COVID-19 Laboratory Billing Information

Quadax is dedicated to keeping our laboratory clients up-to-date on the billing, reporting, and procedural information specific to each payer as it pertains to COVID-19.

Click here for additional COVID-19 Payer Information 

Latest Updates

Indicates most recent updates 

Date Payers and Organizations Overview
2/1/2022 Aetna

COVID-19 News February 2022. COVID-19 Testing - We cover COVID-19 testing without cost sharing when medically necessary. We do not cover testing for returning to work or school, or for surveillance purposes or travel purposes. The patient is responsible for the full cost of testing if the billed place of service is work or school. READ MORE

Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. READ MORE 

>>>Click here to read past updates

2/23/2022 American Medical Association (AMA)

AMA Updates/Category I and Proprietary Laboratory Analyses (PLA). Review and download the full CPT code descriptor release. READ MORE 

2/21/2022 - AMA/CPT Category I and PLA Codes for Severe Acute Respiratory Syndrome Coronavirus 2 (CARS-CoV-2) (coronavirus disease {COVID-19}). Most recent changes to this long descriptor document. READ MORE 

4/29/2020 Amerigroup Member cost shares will be waived for COVID-19 lab tests performed by participating and non-participating providers. Lab testing should be billed with codes U0001, U0002, U0003, U0004, 86328, 86769 or 87635. READ MORE
5/8/2020 Anthem California

Prior authorizations are not required from Anthem or it's delegated entities for screening or testing related to Covid-19. READ MORE

>>>Click here to read past updates

4/22/2020 Anthem Colorado, Indiana, Kentucky, Missouri, Ohio, Wisconsin Payer is encouraging providers to bill with codes U0001, U0002, U0003, U0004, 86328, 86769, or 87635 based on the test provided. READ MORE
1/18/2022  Blue Cross Blue Shield 
Texas

Labs for Prompt COVID-19 Testing. READ MORE

>>>Click here to read past updates

10/5/2021 CAP College of American Pathologists

CAP Advocacy Update 10/5/21. CAP Urges Senate Leaders to Include Insurance Access Provisions in Reconciliation Bill. READ MORE

/>>>Click here to read past updates

8/10/2022 Centers for Disease Control and Prevention (CDC)

8/2/2022 - Lab Update: Clinical Laboratory COVID-19 Response Calls Are Now LOCS Calls. Beginning this month, the CDC Division of Laboratory Systems (DLS) will change the name of the Clinical Laboratory COVID-19 Response Calls to Laboratory Outreach Communication System (LOCS) Calls. READ MORE 

Lab Update 7/27/22. FDA Updates FAQs on Testing for SARS-CoV-2. On July 26, 2022, the U.S. Food and Drug Administration (FDA) updated its FAQs on Testing for SARS-CoV-2 page to note that no tests remain on the commercial manufacturer serology test notification list described in FDA’s Policy for Coronavirus Disease-2019 Tests. All tests previously on the commercial manufacturer serology test notification list have either been issued an Emergency Use Authorization (EUA) or should no longer be distributed, marketed, or offered. READ MORE 

6/27/2022 - Lab Alert 6/27/22: FDA Revokes EUAs for Two SARS-CoV-2 Tests. READ MORE 

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1/13/2022 Centers for Medicare & Medicaid Services (CMS)

Clinical Lab Fee Schedule - Revised. Note the upcoming changes to the payment rules for independent labs when collecting specimens from homebound patients and inpatients.
READ MORE 
                  

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4/6/2021 Cigna

Cigna covers diagnostic molecular and antigen tests for COVID-19 through April 20, 2021 without cost-share when an individual seeks and receives a diagnostic test from a licensed or authorized health care provider, or when a licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test. READ MORE 

>>>Click here to read past updates
11/5/2020 Excellus Blue Cross Blue Shield

Modifier CG Clarification for COVID-19 Viral and Antibody Testing (Audience: Participating Physicians, Hospitals, Facilities and Laboratories). READ MORE 

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7/15/2022 First Coast Service Options -
JN A & B

Fee Schedule News 7/15/22 for Part A & B Providers. COVID-19: Allowances for laboratory test codes. CMS has established new codes for laboratory tests for the novel coronavirus (COVID-19). CMS provided pricing for codes U0001 and U0002, but instructed MACs to develop the allowance for the remaining codes. READ MORE

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1/25/2022 Food and Drug Administration (FDA)

UPDATE - FDA Roundup News 1/25/22. READ MORE 

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11/15/2021  Department of Health and Human Services (HHS)

Laboratory-Developed Tests: The U.S. Department of Health and Human Services and the Food and Drug Administration are committed to helping ensure that COVID-19 tests are accurate, reliable, and available. As part of that commitment, HHS is withdrawing a policy established during the previous administration that limited FDA’s ability to address certain problematic COVID-19 tests. READ MORE 

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6/11/2020 Highmark

COVID-19 Molecular Testing. The following codes have been created for providers and laboratories to allow billing for COVID-19 patient diagnostic tests. READ MORE

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2/17/2021 Horizon BCBC New Jersey

Effective January 1, 2021 and throughout the period of public health emergency, Horizon BCBSNJ shall consider an additional add-on payment (U0005) for COVID-19 diagnostic testing run on high throughput technology, when billed with procedure code U0003 or U0004, and when the following conditions are met:

• U0003 or U0004 COVID-19 testing is completed in two (2) calendar days or less for the specific test billed, and
• The laboratory can certify that 51% of the previous months U0003 and U0004 COVID-19 diagnostic testing was completed within two (2) calendar days or less.

>>READ MORE

2/17/2021 HRSA Beginning, January 1, 2021, Medicare will reimburse independent laboratories $75 per claim (HCPCS codes U0003 and U0004) with a potential add-on reimbursement of $25 (HCPCS code U0005) if the laboratory returned results to patients within 48 hours and returned results for a majority of its tests (Medicare and non-Medicare) during the previous calendar month within two days. READ MORE

3/26/2020 Humana

Lab providers should use the newly created HCPCS codes when billing for COVID-19 testing.  Member cost-share waivers for COVID-19-related testing have been expanded, which includes both the COVID-19 test and viral panels that rule out COVID-19; cost-share waivers now apply to laboratory testing, specimen collection and certain related services that result in the ordering or administration of the test, including, physician office or emergency department visits. This change will apply on a retroactive basis to services delivered on or after March 6, 2020.  READ MORE

3/16/2020 Independence Blue Cover and reimburse member cost-sharing (such as co-pays, deductibles, and coinsurance) for the COVID-19 test and the administration of the test when performed at a physician’s office, urgent care center, or an emergency room. Treatment for COVID-19 is subject to the specific out-of-pocket cost-sharing for each member’s health plan.  This includes members enrolled in fully insured plans, employer-sponsored plans, Medicare Advantage and the individual and family plans available through the Affordable Care Act. Self-funded plans will be able to opt-out of this program. In addition, IRS guidance, released March 11, allows for testing and treatment services before the deductible is met for members with high-deductible health plans and health savings accounts (HSAs).  Independence continues to cover medically necessary health care costs to treat infectious diseases, including COVID-19, based on the terms of the member’s insurance plan. READ MORE
2/17/2021 Medica

COVID-19 Testing Reimbursement Policy. READ MORE 

Reimbursement Rates for Coronavirus Diagnostic Testing:
 HCPCS U0001: $35.92
 HCPCS U0002: $51.33
 HCPCS U0003: $75.00 (effective date 4/14/2020)
 HCPCS U0004: $75.00 (effective date 4/14/2020)
 HCPCS U0005: $25.00 (Effective 1/1/2021)
 CPT 87635: $51.33
 HCPCS G2023: $23.46
 HCPCS G2024: $25.46
 HCPCS C9803: $24.67

3/16/2022 Medi-Cal

Frequency Limits Updated for COVID-19 Related Laboratory Codes. READ MORE 
Effective retroactively for dates of service on or after the effective dates of the codes listed within the chart, frequency limits are applied to select COVID-19 related laboratory codes. Procedure Codes are 86328, 86408, 86409, 86413, 86769, 87426, 87428, 87635, 87636, 87637, 87811, C9803, G2023, G2024, U0001, U0002, U0003, and U0004.

>>>Click here to read past updates

4/13/2021 Medical Mutual of Ohio

You will be able to get the vaccine from in-network or out-of-network providers or locations during the national public health emergency declared by the U.S. Department of Health and Human Services. READ MORE

>>>Click here to read past updates

2/17/2021 Molina Effective 1/1/2021, only submitters of U0003 or U0004 that also include code U0005 will earn the higher payment of $100 per test. Submitters unable to support the additional code of U0005 high throughput tests will receive a lesser CMS payment of $75 per test. READ MORE 
11/2/2020 National Government Services - J6 A/B, JK A/B

2021 Gap-Fill Request. National Government Services , the MAC for Jurisdictions JK and J6 is in receipt of the new laboratory test codes identified by CMS to be gap-fill priced for 2021. READ MORE 

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6/29/2021 New York Medicaid

NY Dept. of Health 6/29/21. Letter to Clinical Laboratories (i.e. temporary approval) . READ MORE 

NY Dept of Health Letter to Clinical Labs (i.e. remote supervision). READ MORE 

>>>Click here to read past updates

7/16/2022 Noridian - JE & JF A & B

UPDATE - NorIdian Provider Bulletin July 2022. Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (A58726) - R3 - Effective June 02, 2022. READ MORE 

>>>Click here to read past updates

4/28/2021 Novitas Solutions - JH & JL

Revised Editing for Ordering/Referring Providers on Lab Claims. Because of the COVID-19 public health emergency (PHE), CMS previously amended regulations to remove the requirement that certain diagnostic tests are covered only when ordered by the treating  physician. READ MORE 

With CMS' revised policy, Medicare beneficiaries may receive coverage for one COVID-19 and related test without the order of a physician or non-physician practitioner. This revised policy includes the following codes:

U0001 - U0004 87635 86769
86328 87275 87276
87279 87400 87501-87503
87631 87804 87280
87240 87634 87807

 

3/2/2021 Novitas Solutions - JL

Clinical Diagnostic Laboratory Tests for COVID-19. Updates have been made to the reimbursement for U0003, U0004 and add-on code U0005. READ MORE 

>>>Click here to read past updates

4/22/2022 Palmetto GBA - JM and JJ Enforcement Delay - MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing L38988. READ MORE 
4/28/2020 SummaCare

Covid-19 Provider FAQ. READ MORE

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1/25/2022 Texas Medicaid

QW Modifier Required for COVID-19 Testing Procedure Code 86328. Following changes to the Clinical Laboratory Improvement Amendments (CLIA) regulations, the Centers for Medicare and Medicaid Services (CMS) has released updated guidance for COVID-19 test billing effective September 23, 2020. READ MORE 

>>>Click here to read past updates

3/31/2020 Tricare East Many military laboratories are operating under limited capacity due to the coronavirus pandemic. Tricare West providers may be asked by local military hospitals and clinics to direct patients to civilian network laboratories for tests military labs can’t perform in house. If Providers need to locate a new laboratory for Tricare patients, use the online directory on this page. READ MORE
3/31/2020 Tricare West Many military laboratories are operating under limited capacity due to the coronavirus pandemic. Tricare West providers may be asked by local military hospitals and clinics to direct patients to civilian network laboratories for tests military labs can’t perform in house. If Providers need to locate a new laboratory for Tricare patients, use the online directory on this page. READ MORE
6/1/2020 UnitedHealthcare

UHC summary of COVID-19 Dates by Program. READ MORE

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3/27/2020 Washington Medicaid Effective April 1, 2020 for dates of service February 4, 2020, the following codes have been created to use for COVID-19 testing for FFS and MCO programs - U0001 and U0002. Effective for dates of service March 13, 2020, providers may also use CPT 87635 with the CR modifier. See ICD-10 codes posted by the payer for COVID-19 conditions provided by the CDC. For COVID-19 billing or coding policy questions, email HCAAH_COVID19@hca.wa.gov. READ MORE
5/23/2022 WPS Government Health Administrators - J5 A/B, J8 A/B June 2022 Local Coverage Determination (LCD) and Billing and Coding/Policy Article Updates. Last updated May 23 2022. READ MORE 
Jurisdictions J8 A&B, J5 A&B. Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing - LCD A58761 - Effective Date 5/17/22.