CMS recently announced new payment rates for Current Procedural Terminology codes developed by the American Medical Association for Covid-19 diagnostic tests. The federal agency updated guidance on May 19, to include Medicare Payment Rates for COVID-19. CPT codes 87635, 86769, and 86328, which can be used by healthcare providers. Laboratories can use these codes to bill payers for testing patients for SARS-CoV2. According to Medicare will pay $51.31 for 87635, $42.13 for 86769, and $45.23 for 86328.
AMA added CPT codes 86769 and 86328. The codes can be used for COVID-19 antibody testing in which providers test patients for the novel coronavirus using blood, serum, or plasma.
Below is the full code descriptions for the CPT codes:
- 86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Guidance from the AMA states that CPT code 87635 is most appropriate for COVID-19 diagnostic laboratory testing, while CPT codes 86769 and 86328 should be used for serologic laboratory testing for COVID-19.
New HCPCS Codes
CMS issued a new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the CDC-developed test on February 13, 2020. For more information about this code, visit: CMS new code coronavirus lab test
The new (HCPCS) Healthcare Common Procedure Coding System code (U0001) can be used by health care providers and laboratories to bill for laboratory testing patients for SARS-CoV-2.
HCPCS is a standardized coding system. Medicare and other health insurers use this coding system to submit claims for services provided to patients. This new code will allow laboratories who are conducting the tests to bill for the specific test instead of using an unspecified code. This explains better tracking of the public health response for this particular strain of the coronavirus to help protect people from the spread of this infectious disease.
Local (MAC) Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates.
As other COVID-19 / SARS-CoV-2 tests are developed, that they will also be reimbursed at the $100 rate using the following new HCPCS codes:
- U0003: 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, making use of high throughput technologies as described by CMS-2020-01-R.
- U0004: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
CMS previously provided guidance about detailed Medicare payment rates for HCPCS codes U0001 and U0002. These were created by CMS in February for providers to bill for Covid-19 tests developed by the CDC (Centers for Disease Control and Prevention), as well as for laboratories using non-CDC tests. Medicare reimburses providers and laboratories $35.91 for U0001 and $51.31 for U0002.
CMS intends for the HCPCS codes and higher Medicare payment rates to respond quickly to COVID-19 outbreaks, especially in nursing homes, CMS Administrator Seema Verma said.
New CPT Codes and EHR
You will need to manually upload these new code descriptors into your HER system. These CPT codes will become part of the complete CPT code set in the data file for 2021 later this year.
Ambulatory Services in a Hospital or Other Location
Medicare Part B covers medically necessary ambulatory services, including doctors’ services, hospital outpatient department services, home health services, durable medical equipment, mental health services, and other medical services. Coinsurance and deductible would generally apply depending on the service. In the event a patient is quarantined in an ambulatory setting, the existing Medicare payments for medically necessary services apply.
Telehealth and Other Communication-Based Technology Services
Please see the link to the Medicare Telemedicine Health Care Provider Fact Sheet at https://go.cms.gov/2MxWf3I. For error-free coding and billing, you can get in touch with our RCM manager at email@example.com.