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Coding Guidelines for Coronavirus for Medicare Beneficiaries

In the 2nd week of March 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. The legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency. What is happening in the private health insurance sector remains unclear and may vary from payer to payer. CMS also issued a fact sheet on ‘Information Related to COVID–19 Individual and Small Group Market Insurance Coverage.’

  • CMS has created two Healthcare Common Procedure Coding System (HCPCS) codes to report testing for coronavirus. Labs that test patients for the new coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel may bill for that test using the new HCPCS code (U0001). This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.
  • The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On Feb. 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 tests.
  • This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. Diagnosis coding for coronavirus is also available.
  • For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
  • For suspected COVID-19, not confirmed or ruled out at the encounter, report codes for the presenting signs and symptoms. Do not report a code for coronavirus when this diagnosis is not stated in the medical record.
  • For known exposure to COVID-19 (without a diagnosis of COVID-19), report Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
  • For suspected exposure to COVID-19 that is ruled out after evaluation, report Z03.818, “Encounter for observation for suspected exposure to other biological agents ruled out.”

For more information, please see CMS’s frequently asked questions for health care providers regarding Medicare payment for laboratory tests and other services related to the 2019 novel coronavirus. CMS has also provided related fact sheets pertaining to Medicare and Medicaid and the Children’s Health Insurance Program. Coverage, payment, and other aspects of getting paid for services related to the coronavirus are continuously evolving. Stay tuned to the MBC blogs for further updates.

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