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We heard CMS just approved a new code for hospitals to report COVID-19 laboratory specimen collections. What is the new code, to what date is the code retroactively effective and what is the reimbursement rate?

In the COVID-19 Interim Final Rule, CMS-5531-IFC, released on April 30, 2020, CMS announced it would be establishing a new HCPCS code for hospitals to report COVID-19 diagnostic laboratory specimen collections performed by qualified hospital staff. The new HCPCS code is C9803. We have included the code’s full description below for reference. Per the CMS Interim Final Rule, the code is retroactively effective and may be reported for COVID-19 laboratory specimen collections performed on or after March 1, 2020.

In the IFC, CMS notes the national unadjusted reimbursement rate for HCPCS C9803 will be $22.98. However, it is important to note that CMS has assigned HCPCS C9803 a status indicator of Q1, meaning the code is conditionally packaged – and all normal status indicator bundling logic will apply. This means that if HCPCS C9803 is billed in conjunction with a clinic visit, ED visit, observation services and/or any other primary service, HCPCS C9803 will be considered bundled and will not be separately reimbursed. There is also no separate reimbursement when specimen collection is performed on inpatients. For inpatients, the specimen collection would be bundled into the overall DRG payment rate.  Per CMS separate payment for HCPCS C9803 will be made if the code is billed with a clinical diagnostic laboratory test with a status indicator of “A” – so long as no other primary services are reported on the claim.

We would caution that the IFC did not state when Medicare claims processing systems will be updated to accept this new code. To avoid claim rejects and/or incorrect denials we advise contacting your MAC directly to check code availability prior to claim submission.

C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source)

CMS-5531-IFC, HCPCS C9803 is discussed on pages 188-192:

https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf