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New CPT and HCPCS Codes for COVID-19 Testing

March 19, 2020

The American Medical Association (AMA) announced, effective March 13, that hospitals, health systems and laboratories may use new CPT code 87635 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19), amplified probe technique) to report testing for COVID-19. Health care professionals may contact third-party payers to determine their guidelines regarding applicability for retroactive billing and reimbursement.

Last month, CMS developed the first HCPCS code (U0001) to bill for tests and 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 billing code (U0002) has been added which allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). (On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers.) CMS expects that having specific codes for these tests will encourage testing and improve tracking. The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after Feb. 4, 2020.

The Coordination and Maintenance Committee Meeting announced that the COVID-19 code that was originally scheduled to become effective October 1, 2020 will now be effective April 1, 2020. The code that will be effective is U07.1. The effective date was changed due to the national health emergency of COVID-19. The code is not retroactive and more guidance on its usage will be out soon.

The WHA Information Center recently updated its database to accept either code from the AMA or CMS in the discharge data files. For more information contact WHAIC Vice President and Privacy Officer Jennifer Mueller.

This story originally appeared in the March 19, 2020 edition of WHA Newsletter