The purpose of this bulletin is to notify providers that the Department of Human Services (Department) is adding procedure codes for Coronavirus (COVID-19) laboratory tests to the Medical Assistance (MA) Program Fee Schedule effective with dates of service on and after February 4, 2020

This bulletin applies to physicians, certified registered nurse practitioners (CRNPs), certified nurse midwives (CNMs), acute care general hospitals (hospitals), outpatient laboratories and clinics that are enrolled in the Medical Assistance (MA) Program and render services to MA beneficiaries in the fee-for-service delivery system and the managed care delivery system. Physicians, CRNPs, CNMs, hospitals, outpatient laboratories and clinics that render services to MA beneficiaries in the managed care delivery system should address any billing, prior authorization or payment related questions to the appropriate managed care organization (MCO). 

Background

The Centers for Medicare & Medicaid Services (CMS) recently advised all Medicaid agencies to take action to ensure clinical laboratories are prepared to test for Coronavirus. Specifically, CMS and the American Medical Association (AMA) developed new Healthcare Common Procedure Coding System (HCPCS) and Current Procedure Terminology (CPT) codes to allow providers, with the applicable CLIA certification, to bill and track COVID-19 virus tests. 

CMS announced the addition of two HCPCS codes intended for use to test and track services related to COVID-19. In response to the CMS announcements to the COVID-19 public health emergency, the Department added the laboratory test codes to the MA Program Fee Schedule, effective with dates of services on and after February 4, 2020 as follows:

• HCPCS code U0001, defined as “CDC 2019 - novel Coronavirus (2019-nCoV) realtime RT-PRC diagnostic panel,” is to be used specifically by Centers for Disease Control and Prevention (CDC) laboratories to test patients for SARS-CoV-2.
• HCPCS code U0002, defined as “2019-nCoV Coronavirus, SARS-CoV-2/2019-nCov (COVID-19), any technique, multiple types or subtypes (includes all targets), nonCDC” is to be used specifically for by laboratories to test non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).  
  

The AMA announced the establishment of (3) new CPT codes to efficiently report and track testing services related to COVID-19. 

The department added the following laboratory test code to the MA Program Fee Schedule, effective with dates of services on and after March 13, 2020.

• CPT code 87635, defined as “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.”
  

The department added the laboratory test codes to the MA Program Fee Schedule, effective with dates of services on and after April 10, 2020 as follows: 

• CPT code 86328, defined as “Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]).”
• CPT code 86769, defined as “Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).”
  

On April 14, 2020, CMS announced the creation of two new HCPCS Level II codes for laboratory tests that use high-throughput technologies to detect SARS-CoV-2, the virus that causes COVID-19. The Department added the laboratory test codes to the MA Program Fee Schedule, effective with dates of service on and after April 14, 2020, as follows: 

• HCPCS code U0003, defined as “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, making use of high throughput technologies as described by CMS-2020-01-R”.
• HCPCS code U0004, defined as “2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), nonCDC, making use of high throughput technologies as described by CMS-2020-01­ R”.
  

On April 24,2020, CMS announced that effective March 20, 2020, Medicare will permit the use of HCPCS code U0002 QW and CPT code 87635 QW for claims submitted by facilities with a valid, current Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver. 

The department updated the MA Program Fee Schedule to allow the use of the QW modifier for HCPCS code U0002 and CPT code 87635, effective with dates of services on and after March 20, 2020. 

The CDC noted that it will continue to review medical information related to the COVID19 virus. Providers are encouraged to monitor the CDC website for updated information and clinical guidance on the COVID-19 virus by accessing the website at https://www.cdc.gov/COVID-19/2019-ncov/index.html. 

Discussion

Consistent with the Administration’s commitment to ensuring the health and safety of all Commonwealth citizens, the Department added the Coronavirus laboratory testing procedure codes to the MA Program Fee Schedule as follows: 

Procedure

Providers are to bill and the Department will pay for COVID-19 laboratory testing as described above. 

Information on MA Program coverage related to COVID-19, to include an FAQ document, can be found on the Department of Human Services website here. 

The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides regular updates. Click here for the most up to date information regarding COVID-19.  

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