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Frequently Asked Questions on Covid-19 Billing

The word “Covid-19” shook the world apart by creating a big disaster in most of the firms. Even though Covid-19 is still showing its existence, the world has resumed its daily duties. We learned about various coding and billing changes that took place for Covid-19. This article will answer in details all the frequently asked questions about Covid-19 billing.

In an effort to support healthcare facilities as well as clinical laboratories, the Centers for Medicare & Medicaid Services established several new Healthcare Common Procedure Coding Systems at the beginning of March 2020.

Let’s dive in to the article now!

What are the new HCPCS Covid-19 billing codes?

  • CMS has developed two separate COVID-19 HCPCS billing codes. They are:
  1. U0001– The U0001 code is used to bill for tests and track new cases of the virus. It’s especially made for CDC testing laboratories that screen patients for SARS-CoV-2.
  2. U0002– The U0002 code allows laboratories to bill for non-CDC tests that screen patients for SARS-CoV-2. Additionally, code U0002 can do laboratory billing developed for 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?

  • The section 1135 of the Social Security Act authorizes the secretary of the Department of Health and Human Services to waive off and modify certain Medicare, Medicaid, CHIP, and HIPAA requirements.
  • This particular waiver changes the Medicare payment rules and also provides testing coverage to the independent laboratories.
  • Under these new guidelines, the quarantined people and those who have tested as in patients outside the hospital can still benefit from the coverage.

Who can bill Medicare for specimen collection-testing fees?

  • Under the section 1135 waiver, independent laboratories will have the opportunity to bill Medicare via Medicare administrative contractor.
  • However, it includes various pre-requisites to qualify for the coverage of specimen. They include:
  1. Collection by trained laboratory personnel
  2. One that does not require a messenger pick-up service
  • Medicare will not provide any coverage for the tests where the patients collect their own specimen.

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

  • There are two new level II HCPCS codes and they are G2023 and G2024. Independent laboratories should use one of these codes to bill Medicare for COVID-19 testing.
  1. G2023– Code G2023 can be used for any specimen source.
  2. G2024– Code G2024 is more specific. It applies to COVID-19 testing conducted in a Special Nursing Facility or by a Home Health Aid.

What changes did CMS announce regarding specimen collection fees for COVID-19 testing?

  • During the Public Health Emergency (PHE) for the COVID-19 pandemic, an effort has been made to be as expansive as possible within the current authorities. Diagnostic testing is being made available to Medicare beneficiaries who need it. In the interim final rule with comment period, they are changing the Medicare payment rules during the PHE for the COVID-19 pandemic to provide payment to independent laboratories. It is for specimen collection from beneficiaries those who are homebound or in-patients who are not in a hospital for COVID-19 testing under certain circumstances.

Can any laboratory use these codes to bill Medicare for Covid-19 billing?

  • Yes, all these codes arrived on April 1, 2020. If at all the labs are processing Covid-19 tests for Medicare and Medicaid patients, they can label them accordingly and receive proper reimbursements at appropriate timings.
  • CMS has 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?

  • From the beginning of the pandemic, dozens of companies released the improved COVID-19 tests.
  • Healthcare professionals should use one of the already established codes: U0001, U0002 or 87635. CMS has continued to monitor new COVID-19 testing methods. If CMS decides to adjust codes in the future, healthcare professionals can expect an official announcement.

What codes should be used for telemedicine services in Covid-19 billing?

  • Over the past few months, increasing number of healthcare professionals and clinics began to access medical care from homes.
  • Telemedicine uses smart phones, tablets and the internet to exchange confidential health information, offering both diagnosis and treatment.
  • In order to assist healthcare professionals with this transition, CMS has lifted many Medicare restrictions which were associated with telehealth.

What is the nominal fee for specimen collection for COVID-19 testing for homebound and non-hospital in-patients during the PHE?

  • The nominal specimen collection fee for COVID-19 testing for quarantined and non-hospital in-patients generally is $23.46. For individuals in a non-covered stay in a SNF or for individuals whose samples are collected by a laboratory on behalf of an HHA, it is $25.46.

How should a laboratory document the miles traveled to collect a specimen?

  • An independent laboratory billing Medicare for the travel allowance is required to log the miles traveled. CMS will not require any paper documentation logs that some MACs may have otherwise required. Electronic logs can be maintained instead.

Are there any HCPCS and Current Procedural Terminology CPT codes available for COVID-19 laboratory testing?

  • Yes, CMS has created two HCPCS codes in response to the urgent need for Covid-19 billing services. The codes are:
  • U0001, CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel and
  • U0002, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or sub types, non-CDC.

Are all of these codes available for laboratories to bill Medicare?

  • The CMS HCPCS codes will be available on the HCPCS and Clinical Laboratory Fee Schedule (CLFS) file beginning April 1, 2020, for dates of service on or after February 4, 2020.
  • The AMA CPT code, 87635 was also available on the HCPCS and CLFS file from April 1, 2020, for dates of service on or after March 13, 2020.

What code should we use to bill Medicare if new types of COVID-19 tests are created in the future?

  • The appropriate code to use would be HCPCS Code U0002 for COVID-19 test methods that are not specified by either U0001 or 87635. CMS will continue to monitor the types of COVID-19 testing methods and adjust coding as necessary depending on the methodology.

 

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