Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
2008
2009
2010
Announcements
Articles
Articles and Publications
Campaign
Case Studies
Charge Capture and Pricing
Coding Integrity
Company
Consulting
Craneware Insights Articles
Education
Home
Journey
News & Events
Opportunities
Other
post
Press Releases
Products
Services
Testimonial
Trade Shows
Uncategorized
Uncategorized
Upcoming Events
Value Cycle
Webinars
White Papers

CMS Updates COVID-19 Lab Reporting Requirements

Craneware® Insights Regulatory Updates – CWI1214 (24 March 2020)


Topic

CMS Updates COVID-19 Lab Reporting Requirements

CMS posted an update of their Frequently Asked Questions (FAQ) document in which information is provided regarding HCPCS/CPT® codes for SARS-CoV-2/2019-nCoV (COVID-19) testing.

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
Emergency Department
Laboratory – General
HIM/Medical Records
OP Clinics
Urgent Care

What You Need to Know

This Craneware Insights article is providing an overview of the CMS and the American Medical Association (AMA) HCPCS/CPT® codes created to report COVID-19 testing.

CMS has created two HCPCS codes, which are effective February 4, 2020:

HCPCS

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 describes COVID-19 testing using the CDC 2019 Novel Coronavirus (2019-ncov) Real Time RT-PCR Diagnostic Panel. HCPCS code U0002 describes non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).

On March 13, 2020, the AMA posted one new CPT® code for COVID-19 testing:

HCPCS

Description

87635

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

Per the updated CMS FAQ document entitled “COVID-19 FAQs”, the CMS HCPCS codes may be used for lab tests with dates of service on or after February 4, 2020. The AMA CPT® code (87635) may be used for dates of service on or after March 13, 2020. The CMS claims processing system will be able to accept all three codes as of April 1, 2020. CMS is instructing the MACs to hold claims submitted until the first week of April at which time the claims will be released for adjudication.

The FAQ document also offered guidance regarding the circumstances in which each of three codes should be used for reporting purposes:

  • Any COVID-19 tests performed with a CDC developed test kit should be billed to Medicare with HCPCS U0001.
  • If the laboratory is using the method specified by CPT® code 87635, then report the test with code 87635.
  • If the laboratory is using a method not described by CPT® code 87635, then report HCPCS code U0002.

The Medicare Administrative Contractors (MACs) are responsible for developing the payment amounts for the newly created CPT/HCPCS codes until Medicare can establish national payment rates. The current MAC payment rates can be accessed via the following link: https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf.

In the FAQs document, the question of how to bill Medicare for new types of COVID-19 tests created in the future was answered by CMS with the following: “The appropriate code to use would be HCPCS Code U0002 for COVID-19 test methods that are not specified by either U0001 or 87635. CMS will continue to monitor the types of COVID-19 testing methods and adjust coding as necessary depending on the methodology.”

Providers will need to determine what codes will be accepted by other third-party payers. In a special edition of CPT® Assistant for reporting laboratory testing for coronavirus (SARS-CoV-2) (CPT® Assistant Special Edition, Volume 30, 2020) the AMA states to “contact your local third-party payer directly to determine their specific reporting guidelines” because the use of HCPCS or CPT® codes is “dependent upon the payer to which the claim is being submitted.”

Action Needed

Facilities and providers need to become familiar with Medicare’s billing and coverage guidelines for diagnosing and treating patients with coronavirus. For hospital laboratories in which the COVID-19 testing is processed “in-house”, it will be necessary to determine if the COVID-19 tests are CDC or non-CDC developed in order to assign the appropriate HCPCS code.

Hospitals and providers need to ensure that the new CPT/HCPCS codes are added to their chargemaster(s) and charge capture tools. Staff who enter orders for laboratory tests need to be informed of the newly created codes.

Effective Date

04 February 2020

Background

N/A

Reference

https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

CPT Codes © 2020 American Medical Association, use of this site denotes acceptance of below terms and conditions

CPT codes, descriptions, and material only are copyright 2020 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained here in. CPT is a trademark of the American Medical Association.

The responsibility for the content of any ‘National Correct Coding Policy’ included in this product is with Centers for Medicare and Medicaid Services, formerly known as Health Care Financing Administration, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Applicable FARS/DFARS Restrictions Apply to Government Use.

Current Dental Terminology copyright © 2020 American Dental Association. All rights reserved.

NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipient(s) and not to be shared with other facilities or vendors outside of Craneware. Craneware Inc, 3340 Peachtree Road, N.E., Suite 850, Atlanta, GA 30326, Tel: 404-364-2032 email: info@craneware.com