CMS: New HCPCS billing codes for coronavirus tests
The CMS has released new billing codes for lab tests pertaining to the coronavirus. This will enable clinical labs and providers to receive reimbursement and increase testing and tracking of new cases.
The billing codes are part of the Healthcare Common Procedure Coding System (HCPCS) that Medicare and other insurance carriers can use to process provider claims. The billing codes include the following:
- U0001, SARS-CoV-2 diagnostic tests performed specifically by CDC testing laboratories
- U0002, SARS-CoV-2 diagnostic tests performed by non-CDC labs
The new codes align with recent Food and Drug Administration policy that allows certain laboratories to develop their own validated COVID-19 diagnostic tests. The second billing code from the CMS (U0002) can be used to bill Medicare and other payers for these tests developed by non-CDC laboratories.
According to the CMS, it expects the new billing codes to “encourage testing and improve tracking.”
The codes are accepted beginning April 1, 2020, and will cover coronavirus lab tests performed on or after Feb. 4, 2020. Local Medicare Administrative Contractors (MACs) will be responsible for establishing payment amounts for these codes.
AMA: New CPT code
The American Medical Association (AMA) announced a new Current Procedural Terminology (CPT) code for reporting tests for COVID-19, effective immediately. The code and descriptor are:
- 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
CMS: Medicaid and Medicare coverage
Medicaid
The CMS released four tools to “permit states to access emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be effectively served in their homes, and modify payment rules to support health care providers impacted by the outbreak.”
Medicare Part A: Inpatient hospitalization
According to a CMS fact sheet on COVID-19 Medicare coverage, when Medicare beneficiaries with COVID-19 no longer require acute inpatient care but remain quarantined in a hospital room to avoid infecting others, Medicare will pay the diagnosis-related group (DRG) rate and any cost outliers until the patient is discharged. In addition, patients will not have to pay an additional deductible for quarantine in a hospital if they otherwise would have been discharged.
Medicare Part B: Outpatient visits
According to the CMS, Part B will cover medically necessary care provided in outpatient quarantine settings, along with clinical lab and medical imaging tests that are medically necessary.
Inpatient and outpatient quality reporting
The CMS announced exceptions from and extensions to reporting requirements for clinicians, providers, hospitals, and facilities participating in quality reporting programs.
Emergency declaration fact sheet
To help clarify its response to the Trump administration’s COVID-19 emergency declaration, CMS has published a fact sheet for healthcare providers.
Telehealth services
The Trump administration announced on March 17, 2020, expanded coverage for Medicare to pay temporarily for a wider range of telehealth services during the COVID-19 crisis. The CMS, the Department of Health and Human Services (HHS), and the AMA have published related information:
