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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