CMS develops additional code for coronavirus lab tests

March 9, 2020

The Centers for Medicare and Medicaid Services (CMS) has developed a second code that can be used by laboratories to bill for certain COVID-19 diagnostic tests.

The code is part of the Healthcare Common Procedure Coding System (HCPCS)—a standardized system that Medicare and other health insurers use for claims.

In February, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is for laboratories using the CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS said it expects that having two codes for the COVID-19 tests will encourage testing and improve tracking.

The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Until Medicare establishes national payment rates, local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions.

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