Coronavirus Provider Information
PROVIDER BILLING GUIDANCE FOR COVID-19 TESTING
We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.
HCPCS and CPT Codes for COVID-19 Testing Services
- Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
- HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
- HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
- CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
Please note: It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
- All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
- We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
- In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.
- Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
- We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
- Adjudication of claims is currently planned for the first week of April 2020.
Medicare Reimbursement Rates for COVID-19 Testing Services for All Provider Types*
- We are complying with the rates published on 3/12/20 by CMS:
- U0001 = $35.91
- U0002 = $51.31
- Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.
- Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.