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CMS Releases New COVID-19 Lab Test Code, Coverage Guidance

The Centers for Medicare & Medicaid Services (CMS) on March 5 created a new Healthcare Common Procedure Coding System (HCPCS) code for COVID-19 tests administered outside Centers for Disease Control and Prevention (CDC) testing laboratories.

This code corresponds with a Feb. 29 Food and Drug Administration policy that allows certain laboratories to develop their own tests. Providers should use existing HCPCS code U0001 for CDC testing laboratories and the new HCPCS code U0002 for non-CDC lab tests. Medicare claims processing systems can accept these codes starting April 1 for dates of service on or after Feb. 4. Local Medicare Administrative Contractors must develop the payment amount for claims received for these new codes in their respective jurisdictions until Medicare establishes national payment rates.

CMS also published three fact sheets focusing on coverage through Medicare, Medicaid and the Children’s Health Insurance Program, and the individual and small group market. These fact sheets summarize coverage for diagnostic tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies. Additionally, the agency issued frequently asked questions (FAQs) and answers for health care providers regarding Medicare payment for lab tests and related services for COVID-19. Of note, the FAQs include billing guidance for telehealth services to minimize contamination.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Emily Schweich is a senior communications associate for America's Essential Hospitals.

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