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CMS Releases Pricing Information for SARS-CoV2 Testing

Craneware® Insights Regulatory Updates – CWI1210 (17 March 2020)


Topic

CMS Releases Pricing Information for SARS-CoV2 Testing

CMS released a document entitled: “Medicare Administrative Contractor (MAC) COVID-19 Test Pricing March 12, 2020” in which pricing by each Medicare Administrative Contractor (MAC) is provided.

Provider Types Affected

Critical Access Hospitals
OPPS Hospitals
Provider-Based FQHC
Provider-Based Rural Health Clinics
Physicians

Departments/Areas Affected

Business Office
Compliance / Revenue Integrity
Finance
Laboratory – General
HIM/Medical Records

What You Need to Know

CMS has created two new HCPCS codes for SARS-CoV2 testing. Laboratories performing the new tests can bill Medicare starting April 1, 2020 for dates of service on or after February 4, 2020. The new codes are as follows:

HCPCS Code

Long Description

U0001

2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories. 

HCPCS code U0001 is to be used for CDC testing laboratories to test and track patients for SARS-CoV-2. HCPCS code U0002 is to be used for laboratories to report non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVID-19), using any technique, multiple types, or subtypes (includes all targets).

CMS states that the MACs are responsible for developing payment amounts for the new codes until Medicare can establish national payment rates. CMS is providing the following payment rates for each MAC jurisdiction:

MAC Jurisdiction

MAC States/Territories

U0001 Test Price

U0002 Test Price

J6 – National Government Services (NGS

Illinois, Minnesota, Wisconsin

$35.91

$51.31

JK – National Government Services (NGS

Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

$35.91

$51.31

JH – Novitas Solutions

Arkansas, Colorado, New Mexico, Oklahoma, Texas Louisiana, Mississippi

$35.92

$51.33

JL – Novitas Solutions

Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania; Part B services include Arlington and Fairfax counties in VA, and the city of Alexandria, VA

$35.92

$51.33

JN – First Coast Service Options (FCSO)

Florida, Puerto Rico, U.S. Virgin Islands

$35.92

$51.33

JJ–Palmetto Government Benefits Administrators (PGBA)

Alabama, Georgia, Tennessee

$35.91

$51.31

JM–Palmetto Government Benefits Administrators (PGBA)

North Carolina, South Carolina, Virginia, West Virginia

$35.91

$51.31

JE – Noridian Healthcare Solutions

California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands

$35.91

$51.31

JF – Noridian Healthcare Solutions

Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming

$35.91

$51.31

J5 – Wisconsin Physician Services (WPS)

Iowa, Kansas, Missouri, Nebraska

$35.92

$51.31

J8 – Wisconsin Physician Services (WPS)

Indiana, Michigan

$35.92

$51.31

J15 – CGS

Kentucky, Ohio

$35.92

$51.31

There is no beneficiary cost sharing, under Medicare, for the above mentioned lab tests.

Action Needed

Hospitals and provider offices should read the Medicare document on COVID-19 test prices in its entirety. Hospitals/provider offices should ensure that the new HCPCS codes are built into their chargemasters and charge capture tools. Staff responsible for charge capture and coding of these services should be informed of the availability of the new HCPCS codes.

Hospital financial systems that perform proration functions should reflect the lab test pricing of the area in which the hospital/provider office resides.

Effective Date

01 April 2020

Background

Coverage and Payment Related to COVID-19 Medicare Fact Sheet:

https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

Reference

https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

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