We are complying with CMS coding guidelines for COVID-19 testing.
The American Medical Association created new CPT codes effective for dates of service on or after April 10, 2020, to describe COVID-19 antibody testing.
The American Medical Association created a new CPT code effective for dates of service on or after March 13, 2020, to describe COVID-19 testing by amplified probe technique:
- 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
Previously, CMS released two HCPCS codes effective for dates of service on or after Feb. 20, 2020, available for use on April 1, 2020:
- U0001 - CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel
- U0002 - 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19)
Effective Jan. 1, 2021, add-on HCPCS code U0005 may be used in addition to HCPCS codes U0003 and U0004 when high throughput technologies are used to complete testing within two calendar days from the date of specimen collection. When testing is not completed within two calendar days, codes U0003 and U0004 should be reported without U0005.
See our March 18, 2021, COVID-19 Provider Communication
for more information.
Laboratories using the CDC test kit should report U0001. Laboratories not using the CDC test kit should report 87635 if the testing method meets the code description. If your laboratory uses any other method not described by CPT 87635, HCPCS U0002 may be billed. We do not anticipate a need to receive code U0001 at this time as the government is testing at no cost.
The American Medical Association created new CPT codes effective for dates of service on or after April 10, 2020, to describe COVID-19 antibody testing:
- 86328 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
CPT code 86328 should be reported once per single-step method (e.g., reagent strip) even if multiple antibody classes (IgG and IgM) are tested. If two antibodies are tested in two separate single-step assays, 86328 may be reported twice. Modifier 59 should be appended to the code for the second test to identify that two distinct analyses were performed.
- 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Similarly, if IgG and IgM are tested in separate assays, 86769 may be reported twice. Modifier 59 should be appended to the code for the second test to identify that two distinct analyses were performed.
With the addition of these two new codes, the guidelines for codes 86602-86804 have been revised to incorporate new CPT code, 86328. A parenthetical note has been added following code 86635 directing users to new codes 86328 and 86769. Lastly, the description for code 86318 has been changed.
Screening for COVID-19 should be reported with the appropriate screening code:
- Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out
- Screening for COVID-19 due to potential exposure, but COVID-19 diagnosis is ruled out
- Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases
- Screening for COVID-19 due to contact with and suspected exposure
- Z11.59 – Encounter for screening for other viral diseases
- Asymptomatic, no known exposure, results unknown or negative
The implementation date for ICD-10-CM code U07.1 (COVID-19) has been moved up to April 1, 2020, from Oct. 1, 2020. Effective for discharge/dates of service on and after April 1, 2020, diagnosed cases of COVID-19 and presumptive positive COVID-19 tests should be reported with ICD-10-CM code U07.1, except in the case of newborns and obstetrics patients. Appropriate codes for associated medical manifestations should be reported as additional diagnoses.
For discharge/dates of service before April 1, 2020, providers should follow previously communicated guidelines
using the ICD-10 code for the condition as the primary diagnosis followed by B97.29 as the secondary diagnosis.
For dates of service on and after March 18, 2020, WellFirst Health requires modifier CS when billing E&M services related to the administration of a COVID-19 test or to the evaluation of a patient for purposes of determining the need for such a test. Modifier CS will allow us to accurately waive member cost share on services related to COVID-19 testing.
Providers may submit corrected claims to include modifier CS if member cost share was applied to a service related to COVID-19 testing on a previously-processed claim.
Telehealth service (either temporary or standard) is provided via Zoom or similar audio/visual technology
- Modifier: ’95 - indicating that the service rendered was actually performed via telehealth
- Place of Service: Equal to what it would have been had the service been furnished in-person (eg, 11, 20, 21, 22)
Telehealth service (either temporary or standard) is provided via traditional method involving originating site and distant practitioner
Communication technology-based services
- Modifier: None (Medicaid requires ‘GT - Via interactive A/V telecommunication systems)
- Place of Service : ’02’ – telehealth
Communication technology-based services (CTBS) are furnished via telecommunications technology but are not considered telehealth services. Examples include telephone services (CPT 99441-99443, 98966-98968), online E/M services (99421-99423, G2061-G2063).
Because these are not considered telehealth services, a telehealth modifier is not required. The Place of Service should be ‘11’ or other applicable site of the practitioner’s normal office location.
Codes and travel allowance for specimen collection
For dates of service on and after March 1, 2020, WellFirst Health accepts the following codes for COVID-19 specimen collection:
- G2023 — Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
- G2024 — Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
The laboratory technicians must personally draw the sample and collect the specimen from a homebound or nursing home patient. Enlisting a messenger service for a specimen pick up does not qualify.
A travel allowance may be provided to laboratory technicians collecting specimens for COVID-19 testing from a non-hospital inpatient or homebound patients under existing codes P9603 and P9604.
Specimen collection code for hospital outpatient clinic vis
Effective for dates of service on and after March 1, 2020, CMS established a new Level II HCPCS code for COVID-19 specimens collected during a hospital outpatient clinic visit:
- HCPCS C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
Effective May 1, 2020, specimen collections reported with HCPCS codes G2023 and G2024 for hospital outpatient clinic visits instead of C9803 will be returned.
COVID-19 testing using high throughput technologies
Effective on and after March 18, 2020, COVID-19 testing that uses high throughput technologies will be paid in accordance with CMS’ recently-released guidance. A high throughput technology is defined as a platform capable of automated processing of more than two hundred specimens per day. The highly sophisticated equipment requires more intensive processes and technician training to ensure quality and warrants a change in reimbursement.
Examples of high throughput technology as of April 14, 2020, include, but are not limited to, the following technologies:
- Roche cobas 6800 System
- Roche cobas 8800 System
- Abbott m2000 System
- Hologic Panther Fusion System
- GeneXpert Infinity System
- NeuMoDx 288 Molecular
HCPCS U0003 is used to report the high throughput version of tests that would otherwise be identified with CPT 87635. HCPCS U0004 is used to report the high throughput version of tests that would otherwise be identified with U0003. Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.