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Medicare Payment Rates Announced for COVID-19 Test CPT Codes

Posted by David Fong on May 22, 2020 9:30:00 AM


More than 10 million COVID-19 laboratory tests have been conducted in the United States thus far. While the US testing per capita rate still lags behind several other countries, the number of tests completed continues to rise. These tests are medical coded and reimbursed just like other medical procedures. The CPT codes announced in March and April when testing became prevalent in the United States now have associated Medicare MAC payment rates.


As reported by RevCycle Intelligence, the Centers for Medicare & Medicaid Services (CMS) announced this week how much it will pay for new Current Procedural Terminology (CPT) codes developed by the American Medical Association (AMA) for COVID-19 tests. On May 19, the federal agency provided updated guidance to include Medicare payment details for CPT codes 87635, 86769, and 86328, which can be used by healthcare providers and laboratories to bill payers for testing patients for SARS-CoV2. Medicare will pay $51.31, $42.13, and $45.23, respectively, for the codes.

The guidance previously detailed Medicare payment rates for Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002, which were created by CMS in February for providers to bill for COVID-19 tests developed by the Centers for Disease Control and Prevention (CDC), as well as for laboratories using non-CDC tests. Medicare reimburses providers and laboratories $35.91 for U0001 and $51.31 for U0002.


As first published in March, the AMA guidance states that CPT code 87635 is most appropriate for COVID-19 diagnostic laboratory testing, while CPT codes 86769 and 86328 unveiled in April should be used for serologic laboratory testing for COVID-19.


These codes are in addition to CMS's previously established HCPCS codes for other COVID-19 tests. Medicare reimburses providers and laboratories about double the rate for these codes (U0003 and U0004), because they indicate the use of high throughput technologies. CMS notes in its guidance that these technologies can process more than 200 specimens a day, although the codes should not be used to bill for tests that detect COVID-19 antibodies,


Aviacode's medical coders are experienced to  code properly for COVID-19 testing, along with the other current growth areas of telehealth and emergency medicine. As providers look to strength their bottom line, accurate coding will ensure providers get money sooner.


Topics: ICD-10, Medical Coding, Pro-Fee Coding, Facility Coding, Outpatient Coding, COVID-19