How to code Medicare Part B claims for reimbursement.
These past few months have been a whirlwind for everyone, but it’s fair to say medical coders have been hit with a category 5 hurricane. New codes and revised guidelines have been whirring about, making our heads spin. And now we have another new CPT® code to add to the fray.
The American Medical Association (AMA) has released a new proprietary laboratory analysis (PLA) code for novel coronavirus testing. This code is to be used specifically to report the BioFire® Respiratory Panel 2.1 test.
0202U Infectious disease(bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
With yet another testing code, you may be a little confused as to which code to use for what test. Here’s a rundown of the COVID-19 clinical diagnostic laboratory testing codes, with effective dates and Medicare payment rates.
|Code||Descriptor||Effective Date||Medicare Payment|
|U0001||CDC 2019 novel coronavirus (2019-nCoV) real-time RT-PCR diagnostic panel||2/4/20||$35.91*|
|U0002||2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC||2/4/20||$51.31|
|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||4/14/20||$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||4/14/20||$100|
|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||3/13/20||$51.31|
|86769||Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])||4/10/20||$42.13|
|86328||Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])||4/10/20||$45.23|
*$35.92 in MAC A/B JH, JL, JN, JS, J8, J15
The effective date for 0202U, per the AMA, is May 20, 2020. The Centers for Medicare & Medicaid Services (CMS) has not weighed in on this new code, as yet. In an earlier FAQ, CMS says to use HCPCS Level II code U0002 for COVID-19 test methods that are not specified by either HCPCS Level II U0001 or CPT® 87635.
See the CPT® Assistant Special Edition May Update for more details on how the AMA intends us to use this new code. See also the CPT® Assistant Special Edition April Update for the AMA’s guidance on using 86328 and 86769. (Note: CPT® Assistant is a paid subscription service. These special editions, however, are free and available for download on the AMA’s website.)
Ordering COVID-19 Diagnostic Lab Tests
During the public health emergency (PHE) for COVID-19, CMS has removed the requirement that certain diagnostic tests are covered only under the order of at treating physician or nonphysician practitioner (NPP). Any healthcare professional authorized to do so under state law may order COVID-19 diagnostic lab tests.
Medicare will allow payment for COVID-19 specimen collection billed by qualifying practitioners with CPT® code 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
Use CPT® 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physician’s or NPP’s services.
Hospital outpatient departments should use HCPCS Level II code C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19])), any specimen source to be paid for COVID-19 symptom assessment and specimen collection.
Independent labs may bill Medicare for specimen collection fees, transportation fees, and personnel expenses for the duration of the PHE for COVID-19. These fees are billable if the specimen is collected by trained lab personnel from a homebound or non-hospital inpatient. These fees and expenses are not billable if the patient collects their own specimen and a messenger service picks it up.
Price Transparency Requirements
Providers of diagnostic tests for COVID-19 are required to post on their website how much they will charge a patient for the service. This requirement, enacted in section 3202(b) of the CARES Act, is effective for the duration of the PHE for COVID-19. Medicare patients should not be charged a deductible or copay for any COVID-19 test.
CMS COVID-19 FAQ on Medicare FFS Billing
CMS MLN Matters 11805