. Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Two new HCPCS Level II codes were created for specimen collection, effective March 1, 2020 . that requires CPT codes, then code 87635 should be Viral transport medium acceptable for collection of influenza specimens in 1 mL or 3 mL volumes can be used to transport swabs for COVID-19 testing. What 2 codes would she sent for these? Resubmit returned claims as a packaged service to include C9803, as appropriate. HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. For each state, we searched for COVID-19 test prices posted on public websites of the two largest hospitals. be included in the CPT 2021 code set in the Microbiology subsection of the Pathology and Laboratory section. Questions and answers regarding policies described . Watch this webinar about all these changes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. When identifying infectious agents on primary source specimens using antigen detection by immunoassay with direct optical (i.e., visual) observation, see 87802-87899 . Can we bill 36415 and G2023 on the same Date of Service? can be found in the Telehealth procedure codes for COVID-19 document. Outpatient Prospective Payment System (OPPS) claims receive on or after May 1, 2020 with coronavirus specimen collection codes G2023 and G2024 will be returned with edit W7062. Microbiology. For specimen collection use *99000, *99001 or G2023. Use the CPT code(s) for in-office visit for the particular service(s) rendered. 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. %%EOF (MLN Matters MM11765). %PDF-1.6 % Imran. Providers of diagnostic tests for COVID-19 are required to post on their website how much they will charge a patient for the service. Was the sample for the test personally collected . We note that G2024 is applicable to patients in a non-covered stay in a SNF and not to HWn\7W9!;`c e$Iv,b#MV=tx`/_;:;;6jtpnqs{O~;x9t#mrm\F ub.,7o#.i`%(L%$,]%m. . CPT/ HCPCS Code Laboratory Code Long Descriptor Target 1. (As of 01/21/2021) . K7q5H+l`Q`o$uH320p\!@Z! Copyright 2023, CodingIntel CPT Assistant SE says: testing and specimen collection? International multicenter examination of MOG . To avoid delays by turnaround time when requesting multiple tests up frozen samples, please submit separate frozen specimens to each test . Current Procedural Terminology (CPT) codes for COVID-19 testing. Thanks for any guidance. 117-2), which allocated funding to reimburse providers for COVID-19 testing of the uninsured. You may bill for both the collection and test if you meet the requirements. %%EOF Other payers may have different policies on this. Medicare will pay for COVID-19 testing performed by any entity that is (1) certified by CLIA, (2) licensed under state law to perform lab tests, if required, and (3) enrolled in Medicare as a type . Thank you. HCPCS/CPT Description DHCS rate . 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). Providers who are already receiving payment, from another source, for either lab specimen collection or for COVID-19 testing should not bill . regarding payment for specimen collection for purposes of testing for COVID-19 and certain related services. hUN@}Uh/7KB`Ubm=NBCXm1y&q/Ia #f|6?=mx/|qqXE:.18Kx8m"9 N*o'zk(fYR |2hGu #(TZ w:E5){]Q&M ys5/&t9?E^&u_wpW20/b^xXC2a5E5E_z? The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection are for use by independent laboratories, not medical practices, Do you know if the PCP office can bill any codes for the collection of the specimen (swab) of Covid19 testing? 597 0 obj <> endobj The file contains the SARS-CoV-2-related CPT codes released since the 2021 data file release on Aug. 31, 2020 and includes: CPT code descriptors (long, medium, and short) Published date; Effective date; Type of change. Standard Diagnostic COVID-19 Testing Combined with Flu A and B : On or after October 6, 2020. C9803. CA PREP RFA 2021 Addendum #1; CA PREP Questions and Answers for 2021 RFA . Contact your local third-party payer directly to COVID-19 Test Date of Service Code(s) Standard Diagnostic COVID-19 Testing : On or after February 4, 2020. CMS's 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. We have lab personnel collect the specimens on outpatients that come to the Lab as well as lab personnel go to skilled facilities and collect the COVID specimens. and use Z86.16 as the secondary diagnosis code (Jan. 1, 2021, and after). G2024, specimen collection for severe acute respiratory syndrome coronavirus2 instead under Part As SNF benefit at 1861(h) of the Act). Note: The waiving of member cost sharing, which . COVID-19-related office visits for COVID-19 vaccines, testing, and treatment, including preventative therapies and treatment of post-COVID conditions (long-haul COVID-19), and treatment of health conditions that may seriously complicate the treatment of COVID-19 during the period when a patient is diagnosed with or is presumed to have COVID-19. Urgent care doing curbside covid testing/ eval. 140 0 obj <> endobj endstream endobj 1791 0 obj <. . The specimens must be collected by trained lab personnel. All four were approved under the FDAs emergency authorization program. testing for the duration of the PHE for the COVID-19 pandemic. endstream endobj startxref On or after March 13, 2020. She knows what questions need answers and developed this resource to answer those questions. PDF | Word. 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. The Centers for Medicare & Medicaid Services (CMS) has not weighed in on this new code, as yet. Independent laboratories must use one of these More information on testing codes is available here. 0 Please note that this is the most widely used code. CPT is a registered trademark of the American Medical Association. Proper specimen collection is the most important step in the laboratory diagnosis of infectious diseases. services must be reported using procedure code 99000 or 99001 and one of the new 2021 diagnosis codes listed below: Z20.822 - Contact with and (suspected) exposure to COVID-19 Z11.52 - Encounter for screening for COVID-19 . Though there may be many tests being marketed right now, as of April 18 the Food and Drug Administration (FDA) had approved only four for detecting COVID-19 antibodies. The AMA has more information about the new codes here. 559 0 obj <> endobj Check NCCI edits. Either CPT U0002 or 87635? CPT 99211 is encounter eligible when performed by an encounter eligible provider in an eligible place of service. %%EOF Wisconsin. They brought us testing kits today for the U0002, but there should be a code reimbursable to the Provider, I would think? multiple specimens, modifier 59 should be used to According to a CMS Fact Sheet, CMS changed the Medicare payment rules during the PHE for the COVID-19 pandemic to provide payment to independent labs for specimen collection from beneficiaries who are homebound or inpatients not in a hospital for COVID-19 testing under certain circumstances., Hospital outpatient departments can be paid for symptom assessment and specimen collection for COVID-19 using a new HCPCS code C9803 (Hospital outpatient clinic visit Some terms for different types of molecular tests are diagnostic test, viral test, molecular test, nucleic acid amplification test (NAAT), RT-PCR test, and LAMP test. 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? Such testing should employ either a nucleic acid amplification test (NAAT) or an antigen test to detect SARS-CoV-2. . Independent labs must use G2023 and G2024 to bill Medicare for the specimen collection fee for COVID-19 testing during the public health emergency (PHE), the interim final rule states. A FQHC is not a physicians office (11) and G2023 isnt performed via telehealth (02). Test Usage: Based on literature review and in-house evaluation of saliva samples collected in parallel with nasopharyngeal swabs, saliva approaches, but may not equal, the sensitivity of nasopharyngeal samples for . Can a PCP bill for COVID 19 specimen collection during a pre-op visit? For use by independent clinical diagnostic labs: Specimen collection for severe acute respiratory syndrome coronavirus 2 . 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? Specimen Collection For COVID-19. We do the collection in our office and send to the lab. Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021; COVID-19 Third Dose Vaccine - 08-23-2021 . endstream endobj 560 0 obj <>/Metadata 23 0 R/OCProperties<>/OCGs[578 0 R]>>/Outlines 56 0 R/PageLayout/SinglePage/Pages 557 0 R/StructTreeRoot 69 0 R/Type/Catalog>> endobj 561 0 obj <>/Font<>/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 562 0 obj <>stream Specimen Collection & Handling of Rapid Tests in Point-of-Care Settings. 0 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. Im not sure you can unbundle those codes. COVID-19 Vaccines CPT codes are developed as needed for the reporting of immunizations for the novel coronavirus (SARS-CoV-2). Usually, the presenting problem(s) are minimal. Can a SNF bill Medicare for G2024 if the nurses are the ones doing the swabs? 2019. %PDF-1.5 % Copyright 2023, AAPC With yet another testing code, you may be a little confused as to which code to use for what test. The data file will also include new CPT codes for other recent digital medicine innovations G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source hb```f``f`a`~ @ 8pB;,A H~gcTfN`\w~ Lp00^ 2 / Although CMS does not address it, if a specimen is collected on the day of an office visit, there wont be separate payment for 99211. If so, would modifiers be needed? 2021 Cpt Code Set Simplifies E/m Coding, Adds Covid-19 Tests. Supplies ; Instructions by Specimen Type ; Microbiology Culture Tests ; . What modifier do we use to Unbundle CPT U0003 & C9803 ? Description. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. 6. She holds a Bachelor of Science degree in Media Communications - Journalism. ?LLO@@{FH0 164 0 obj <>stream If a patient is seen via a curbside/virtual visit at our urgent care clinic for possible Covid and the provider orders a covid collection to be obtained for send out. Hospital outpatient departments should use HCPCS Level II code C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19])), any specimen source to be paid for COVID-19 symptom assessment and specimen collection. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. (CPT) codes should be used for COVID-19 testing? Blood sample collections are reported with CPT code 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen, e.g., finger, heel, ear stick). *$35.92 in MAC A/B JH, JL, JN, JS, J8, J15, Update: CMS added the QW modifier to HCPCS Level II U0002 and CPT 87635. Medicare patients should not be charged a deductible or copay for any COVID-19 test. [1] CMS-5531-IFC, released April 30, 2020 page 188. 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. Use CPT 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physicians or NPPs services. 20:iA ?9 not both be reported on the same claim. Cost-sharing "EXCEPTION" does not apply to inpatient admissions. Medical office providers can be reimbursed for COVID-19 specimen collection using CPT code 99211 (ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY FIVE MINUTES) with modifier CR. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. 0 HCPCS Level II specimen collection codes G2023 and G2024 aren't the only recent additions related to COVID-19. 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 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. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part. Privacy Policy, Get Unlimited Access to CodingIntels Online Library, CMS-5531-IFC, released April 30, 2020 page 188, Compliance issues in ICD-10 coding for risk based contracts and HCCs, CPT Coding for Bronchoscopy Procedures | Webinar, screening and counseling for behavioral conditions, 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, The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection are for use by independent laboratories, not medical practices, Patient seen in the office, swab collected: swab collection part of E/M, can use 99000, Patient evaluated via telemedicine or telehealth, sent to office for swab: 99211 if separate day, can use 99000, Patient evaluated using on line digital codes 9944199443 or virtual check in: 99211 if separate day, can use 99000. for Commercial & Medicare payor. Im looking for specific guidance. Would they ever be . Trained personnel must collect the sample. HCPCS codes when billing Medicare for the nominal specimen collection fee for COVID-19 For use by hospital outpatient departments and physician offices: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source G2023. (As of 05/27/2021) . Further guidance from CMS on the reporting of The }*3p~Q` g hbbd```b``"H Rdl`6XMX}7d code, or both be reported if the test for COVID-19 is . Medical coding resources for physicians and their staff. Here is a review of the codes: Codes and Descriptions: U0001 .