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CMS stated it will now reimburse providers $100 for COVID-19 lab tests that utilized “high throughput technologies”, what are some examples of this lab technology and how do we report these kinds of tests on claims?

On April 15th Medicare released CMS Ruling CMS-2020-01-R, linked below, which outlines CMS’s decision to reimburse providers $100 per unit for COVID-19 lab tests that utilize high throughput technologies – which allow for increased testing capacity and faster result times. In the Ruling, CMS defines high throughput technologies as testing systems that “employ automated processing of more than two hundred specimens a day”. Within the Ruling CMS noted current examples of such systems, these examples include (but are not limited to):

  • Roche cobas 6800 System
  • Roche cobas 8800 System
  • Abbott m2000 System
  • Hologic Panther Fusion System
  • GeneXpert Infinity System
  • NeuMoDx 288 Molecular

CMS outlines in the Ruling that they believe the increased reimbursement rate of $100 per unit is warranted because these are highly sophisticated machines that require more intensive technician training than testing methods that do not utilize high throughput technology.

In order to identify COVID-19 laboratory tests that utilize high throughput technology CMS has established the two new HCPCs codes noted below:

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.

Per CMS, code selection is as follows:

“It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies. It is further noted that U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies. Finally, it is noted that neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.”

We would caution that the Ruling does not state when CMS claims processing systems will be updated to accept these new codes. We will provide an update as soon as any additional guidance is released. Please check with your individual MACs and/or commercial payers prior to claim submission for code availability.

CMS Ruling CMS-2020-01-R:

https://www.cms.gov/files/document/cms-2020-01-r.pdf