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Laboratory Testing and Billing for COVID-19

Labs performing diagnostic tests for the 2019-Novel Coronavirus (COVID-19) have new HCPCS and CPT codes for billing and tracking new cases of the virus.

The Center for Medicaid and Medicare Services (CMS) has updated their standardized coding system,which Medicare and other health insurers use to submit claims for services provided to patients. Laboratories should now use the code HCPCS "U0002"to submit bills and report non-CDC laboratory tests for SARS-COV-2/2019-nCov (COVID 19). The HCPCS code "U0001" is used specifically for the CDC testing lab to patients.

Beginning on April 1, 2020, the Medicare claims processing system will start accepting the codes for services rendered on or after February 4, 2020. Until Medicare establishes national payment rates, the reimbursement amount for claims received under the new HCPCS codes will be determined by the Local Medicare Administrative Contractors (MACs). Labs are encouraged to seek guidance from MACs on payments for COVID-19 tests prior to billing for them.

For payers that require CPT codes, the American Medical Association has issued CPT 87635. The new CPT code will be found in the Microbiology Subsection of the Pathology and Laboratory and described as "87635 - infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID019], amplified probe technique."The CPT code can be used for billing and reporting COVID-19 diagnostic tests conducted as of March 13, 2020.

If your laboratory or billing agent is unable to obtain laboratory reimbursements, do not hesitate to contact our knowledgeable and experienced attorneys at 212-668-0200 or by email at info@mdrxlaw.com

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Monday, November 30, 2020