by Jan Elezian
May 22, 2020
The Center for Medicare and Medicaid Services (CMS) has issued new clarifying guidance for the coding and payment of clinical laboratory tests under the Medicare Part B Clinical Laboratory Fee Schedule, used to detect COVID-19. For dates on or after February 4, 2020, continue to code U0001 (used in tests developed by the Center for Disease Control and Prevention (CDC)), and U0002 (used in laboratories performing non-CDC tests).
The following CPT codes were created by the American Medical Association (AMA) for COVID-19 detection and serology testing:
87635 – infectious agent detection by nucleic acid tests effective March 13, 2020;
86769 and 86329 – serology tests effective April 10, 2020.
Regional Medicare Administrative Administrators (MAC’s) have developed payment amounts for the above CPT and HCPCS codes until national payment rates are established. See table on page 2 of the CMS Ruling 2020-01-R referenced below.
For dates on or after April 14, 2020, Medicare will pay $100 for lab tests to detect COVID-19 using high throughput technologies. HCPCS codes below.
U0003 – infections agent detection by nucleic acid (DNA or RNA), COVID-19, amplified probe technique, using high throughput technologies as described by CMS-2020-01-R.
U0004 – detection COVID-19, any technique, multiple types or subtypes (includes all targets), non-CDC, using high throughput technologies as described by CMS-2020-01-R.
HCPCS code U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies. Code U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
Note that neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
There is generally no beneficiary cost sharing for these lab tests under Original Medicare.
Ramping Up Virtual Project Management / Team Facilitation in Response to COVID-19? SunHawk Can Help
Our skilled leaders and professionals at SunHawk are experts at managing complex and time sensitive projects in a virtual on-line world. In these disruptive times, we can jump in to help your organization with regulatory and compliance management needs including:
Organizing a short-term crisis management/response team,
Facilitating or assume leadership of a new compliance initiative, or
Provide leadership to an established team or add additional expertise.
Do you have work that needs to be done? Do you not have the immediate bandwidth or resources to see such projects to fruition given other priorities? We can help, please reach out to Jim Rough or James Rose for assistance:
SunHawk Consulting is a team of highly skilled and experienced subject matter experts in the Healthcare, Life Sciences, and Insurance Industries who understand that the client’s needs and budgets come first. SunHawk provides Crisis Management Response, Compliance Consulting, Disputes & Investigations, and Staff Augmentation services for Boards of Directors, internal/external legal counsel, company management and employees, special committees, bankruptcy trustees and receivers, and government agencies.