the following CPT or HCPCS codes: HCPCS code G2023: Specimen collection for COVID19 [severe acute respiratory syndrome coronavirus 2 (SARS- -CoV-2)], any specimen source. 2021). 1790 0 obj <> endobj what is the correct code to use for the COLLECTION of the COVID 19 test. Labcorp examine details available Bilirubin, Total and Direct Wisconsin. testing and specimen collection? These special editions, however, are free and available for download on the AMAs website.). Each point-of-care test has been authorized for use with certain specimen types and should only be used with those specimen types. hbbd``b`z $X@HlAb Z?k)8$& ()@b[b``M@ - For instance, you should not assume the codes apply only to nasal swabs. If this mobile unit is run by a certified lab and the specimens are being collected by trained personnel, then yes. hb``c``f`e`0ed@ Ai?z+0 uMSS\451sJF'&Nd B#XhXnP95 H `>\7)|gp` QH-[[6hXqs;gk.vP1Z|{>pc`> ECD;)[ eWT; N In an earlier FAQ, CMS says to use HCPCS Level II code U0002 for COVID-19 test methods that are not specified by either HCPCS Level II U0001 or CPT 87635. Using it consistently will help practices be reliable in their determinations and provide support in payer audits. . 0 Back. My understanding is the use of CPT code 99211 is being retired with the new E/M coding guidelines going into effect 1/1/21. *fst|"_yq}Y}Bm[,RWw DO--QhfYiiddVQCG7Ym:`yJg^CXlU=!72!zW*c.rKiQP)VIefc?qZ4MU`\`189?3DpozA%3Uxjfqz\"=p#\=>6P5(8L&HGg!f(VB Imran. endstream endobj startxref . hbbd```b``"Il & u dq k``)0[DvI6$300 ) She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. HCPCS codes G2023 and G2024 should not be billed by certified home health care agencies or skilled nursing facilities. https://provider.excellusbcbs.com/en/resources/news/article?articleId=280991931&classPK=280991927 With yet another testing code, you may be a little confused as to which code to use for what test. DX: Z20.822 - Contact with and (suspected) exposure to COVID-19; If specimen is collected somewhere other than a physician office, bill CPT code 99001 or one of the new COVID-19 specimen collection codes. That depends on the specific tests used and who her insurance is with. 2021 CMS finalized several supply price . 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). For CHHA use only. Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career. endstream endobj 406 0 obj <>/Metadata 75 0 R/PageLabels 400 0 R/Pages 403 0 R/StructTreeRoot 157 0 R/Type/Catalog/ViewerPreferences<>>> endobj 407 0 obj <. (02) Telehealth as of Jan. 1, 2021 Specimen collection HCPCS codes: G2023 and G2024 Cost share will be waived for COVID-19-specific specimen collection. These are not for use by medical practices. HCPCS/CPT Description DHCS rate . ANTIGEN TESTS CPT/HCPCS Codes: not both be reported on the same claim. If more than one reagent strip is used, modifier 59 (distinct procedural service) should be appended to the code for the second reagent strip assay to identify two distinct analyses were performed. The new codes are now part of the complete CPT set in the data file for 2021. code, or both be reported if the test for COVID-19 is . Can G2023 is billable under POS 15? HWn\7W9!;`c e$Iv,b#MV=tx`/_;:;;6jtpnqs{O~;x9t#mrm\F ub.,7o#.i`%(L%$,]%m. Clinics should bill the codes outlined in this guidance via the ordered ambulatory fee schedule. 559 0 obj <> endobj 'Bbc53T h`!3Z8QOC R{p2r>-. Copyright 2023, AAPC CMS has approved the use of this code for new patients, as well as established patients, when used for specimen collection. CPT/ HCPCS Code Laboratory Code Long Descriptor Target 1. She holds a Bachelor of Science degree in Media Communications - Journalism. multiple specimens, modifier 59 should be used to %PDF-1.5 % . This would all be coming from the ED. (As of 01/21/2021) . All Rights Reserved. Watch this webinar about all these changes. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? level ii specimen collection codes g2023 and g2024 aren t the only recent additions related to covid 19 they join new hcpcs level ii covid 19 testing codes and a new cpt covid 19 testing code icd 10 cm has also added a new code u07 However, Medicare reimburses providers and laboratories about double the rate for the codes (U0003 and U0004). endstream endobj 563 0 obj <>stream Providers of diagnostic tests for COVID-19 are required to post on their website how much they will charge a patient for the service. Can you bill the 87635 for lab test that will be sent out, and will be billed to our facility and then bill for specimen collection G2023 and also bill for Specimen handling charge 99001? %PDF-1.6 % Independent laboratories must use one of these CPT 99072 (additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease) is a non-covered code. Tech & Innovation in Healthcare eNewsletter, FDA Amends COVID-19 Vaccine Emergency Use Authorizations, Unlock the Full Potential of a Medical Coder, Trinity Health Centralizes EHR, Revenue Cycle, https://www.bcbsnd.com/coronavirus/covid-19providers/billing, Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of highthroughput technologies, completed within 2 calendar days from date of specimen collection, nfectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g, SARS-CoV, SARSCoV-2 [COVID-19]), Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B SD: SARSCOV & INF VIR A&B AG IA, Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected, Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed, Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-C0V-2) Qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected, Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer, Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected, Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative. G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source COVID-19 Testing and Specimen Collection at Pharmacies As of 12/16/2021 Updates are highlighted The following guidance shall continue to remain in effect in accordance with the Public Readiness and Emergency Preparedness Act (PREP Act) for licensed pharmacists to: order COVID-19 tests, approved by the Food and Drug Administration (FDA), to 20:iA ?9 You may bill for both the collection and test if you meet the requirements. Cost-share will be waived for specimen collection, along with the appropriate ICD-10 code of Z03.818, Z20.828 (effective Feb. 4, 2020) or Z20.822 (effective Jan. 1. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. All rights reserved. The COVID-19 public health emergency will expire on May 11, 2023. Can this specimen collection code G2023 and 87635 be billed on each individual patient samples that we collected in our Lab and also from nursing home.. %PDF-1.6 % Molecular diagnostic tests that detect the . HCPCS Level II code, the HCPCS Level II code Dee. G2024, specimen collection for severe acute respiratory syndrome coronavirus2 2021. CPT Assistant SE says: Thanks, So i see alot of medicare denials with 99203, 99214 with mod CS and a z code for the dx why is that ? (MLN Connects May 7, 2020), Question: we are billing G2023 Commerical Payers Like BCBS, AETNA, UHC and CIGNA are paying for Primary care setting, my question that did commercial insurance payers also returned back paid claims amount, Can we used C9803 for out patient clinics. Im not sure you can unbundle those codes. 117-2), which allocated funding to reimburse providers for COVID-19 testing of the uninsured. 214 0 obj <> endobj The AMA has more information about the new codes here. HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. The MLN Connects post specifies that the codes are effective with line item date of service on or after March 1, 2020. Watch for CMS to issue additional guidance once the PHE is over and when the codes are no longer valid for reporting. office manager or physician? Medicare posted these new specimen collection codes in a March 31, 2020, special edition MLN Connects and in a last-minute revision to the April 2020 HCPCS Level II quarterly update file: Medicare patients should not be charged a deductible or copay for any COVID-19 test. regarding payment for specimen collection for purposes of testing for COVID-19 and certain related services. Reimbursement for COVID-19 Specimen Collection CPT Code Update for 2022. Use the CPT code(s) for in-office visit for the particular service(s) rendered. Question: Should CPT code 87635, a HCPCS Level II The AMA developed and distributed a document that includes many scenarios for collecting COVID-19 specimens, including using 99211, a nurse visit, for collecting a specimen on a day when the patient did not have an in-person visit or telehealth visit. up|q5fx=zmpkq~rFKs-;e1[Z{23f@Qor?8)~-750p40*ut }($2 B@Q 60x 9 i @ A%%9 @ Medical coding resources for physicians and their staff. 631 0 obj <>/Filter/FlateDecode/ID[<8F0CAA201BCE5847AB5A081652A0D9EA><0EC2751726C8A545BED302916B35158C>]/Index[597 76]/Info 596 0 R/Length 147/Prev 446964/Root 598 0 R/Size 673/Type/XRef/W[1 3 1]>>stream }*3p~Q` g . 251 0 obj <>stream Heres a rundown of the COVID-19 clinical diagnostic laboratory testing codes, with effective dates and Medicare payment rates. The following specimen collection guidelines follow standard recommended procedures. Inpatient claims do not apply coinsurance . With the new testing sites that have point of service equipment to detect the COVID virus do you know if POS code 17 can be used to report and receive reimbursement for the test? Editor's note: on June 24, the CPT Editorial Panel approved the addition of a new code for reporting antigen testing, which is designed to be a quicker way to identify patients infected by the novel coronavirus. Per the standard early release delivery process for CPT codes, providers had to manually upload the code descriptors of the COVID-19 test codes into their EHR systems. Can the medical office use G2023 for the collection of the specimen being sent to LabCorp? Medicare will allow the use of U0002QW and 87635QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of servcie on or after March 20, 2020. for Commercial & Medicare payor. C9803 code: Hospital outpatient clinic visit specimen collection for COVID -19, any specimen source. Note:HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. For more information, go to the . Billing tips for COVID-19. In an interim final rule related to COVID-19 policy and regulatory revisions, the Centers for Medicare & Medicaid Services (CMS) explains that tests that allow patients to collect the specimen would not be eligible for the specimen collection fee. being submitted. The MAC adjudicates the FFS claim at physician fee schedule reimbursement. Learn more about the benefits of membership by clicking on the link below. When two distinct analyses are performed (e.g, IgG and IgM), 86769 is reported on two claim lines with modifier 59 (distinct procedural service) appended to 86769 on the second claim line. Providers who are already receiving payment, from another source, for either lab specimen collection or for COVID-19 testing should not bill . Depending on the nature of the encounter and payer, you may be able to consider an E/M code and/or handling code 99000. ? s"LZR8`WQ #eL[S6x-gwgX2-qlre`;j@ k Check the NCCI edits. do not constitute an exhaustive list of all state and federal regulatory requirements applicable to a drive-through COVID-19 specimen . L~`$*2[6.%@jfTHfwi@q,+ In an earlier FAQ, CMS says to use HCPCS Level II code U0002 for COVID-19 test methods that are not specified by either HCPCS Level II U0001 or CPT 87635. Answer: To identify specimen collection for COVID-19 testing, we established two new level Specimen Collection For COVID-19. For Medicare Part B, Services should only be reported as telehealth services when the individual physician or practitioner furnishing the services is not at the same location as the beneficiary. (COVID-19 FAQs on Medicare FFS Billing) Also for Medicare Part B, Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection incident to the billing professionals services for both new and established patients. This requirement, enacted in section 3202(b) of the CARES Act, is effective for the duration of the PHE for COVID-19. But they could play a role in determining the true prevalence of the illness in a given area and determining who can safely return to normal activities. The G2023 code is only for homebound? we received the testing kits and BD veritor system to verify results. This page is part of the FAQs on Testing for SARS-CoV-2 and provides answers to frequently asked questions related to COVID-19 testing supplies. Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. 6. CMS will automatically reprocess claims billed for 99211 that were denied due to place of service editing. Copyright American Medical Association. what can i do to fix this issue. The specimen collection codes listed below are eligible for the IHS (Indian Health Service) encounter rate if rendered Copyright 2023, AAPC In particular, it will allow providers who can bill for specimen collection codes G2023 and G2024 to bill those codes with modifier CG and receive an additional payment, so long as they meet 1809 0 obj <>/Filter/FlateDecode/ID[<309802164BDC6447938BC7E1622FA66D>]/Index[1790 29]/Info 1789 0 R/Length 98/Prev 707847/Root 1791 0 R/Size 1819/Type/XRef/W[1 3 1]>>stream CodingIntel was founded by consultant and coding expert Betsy Nicoletti. Are you a coder, biller, administrator, %PDF-1.6 % SPECIAL BULLETIN COVID-19 #207: Medical Office Specimen Collection and CPT 99070 & 99072 . Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. CMSs 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection. CPT 99211 is encounter eligible when performed by an encounter eligible provider in an eligible place of service. Yes, labs can bill specimen collections, as well as a travel allowance (P9603/P9604) for homebound and non-hospital Part B inpatients, but not for Part A hospital or SNF inpatients. . The PCP can bill an E/M code if the visit is for the specimen collection only, and not if it is done during a scheduled visit. Reimburses $9.35 each way. Copyright 2023 American Academy of Family Physicians. If so, what codes would I use? These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks. State Government websites value user privacy. determine their specific reporting guidelines. Any advise to prevent this. . We are looking for thought leaders to contribute content to AAPCs Knowledge Center. And do you know what the reimbursement will be? During the public health emergency (PHE) for COVID-19, CMS has removed the requirement that certain diagnostic tests are covered only under the order of at treating physician or nonphysician practitioner (NPP). CPT Code & Test Classification Updates ; DEX Z-Codes CMS Date of Service ; References. Here is a review of the codes: Codes and Descriptions: U0001 . Additionally, the AMAs CPT Assistant is providing two fact sheets for coding guidance for the SARS-CoV-2 (COVID-19) test in relation to the use of the new CPT codes. 1818 0 obj <>stream instead under Part As SNF benefit at 1861(h) of the Act). Lastly, the Centers for Medicare & Medicaid Services first issued new HCPCS codes for COVID-19 testing last month, and has since added more codes released last week. For FQHC facility G2023 should have place of service 11 or 02? All Provider Bulletin 344: Update Concerning Coverage of and Payment for the Administration of (1) Remdesivir in an Outpatient Setting (2) COVID-19 Vaccines; and (3) Rapid Antigen Testing for COVID-19 for MassHealth Limited Members supersedes previous bulletins and describes an updated guidance for the three listed items. This is not a substitute for current CPT and ICD-9 manuals and payer policies. Answer: The appropriate code to be reported is Would they ever be . Mult Scler J Exp Trans Clin. (Effective 9/8/2020), Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique (effective 10/6/2020), Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique (effective 10/6/2020), Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (effective 10/6/2020), Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected (effective 10/6/2020), Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected (effective 10/6/2020).