Coding and Billing for Covid-19 (Coronavirus) Lab Tests, and What’s Next

At a time when millions of people in the US are wondering about possibly getting tested for Covid-19 symptoms, thousands of medical service providers are looking for answers on how to code and bill for these tests. Centers for Medicare and Medicaid Services (CMS) took proactive actions and recently announced two HCPCS (Healthcare Common Procedural Coding System) codes that can be used by laboratories to bill for Covid-19 diagnostic tests.

President Trump declared Covid-19 as a National Emergency. He said that this declaration will “open up access” to $50 bn federal funds to fight Covid-19. He also said that the declaration would allow HHS (Health and Human Services) to make necessary laws or bypass existing ones to allow “maximum flexibility” to care providers, doctors and hospitals. President Trump said that 1.4 million Covid-19 test kits will be available within a week and about 5 million will be available within the next month.

Which codes can you use for Coronavirus?

The first HCPCS Code U0001, can be used to bill for tests and to track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.The second HCPCS Code U0002, announced on 5-Mar-2020, allows labs to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (Covid-19. It should be noted that FDA had allowed certain labs to develop their own validated Covid-19 diagnostics on 29-Feb-2020. U0002 may be used for tests developed by these additional labs when submitting claims to Medicare or other insurers.

When can you start billing for Covid-19?

The Medicare claims processing system will be able to accept these codes starting 1-Apr-2020, for dates of service on or after 4-Feb-2020. Local MACs (Medicare Administrative Contractors) are responsible for developing the payment amount for such claims. Labs are advised to check with the respective MACs on the payable amount for these tests before billing for them. Similar to other lab tests, there is generally no beneficiary cost sharing under Original Medicare.

What’s next?

In addition to the codes, CMS also issued a Medicare Fact Sheet to ensure that Medicare subscribers have a clear understanding on their coverage and benefits. In addition to explaining about Diagnostic tests, Vaccines, Inpatient Hospital Care Services and Quarantines, the one thing that caught my eye was the section on Telehealth.

“Beneficiaries can communicate with their doctors or certain other practitioners without necessarily going to the doctor’s office in person for a full visit”, said the fact sheet. “Doctors and certain practitioners may bill for these virtual check-in services furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010)“, the fact sheet added.

The impetus of the CMS on promoting Telemedicine visits in the current scenario is a welcome one where a suspected patient visiting the doctor is not only putting herself in risk but also the doctor, staff in the clinic and other patients present in the clinic during the visit.

Covid-19 crisis will take months, may be a couple of years to get stabilized, but it will surely change the way we think about our hygiene and infectious diseases. Telemedicine phenomenon seems to be lone beneficiary in the current crisis.