagnosis Coding:

Effective April 1, the CDC, is implementing a new diagnosis code, U07.1, COVID-19, into the ICD-10-CM.

If diagnosis code U07.1, COVID-19, is reported as a principal diagnosis, it will only exclude itself from acting as a MCC under the CC Exclusions List Principal Diagnosis Code Exclude Secondary Diagnosis Description U07.1 U07.1 COVID-19.

For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Depending on the circumstances, COVID-19 can also be coded with B97.29 Other coronavirus as the cause of diseases classified elsewhere. Only report B97.29 for confirmed cases of COVID-19.

Payers waiving cost sharing for members:

It’s also worth keeping in mind that most commercial payers, such as UHC, has announced they are waiving cost co-pays and deductibles for their members who undergo COVID-19 testing.

If you have questions related to any of these items, don’t hesitate to reach out to Vachette directly at 517-486-4262.

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