Medical Billing ServicesMedical Coding

Newly Added Lab Specimen Collection HCPCS Codes COVID-19

CMS announced the creation of new COVID-19 lab specimen collection HCPCS codes G2023 and G2024 through their COVID-19 Interim Final Rule effective on and after March 01st, 2020. The rule specifies that these codes are only chargeable by independent laboratories and only in instances where trained personnel from the lab travel to collect the specimens from patients who are either homebound or are non-hospital inpatients.

There is no language in the rule that allows for these codes to be charged in any other scenario including (but not limited to) testing sites where the patient physically presents to be tested, specimens collected from hospital inpatients, or samples collected from ED patients, etc. It is our interpretation of the rule that HCPCS G2023 should be reported by independent laboratories for specimens collected from homebound or non-hospital inpatients and HCPCS G2024 is reported by independent laboratories when specimens are collected from patients in SNFs and specimens collected on behalf of HHAs.

It is important to note the CMS definition of “homebound” was also expanded under the rule to include:

  • when a physician attests it is medically contraindicated for a patient to leave the house because of a confirmed or suspected diagnosis of COVID-19; and
  • when a physician attests it is medically contraindicated for a patient to leave the house because they have a condition that would make them more susceptible to contracting COVID-19.

Homebound status must be clearly documented in the patient’s medical record. A patient who chooses to self-quarantine would not meet the CMS definition of homebound.

 

Procedure Coding

Medicare Reimbursement

G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source $ 23.46
G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source $ 25.46

In interim final rule CMS-1744-IFC, CMS states that it is changing Medicare payment policies for the duration of the COVID-19 pandemic. This change allows Medicare-enrolled independent laboratories to bill Medicare for the COVID-19 specimen collection “G” codes. At this time, we are awaiting clarification if these codes are reportable by hospital-based laboratories on UB-04 claim forms.

If the patient is “confined to the home” (that is, “homebound”), laboratories may also bill for the travel allowance with the current HCPCS codes set forth in Section 60.2 of the Medicare Claims Processing Manual (P9603 and P9604). CMS-1744-IFC clarifies the context of “homebound” for the COVID-19 pandemic. If determined that hospital labs are unable to report the above collection codes, we suggest the Hospital review its charge amounts for testing to ensure they capture the cost of specimen collection, including provisions for special protective measures and/or supplies.

Visit our blog section for more billing resources on COVID-19. These resources will help you to prepare your practice and address patient concerns during COVID-19 pandemic. To get reimbursed for medical services rendered during COVID-19 pandemic, contact Medical Billers and Coders (MBC) at 888-357-3226/ info@medicalbillersandcoders.com

Reference:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

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