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COVID-19 Lab Tests - Coding & Rate Updates from CMS


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[1]. 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.[2]

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.

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[1] https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf [2] https://www.cms.gov/files/document/cms-2020-01-r.pdf

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