They join new HCPCS Level II COVID-19 testing codes and a new CPT COVID-19 testing code. PDF Optum360 Coding for Coronavirus (COVID-19) - OptumCoding CMS's 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection.
hbbd``b`z
$X@HlAb Z?k)8$& ()@b[b``M@ -
Refer to SPECIAL BULLETIN COVID-19 #151: Laboratory Codes for COVID-19 Testing. hbbd```b``"^H DpE$E"`5@$9\&+jvs , lK(8@e?,&{j@g`` i
Medicare patients should not be charged a deductible or copay for any COVID-19 test. Best to ask her insurance company that question. According to a CMS Fact Sheet, CMS changed the Medicare payment rules during the PHE for the COVID-19 pandemic to provide payment to independent labs for specimen collection from beneficiaries who are homebound or inpatients not in a hospital for COVID-19 testing under certain circumstances., Hospital outpatient departments can be paid for symptom assessment and specimen collection for COVID-19 using a new HCPCS code C9803 (Hospital outpatient clinic visit If the claim is submitted to a payer . Sign up for our monthly newsletter to download the reference sheet. testing code. Code 86328 should be used for antibody tests with a single-step method immunoassay typically a strip with all the necessary components for the assay, appropriate for a point-of-care testing platform. And do you know what the reimbursement will be? COVID-19 for Laboratories: FAQ's - California There is no separate Medicare payment for the collection of the sample for the test. office manager or physician? The antibody test codes come on the heels of a new CPT code for COVID-19 diagnostic testing instituted last month: 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. 0
The reimbursement is included in the level of office visit E/M selected. (MLN Connects May 7, 2020). COVID-19 Information for Health First Colorado and CHP+ Providers and Updated: 4/17/20, You will probably find the answers to your questions here: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. S%!oP\O&%|T)
y( ?I
6l
>`s1^H;NPy>JDO,d{d7&;X@wH=]. The G2023 code is only for homebound? They were allowed a small payment for specimen collection during the public health emergency for collection and for associated travel. Interim Guidelines for Clinical Specimens for COVID-19 | CDC / CPT 214 0 obj
<>
endobj
The American Rescue Plan Act of 2021 (ARPA, P.L. 2021 Jun 25;7(2). What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? . CPT Code & Test Classification Updates ; DEX Z-Codes CMS Date of Service ; References. Lastly, the Centers for Medicare & Medicaid Services first issued new HCPCS codes for COVID-19 testing last month, and has since added more codes released last week. On or after March 13, 2020. Guidance for COVID-19 Collection and Testing Sites - California Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. 251 0 obj
<>stream
Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role. COVID-19 Medical Coding Policy - health.mil FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Outpatient hospital specimen collection, HCPCS code C9803, is not allowable in the FQHC or RHC setting. Earn CEUs and the respect of your peers. Collection & Preparation. The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection are for use by independent laboratories, not medical practices, Do you know if the PCP office can bill any codes for the collection of the specimen (swab) of Covid19 testing? CPT Code: 87635. 631 0 obj
<>/Filter/FlateDecode/ID[<8F0CAA201BCE5847AB5A081652A0D9EA><0EC2751726C8A545BED302916B35158C>]/Index[597 76]/Info 596 0 R/Length 147/Prev 446964/Root 598 0 R/Size 673/Type/XRef/W[1 3 1]>>stream
2021 icd 10 cm guidelines covid 19 specimen . conjunction with any of the other CPT test codes that mention coronavirus, namely code 87631, 87632, 87633, 0098U, 0099U, or 0100U? 1818 0 obj
<>stream
COVID-19 CPT coding and guidance | COVID-19 test code | AMA Modifiers Used during the COVID-19 Public Health Emergency (PHE) SPECIAL BULLETIN COVID -19 #207: Medical Office Specimen Collection and Typically, 5 minutes are spent performing or supervising these services. Or can I use this code in place of service 81? Anyone who will be reporting G2023 and G2024 should review the interim final rule, particularly starting around page 95, to be sure they have viewed the official requirements, including the definition of homebound. hbbd```b`` "H1D&E"@$K/XX
,[&| ;XM850[ PDF COVID-19 Coding and Reporting Information CPT , HCPCS, and ICD-10 CM Codes Specimen Collection For COVID-19. Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career. This would all be coming from the ED. (MLN Connects June 18, 2020). Clinics should bill the codes outlined in this guidance via the ordered ambulatory fee schedule. HCPCS code 0240U CPT code 87636: Standard Diagnostic COVID-19 Testing Combined with Flu . For Medicare Part B, Services should only be reported as telehealth services when the individual physician or practitioner furnishing the services is not at the same location as the beneficiary. (COVID-19 FAQs on Medicare FFS Billing) Also for Medicare Part B, Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection incident to the billing professionals services for both new and established patients. Coronavirus and Healthcare Providers | CareFirst BlueCross BlueShield Viral transport medium acceptable for collection of influenza specimens in 1 mL or 3 mL volumes can be used to transport swabs for COVID-19 testing. The MLN Connects post specifies that the codes are effective with line item date of service on or after March 1, 2020. Watch for CMS to issue additional guidance once the PHE is over and when the codes are no longer valid for reporting. This code is to be used specifically to report the BioFire Respiratory Panel 2.1 test. For each state, we searched for COVID-19 test prices posted on public websites of the two largest hospitals. http://www.cms.gov/files/document/03092020-covid-19- Questions and answers regarding policies described . For instance, you should not assume the codes apply only to nasal swabs. CodingIntel was founded by consultant and coding expert Betsy Nicoletti. A FQHC is not a physicians office (11) and G2023 isnt performed via telehealth (02). I know that specimen collection code 99000 is not paid by most payers, and I understand that collecting this specimen costs practices significantly. In particular, it will allow providers who can bill for specimen collection codes G2023 and G2024 to bill those codes with modifier CG and receive an additional payment, so long as they meet 164 0 obj
<>stream
What code can the PCP bill? CMS has also established HCPCS codes for other COVID-19 tests. Recorded April Read More All content on CodingIntel is copyright protected. We bill these on a UB claim not a 1500. 0
You may bill for both the collection and test if you meet the requirements. Provider Information on COVID-19 Coverage - BCBSTX
endstream
endobj
startxref
Find guidelines for healthcare providers and local and state physical departments to collecting, handling, and testing clinical specimens by COVID-19. PDF MEDICARE PAYMENT FOR COVID -19 VIRAL TESTING: Skilled Nursing - CMS Proper specimen collection is the most important step in the laboratory diagnosis of infectious diseases. 597 0 obj
<>
endobj
Unless COVID-19 is the primary diagnosis for the admission, no portion of this . Codes. G2023, specimen collection for severe acute respiratory syndrome coronavirus 2 The COVID-19 test and specimen collection codes are not payable under ambulatory patient groups (APGs). COVID-19 Testing Supplies: FAQs on Testing for SARS-CoV-2 The CPT codes will be included in the complete CPT code set in the data file for 2021, which will be available later this year. Use the CPT code(s) for in-office visit for the particular service(s) rendered. 577 0 obj
<>/Filter/FlateDecode/ID[]/Index[559 27]/Info 558 0 R/Length 91/Prev 149738/Root 560 0 R/Size 586/Type/XRef/W[1 2 1]>>stream
Use CPT 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physicians or NPPs services. Further guidance from CMS on the reporting of HCPCS Level II codes can be found at https:// . Can we bill 36415 and G2023 on the same Date of Service? Since the current CPT . An official website of the State of North Carolina, SPECIAL BULLETIN COVID-19 #207: Medical Office Specimen Collection and CPT 99070 & 99072, SPECIAL BULLETIN COVID-19 #151: Laboratory Codes for COVID-19 Testing. There is no unique CPT code for specimen collection for COVID-19, much like there is no such code for specimen collection for influenza. COVID-19-related office visits for COVID-19 vaccines, testing, and treatment, including preventative therapies and treatment of post-COVID conditions (long-haul COVID-19), and treatment of health conditions that may seriously complicate the treatment of COVID-19 during the period when a patient is diagnosed with or is presumed to have COVID-19. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. This page is part of the FAQs on Testing for SARS-CoV-2 and provides answers to frequently asked questions related to COVID-19 testing supplies. BioFire Respiratory Panel 2.1 (RP2.1) - Instructions for Use Privacy Policy | Terms & Conditions | Contact Us. COVID-19 Test Date of Service Code(s) Standard Diagnostic COVID-19 Testing : On or after February 4, 2020. For use by independent clinical diagnostic labs: Specimen collection for severe acute respiratory syndrome coronavirus 2 . When the specimen collection is performed as part of another service or procedure, such as a higher level visit furnished by the billing practitioner, that higher level visit code should be billed and the specimen collection would not be separately payable. (COVID-19 FAQs on Medicare FFS Billing) Modifier CS may be applicable to waive the patients cost-sharing for the COVID-19-related service. https://www.ama-assn.org/system/files/2020-05/coronavirus-long-descriptors.pdf, https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf, Thanks alot Renee for wonderful and knowledgeable detail oriented updated information sharing, I have a question can please favor me HCPCS/CPT Description DHCS rate . The AMA has more information about the new codes here. Outpatient Prospective Payment System (OPPS) claims receive on or after May 1, 2020 with coronavirus specimen collection codes G2023 and G2024 will be returned with edit W7062. Can a SNF bill Medicare for G2024 if the nurses are the ones doing the swabs? up|q5fx=zmpkq~rFKs-;e1[Z{23f@Qor?8)~-750p40*ut }($2 B@Q
60x 9
i @ A%%9 @ %PDF-1.6
%
To avoid delays by turnaround time when requesting multiple tests up frozen samples, please submit separate frozen specimens to each test . These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks. For swabs in saline: OP, NP or anterior nasal swabs may be placed in 1 to 3 mL of sterile saline (0.85 to 0.9%) in a sterile screw cap container. C9803 Hospital outpatient clinic visit specimen collection for Severe Acute Respiratory Syndrome(sars-cov-2) (Covid-19)any spec $22.99 87426 Infectious agent antigen detection by immunoassay technique (for example, G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source Ship frozen (preferred). For more information, go to the . COVID-19 Telehealth Billing Guide for Medi-Cal ManagedCare Page 3 of 4 . Copyright American Medical Association. Editor's note: on June 24, the CPT Editorial Panel approved the addition of a new code for reporting antigen testing, which is designed to be a quicker way to identify patients infected by the novel coronavirus. Can Indepndant lab bill for this specimen collection service for G2023 and G2024. ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. endstream
endobj
startxref
CPT 87635. %PDF-1.6
%
C9803 Used when COVID-19 specimen collection occurs during . Microbiology. endstream
endobj
141 0 obj
<. If I understand your second question, the answer is yes. The reference to any specimen source also may allow you to continue to use these collection codes as the industry develops new COVID-19 tests that use different specimen sources. But, I didnt see that it followed coding rules. HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. Hospital outpatient departments should bill for symptom assessment and specimen collection for COVID-19 using HCPCS code C9803. PDF Bulletin Number: MSA 21-03 - Michigan can be found in the Telehealth procedure codes for COVID-19 document. This Read More Everyone loves to read the general guidelines at Read More "Breathe in, Breathe out": CPT Coding for Read More Coding for hospital services Standard Diagnostic COVID-19 Testing Combined with Flu A and B : On or after October 6, 2020. as specified in California Business and Professions Code section 1288. She has explored the ins and outs of coding for multiple specialties, particularly radiology, cardiology, and oncology. The new code and long descripter is "87426: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).". hb```f`` ~Abl,/&`z` vM:`07y,j*Z&]6BYHo} Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. (used to identify and reimburse specimen collection for COVID-19 testing) have been released for dates of service on or after March 1, 2020. . These fees and expenses are not billable if the patient collects their own specimen and a messenger service picks it up. THURSDAY, DECEMBER 30, 2021 New CPT codes for effective date of service Jan. 1, 2022 . Test Update 753 | MLabs - University of Michigan In the April rule, CMS notes that in the March rule they changed Medicare payment policies to allow for independent labs to be paid for specimen collection under certain circumstances. Medicare posted these new specimen collection codes in a March 31, 2020, special edition MLN Connects and in a last-minute revision to the April 2020 HCPCS Level II quarterly update file: endstream
endobj
598 0 obj
<>/Metadata 27 0 R/Pages 595 0 R/StructTreeRoot 64 0 R/Type/Catalog/ViewerPreferences<>>>
endobj
599 0 obj
<>/MediaBox[0 0 612 792]/Parent 595 0 R/Resources<>/ExtGState<>/Font<>/Pattern<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>>
endobj
600 0 obj
<>stream
service would be paid as conditionally packaged when furnished with another payable service under the OPPS. These are not for use by medical practices. Some terms for different types of molecular tests are diagnostic test, viral test, molecular test, nucleic acid amplification test (NAAT), RT-PCR test, and LAMP test. Independent labs must use G2023 and G2024 to bill Medicare for the specimen collection fee for COVID-19 testing during the public health emergency (PHE), the interim final rule states. Im looking for specific guidance. 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). In an earlier FAQ, CMS says to use HCPCS Level II code U0002 for COVID-19 test methods that are not specified by either HCPCS Level II U0001 or CPT 87635. My understanding is the use of CPT code 99211 is being retired with the new E/M coding guidelines going into effect 1/1/21. These HCPCS codes are: We have lab personnel collect the specimens on outpatients that come to the Lab as well as lab personnel go to skilled facilities and collect the COVID specimens. that requires CPT codes, then code 87635 should be %PDF-1.6
%
. If this mobile unit is run by a certified lab and the specimens are being collected by trained personnel, then yes. CA PREP RFA 2021 Addendum #1; CA PREP Questions and Answers for 2021 RFA . Learn more about the benefits of those residents in Medicare-covered stays (whose bundled lab tests would be covered SARS-CoV-2 Testing | COVID-19 Treatment Guidelines Such testing should employ either a nucleic acid amplification test (NAAT) or an antigen test to detect SARS-CoV-2. For use by hospital outpatient departments and physician offices: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source G2023. Privacy Policy | Terms & Conditions | Contact Us. The specimens must be collected by trained lab personnel. endstream
endobj
560 0 obj
<>/Metadata 23 0 R/OCProperties<>/OCGs[578 0 R]>>/Outlines 56 0 R/PageLayout/SinglePage/Pages 557 0 R/StructTreeRoot 69 0 R/Type/Catalog>>
endobj
561 0 obj
<>/Font<>/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>>
endobj
562 0 obj
<>stream
Deborah Marsh, JD, MA, CPC, CHONC, is a senior development editor at AAPC. 117-2), which allocated funding to reimburse providers for COVID-19 testing of the uninsured. The guidance below addresses options for collecting specimens. G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source CHHAs providing specimen collection for homebound patients may bill rate code "4921" and rate code "4922" (travel each way) if specimen collection is the only service performed. Supplies ; Instructions by Specimen Type ; Microbiology Culture Tests ; . For this scenario would it be appropriate to bill 99214-25 with 99000 (since the sample will be sent to an outside lab)? For specimen collection use *99000, *99001 or G2023. CPT is a registered trademark of the American Medical Association. endstream
endobj
406 0 obj
<>/Metadata 75 0 R/PageLabels 400 0 R/Pages 403 0 R/StructTreeRoot 157 0 R/Type/Catalog/ViewerPreferences<>>>
endobj
407 0 obj
<. The PCP can bill an E/M code if the visit is for the specimen collection only, and not if it is done during a scheduled visit. Reindl M, Schanda K, Woodhall M, et al. ANTIGEN TESTS CPT/HCPCS Codes: Blood sample collections are reported with CPT code 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen, e.g., finger, heel, ear stick). C9803. Entering incorrect codes will only compromise data accuracy. 'Bbc53T h`!3Z8QOC
R{p2r>-. o This code will not be reimbursed when it is billed with an office visit or specimen collection code. Just the Latest COVID-19 Codes. Regarding specimen collection, please note Medicares response to the question of who can bill: Independent laboratories can bill Medicare through their MAC for the specimen collection fee. Imran. specimen collection for COVID-19 testing using the G2023 or G2024 Level II HCPCS codes noted below. When two distinct analyses are performed (e.g, IgG and IgM), 86769 is reported on two claim lines with modifier 59 (distinct procedural service) appended to 86769 on the second claim line. Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing Proper specimen collection and handling are critical for all COVID-19 testing, including those tests performed in point-of-care settings. Additionally, it is expected that additional CPT or HCPCS codes may be released as vaccination efforts proceed and potential new vaccines are approved. . CPT 99072 (additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease) is a non-covered code. Effective March 9, 2021, MLabs will offer saliva as specimen type for SARS-CoV-2 (COVID-19), PCR (COVID) testing. Coronavirus (COVID-19) Information for Providers | Anthem CMS Reimbursement FAQs COVID-19 | The National Law Review Contact your local third-party payer directly to Dee. endstream
endobj
1791 0 obj
<. Commercial payers make their own rules. (Note: CPT Assistant is a paid subscription service.