CMS Develops New Billing Codes for Coronavirus Lab Tests

CMS recently announced the development of new billing codes for coronavirus lab tests that will enable clinical laboratories and other providers to receive reimbursement for supporting patients during the outbreak and help increase testing and tracking of new cases.

“Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them,” CMS Administrator Seema Verma stated in the announcement. “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.”

The billing codes are now part of the Healthcare Common Procedure Coding System (HCPCS), a standardized coding system used by Medicare and other insurers to process claims from providers.

The first billing code released last month (U0001) was for SARS-CoV-2 diagnostic tests performed specifically for CDC testing laboratories. The second billing code (U0002) released on Thursday will expand medical billing and coding for coronavirus lab tests, permitting laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, otherwise known as the novel coronavirus or COVID-19.

There are over 95,000 cases of the novel coronavirus worldwide, according to the latest numbers from the World Health Organization. Of those cases, nearly 100 are in the US, which has also reported 10 deaths from the new strain of the human coronavirus, the CDC reported yesterday.

Testing and tracking the novel coronavirus are top priorities for world leaders who are implementing emergency protocols to stop the spread of the highly contagious disease. Just yesterday, Congress passed an $8.3 billion spending package to assist state and local agencies, as well as frontline providers, with combatting the outbreak.

CMS has also issued a call to action to healthcare providers in light of the novel coronavirus. On March 4, the agency urged providers to ensure they are implementing appropriate infection control procedures and issued guidance to state survey agencies and accrediting organizations to prioritize inspections focused exclusively on issues related to infection control.

The new billing code is another step CMS is taking to support providers who are dealing with the coronavirus.

“CMS continues to leverage every tool at our disposal in responding to COVID-19,” Verma stated. “CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”

The billing codes align with a new policy from the Food and Drug Administration (FDA) that allows certain laboratories to develop their own validated COVID-19 diagnostic tests. The second billing code from CMS can be used to bill Medicare and other payers for these new tests, CMS highlighted in the announcement.

The agency expects the specific billing codes to “encourage testing and improve tracking,” the announcement stated.

CMS reported that the Medicare claims processing systems will be able to accept the codes starting April 1, 2020. The codes will be able to cover coronavirus lab tests performed on or after Feb. 4, 2020.

Local Medicare Administrative Contractors (MACs) will be responsible for establishing the payment amount for claims with the newly created billing codes, CMS added. However, laboratories will able to ask their MACs for guidance on reimbursement for these tests before submitting claims for them.

There will also be no beneficiary cost sharing under traditional Medicare as with other laboratory tests, CMS reported.

In a separate fact sheet, CMS also highlighted Medicare coverage and payment for services related to COVID-19. The agency stated that, in addition to coronavirus diagnostic tests covered by the new billing codes, traditional Medicare also covers all medically necessary hospitalizations, as well as brief “virtual check-ins” in which providers and patients connect via phone or video chat.