Billing & Coding: CMS Sets Rules for Medicare Coronavirus Testing Reimbursement with Private Payors Expected to Follow Suit

Good news for labs that are testing Medicare patients for the SARS-CoV-2 virus that causes coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Real Time RT-PCR Diagnostic Test Panel or the other commercial assays that have recently received Emergency Use Authorization (EUA) from the FDA. Instead, you can use the new Healthcare Common Procedure Coding System (HCPCS) codes that CMS created for labs and other providers for use in billing the brand new tests:

HCPCS code U0001 for the CDC test, which CMS announced will be reimbursed at between $35.91 or $35.92 per test; and

HCPCS code U0002 for other SARS-CoV-2 virus assays that have received EUA from the FDA, e.g., from Roche and Thermo Fisher Scientific, which will be reimbursed at between $51.31 and $51.33 per test.

Takeaway

The CMS claims processing system will be capable of accepting the new HCPCS codes on April 1 for dates of service on or after Feb. 4, 2020, the date the FDA issued EUA authorization for the CDC coronavirus test. Reimbursement rates vary slightly by region subject to the determination of the local Medicare Administrative Contractor. Commercial insurers haven’t yet announced their reimbursement rates, but are expected to align their own prices with Medicare’s.