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COVID-19 billing: Frequently asked questions answered

The COVID-19 pandemic changed the world overnight. The rapid rate of community spread and the severe side effects of the virus present unique challenges for private clinics, hospitals and major health systems.

In an effort to support these facilities, as well as clinical laboratories, the Centers for Medicare & Medicaid Services established several new Healthcare Common Procedure Coding System codes at the beginning of March. These codes allow doctors and laboratory facilities to bill for certain COVID-19 diagnostic tests, which can result in better revenue cycle management and less hassle.

At the time, CMS administrator Seema Verma said, “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”

But what are the new codes used for COVID-19, and how can you implement them at your practice? Here at Med USA, these are some of the most common questions we’ve received over the past several months. To better explain the process, we’ve developed an FAQ that provides answers to your most pressing questions.

What are the new COVID-19 HCPCS billing codes?

CMS developed two separate COVID-19 HCPCS billing codes — U0001 and U0002.

  • U0001 – The U0001 code is used to bill for tests that test and track new cases of the virus. It’s specifically for CDC testing laboratories that screen patients for SARS-CoV-2.
  • U0002 – The U0002 code allows laboratories to bill for non-CDC tests that screen patients for SARS-CoV-2. Additionally, code U0002 can bill for laboratory-developed COVID-19 diagnostics. Many of the COVID-19 tests that are currently available fall into this category.

How does Section 1135 of the Social Security Act affect COVID-19 billing?

Section 1135 of the Social Security Act authorizes the secretary of the Department of Health and Human Services to “waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements.”

This waiver changes the Medicare payment rules and provides testing coverage to independent laboratories. Under the new guidelines, people who are homebound or tested as inpatients outside of a hospital can still receive coverage.

Who can bill Medicare for specimen collection (testing) fees?

Under the Section 1135 Waiver, independent laboratories can bill Medicare through their Medicare Administrative Contractor. However, there are several prerequisites. To qualify for coverage, a specimen must be:

  • Collected by trained laboratory personnel
  • One that does not require a messenger pick-up service

Additionally, Medicare won’t provide coverage for tests where a patient collects his or her own specimen.

What are the level II HCPCS codes for COVID-19 testing?

The two new level II HCPCS codes are G2023 and G2024. Independent laboratories must use one of these codes in order to bill Medicare for COVID-19 testing.

  • G2023 – Code G2023 can be used for any specimen source.
  • G2024 – Code G2024 is more specific. It applies to COVID-19 testing conducted in a Special Nursing Facility or testing that’s performed by a Home Health Aid.

Can any laboratory use these codes to bill Medicare?

Yes. All of these codes took effect April 1. If you’re processing COVID-19 tests for Medicare or Medicaid patients, you can label them accordingly and receive reimbursement right away. CMS developed an additional code –– 87635 — to cover all tests conducted after March 13, 2020.

What code should I use if my laboratory processes newer COVID-19 tests?

Since the beginning of the pandemic, dozens of companies have released improved COVID-19 tests. Even so, you should use one of the already established codes: U0001, U0002 or 87635. CMS continues to monitor new COVID-19 testing methods. If CMS decides to adjust codes in the future, you can expect an official announcement.

To stay abreast of changes, make sure to bookmark CMS’ Coronavirus (COVID-19) Partner Toolkit. CMS regularly updates this page with news and information.

What codes should I use if I provide telemedicine services?

Over the past few months, a growing number of doctors and clinics have begun offering telemedicine services. Telemedicine allows patients to access medical care from the comfort of their own home. It uses smartphones, tablets and the internet to exchange confidential health information, offering both diagnosis and treatment.

To assist providers with this transition, CMS lifted many of the Medicare restrictions associated with telehealth. This FAQ from CMS covers a variety of topics, including coding recommendations for fee-for-service billing. This blog covers telemedicine billing CPT codes more in-depth.

I still have questions about COVID-19 billing. What should I do?

If you have further questions about COVID-19 billing, know you aren’t alone. The pandemic is a fluid situation that changes on an almost daily basis. CMS wants to ensure medical laboratories and facilities are familiar with the coding and billing guidelines. Here at Med USA, we passionately support this cause. In fact, we provide a range of specialized lab billing services.

With more than 40 years of experience in the medical billing industry, we’re well-equipped to answer any questions or concerns you have. Feel free to reach out to us at any time, and we’ll be happy to assist however we can. To get in touch, you can either fill out an online contact form here, or you can give us a call at (801) 852-9500.