Elizabeth Barry Heddleston

Elizabeth Barry Heddleston
Associate

The Centers for Medicare & Medicaid Services (CMS) announced it has developed a new billing code for use by laboratories to bill for certain COVID-19 diagnostic tests. The Medicare claims processing systems will be able to accept the new COVID-19 codes on April 1, 2020, for dates of services on or after February 4, 2020.

The Healthcare Common Procedure Coding System (HCPCS) is the standardized coding system that Medicare and other health insurers use to process claims for healthcare services provided to patients. In February, CMS developed the first HCPCS code (U0001) in response to the COVID-19 outbreak. This code is limited to billing for COVID-19 tests developed by the CDC. The new billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for COVID-10.

Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created codes in their respective geographic jurisdictions until Medicare establishes national payment rates.

Palmetto GBA, the MAC for Virginia, has announced the reimbursement rate is $35.91 for the tests developed by the CDC (U0001) and $51.31 for tests developed by other entities (U0002).

Takeaways

According to CMS, the new code is designed to help increase the testing and tracking of COVID-19 cases.

Patients enrolled in Medicare Part B can have their diagnostic tests for COVID-19 fully covered if the test was performed on or after February 4, 2020.

More information

Visit the Woods Rogers COVID-19 Legal Updates page for a full list of alerts and resource links.

CMS News Alert on the New COVID-19 Billing Code

CDC COVID-19 Billing Guidance (pdf) 


If you have any questions about the COVID-19 pandemic and healthcare law:
Contact Liz Heddleston at lheddleston@woodsrogers.com.
View Liz’s full profile.