COVID-19 Laboratory Billing Information

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 

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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 

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

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Reimbursement changes to COVID-19 laboratory services codes for Commercial and Medicare Advantage programs. Beginning with dates of service on or after March 1, 2023, or the end of the public health emergency (PHE), whichever is the latter, reimbursement for COVID-19 laboratory services codes may be reduced for providers contracted as independent laboratory (ancillary) providers and participating in an Anthem independent laboratory provider network. READ MORE 

Labs for Prompt COVID-19 Testing. READ MORE

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

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UPDATE for Laboratory and Testing Professionals. The Division of Laboratory Systems will host a call to discuss hot topics and to solicit the laboratory community’s questions about emergency preparedness and response. The Laboratory Outreach Communication System (LOCS) Calls take place on the third Monday of each month and are scheduled for one hour. The next call is scheduled for Monday, September 19. READ MORE 

8/12/2022 - FDA Advises Repeat Testing to Reduce False Negative Results with COVID-19 Antigen Tests. READ MORE

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 

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

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

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

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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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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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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.

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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

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

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.

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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

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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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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 

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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 

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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:

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

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Covid-19 Provider FAQ. READ MORE

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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 

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

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