hb```f`` Ab@qax H00Ttt|xY@ ``Z 63*J/XOcab=aNsUX`cPd -$YTY$]2&^ 3 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. 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.. endstream endobj startxref (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source Long Descriptor: specimen collection for severe acute respiratory syndrome coronavirus 2 Providers who are already receiving payment, from another source, for either lab specimen collection or for COVID-19 testing should not bill . dependent upon the payer to which the claim is instead under Part As SNF benefit at 1861(h) of the Act). hbbd```b``k@$bu0,9 &g`P0"K$6@QoR,H7O ? https://www.ama-assn.org/system/files/2020-05/coronavirus-long-descriptors.pdf, https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf, Thanks alot Renee for wonderful and knowledgeable detail oriented updated information sharing, I have a question can please favor me This audit tool for modifier 25 will help determine if a separate E/M service should be reported. Thanks for any guidance. For the duration of the COVID-19 PHE, we are therefore finalizing on an interim basis that when the services described by CPT code 99211 for a level 1 E/M visit are furnished for the purpose of a COVID-19 assessment and specimen collection, the code can be billed for both new and established patients. CMS, in the same paragraph, notes that direct supervision for specimen collection may be met through the virtual presence of the supervising physician or practitioner using interactive audio and video technology for the duration of the public health emergency. [1]. 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. endstream endobj 141 0 obj <. HCPCS Level II Professional Edition -- E-Book Buck's Step-by-Step Medical Coding, 2021 Edition 2018 HCPCS Level II Professional Edition - E-Book Understanding Current Procedural Terminology and HCPCS Coding Systems, Spiral bound Version 2020 Ob/GYN Coding Manual: Components of . Code 86328 should be used for antibody tests with a single-step method immunoassay typically a strip with all the necessary components for the assay, appropriate for a point-of-care testing platform. 0 2021). 2>m "hpU4tF5"ymYbG\^^ P8c9j| BlY@Z"2. For instance, you should not assume the codes apply only to nasal swabs. Copyright American Medical Association. we are getting a lot of denials for 99202/99212 and g2023 for our collection or the specimens. 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. Clinics should bill the codes outlined in this guidance via the ordered ambulatory fee schedule. Other payers may have different policies on this. Effective March 9, 2021, MLabs will offer saliva as specimen type for SARS-CoV-2 (COVID-19), PCR (COVID) testing. The CPT codes will be included in the complete CPT code set in the data file for 2021, which will be available later this year. Im looking for specific guidance. :N=?A Medicare patients should not be charged a deductible or copay for any COVID-19 test. CPT/ HCPCS Code Laboratory Code Long Descriptor Target 1. %%EOF They were allowed a small payment for specimen collection during the public health emergency for collection and for associated travel. The specimens must be collected by trained lab personnel. The place of service code for FQHCs is 50. thank you for your response Renee , It was very helpful. However, the specimen collection fee is not available for tests where a patient collects his or her own specimen. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf, Hi Barbara Ann According to the interim final rule, the codes are intended for use by independent laboratories, particularly when lab technicians are traveling to patients: We will provide for Medicare payment of a nominal specimen collection fee and associated travel allowance to independent laboratories for collection of specimens related to COVID-19 clinical diagnostic laboratory testing for homebound and non-hospital inpatients. This CMS FAQs document also refers only to independent labs when answering Who can bill for the Medicare specimen collection fee? https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. I know that specimen collection code 99000 is not paid by most payers, and I understand that collecting this specimen costs practices significantly. ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. This code is to be used specifically to report the BioFire Respiratory Panel 2.1 test. summary of CPT codes most relevant to the specialty. If not what code needs to bill for mobile unit. CPT 99211 is encounter eligible when performed by an encounter eligible provider in an eligible place of service. Using it consistently will help practices be reliable in their determinations and provide support in payer audits. HCPCS codes when billing Medicare for the nominal specimen collection fee for COVID-19 endstream endobj 598 0 obj <>/Metadata 27 0 R/Pages 595 0 R/StructTreeRoot 64 0 R/Type/Catalog/ViewerPreferences<>>> endobj 599 0 obj <>/MediaBox[0 0 612 792]/Parent 595 0 R/Resources<>/ExtGState<>/Font<>/Pattern<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 600 0 obj <>stream What 2 codes would she sent for these? Hi Mary You should be able to follow your usual process for reporting handling and the outside lab test billed to the facility, but checking with your compliance team is a good idea. Molecular diagnostic tests that detect the . Mult Scler J Exp Trans Clin. Report 86328 once per reagent strip. hbbd```b``"H Rdl`6XMX}7d 2021 Jun 25;7(2). These codes should only be used when the provider or facility is NOT running the test. endstream endobj 563 0 obj <>stream %PDF-1.6 % For each state, we searched for COVID-19 test prices posted on public websites of the two largest hospitals. We have lab personnel collect the specimens on outpatients that come to the hospital as well as lab personnel go to skilled facilities and collect the COVID specimens. Billing tips for COVID-19. (CPT) codes should be used for COVID-19 testing? As a reminder, COVID-19 specimen collection is reimbursed as a separate service only urgent care or emergency room and is not separately billable with applicable CPT/HCPCS codes on the inpatient claim. She has been a self-employed consultant since 1998. Conversely, if the payer requires use of the Plasma from a PPT capacity be frozen and shipped in situ. 577 0 obj <>/Filter/FlateDecode/ID[]/Index[559 27]/Info 558 0 R/Length 91/Prev 149738/Root 560 0 R/Size 586/Type/XRef/W[1 2 1]>>stream Virginia. Question: What are the new level II HCPCS codes for specimen collection for COVID-19 CPT had previously recommended this. (As of 01/21/2021) . Everyone who has symptoms that are consistent with COVID-19 and people with known high-risk exposures to SARS-CoV-2 should be tested for SARS-CoV-2 infection. performed? 2021. COVID -19 G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source . Codes. Coding for telehealth is everchanging. 'Bbc53T h`!3Z8QOC R{p2r>-. CMS will automatically reprocess claims billed for 99211 that were denied due to place of service editing. 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). Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. To avoid delays by turnaround time when requesting multiple tests up frozen samples, please submit separate frozen specimens to each test . To learn more, view our full privacy policy. 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 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. COVID -19 Related Codes . Just the Latest COVID-19 Codes. HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. 559 0 obj <> endobj These are not for use by medical practices. For FQHC facility G2023 should have place of service 11 or 02? * This billing requirement and associated reimbursement applies to claims submitted on CMS 1500 claims forms, UB04 or electronic equivalent . Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing I have a scenario where the PCP office is collecting the swab but then sending the specimen to outside lab for processing. Inpatient claims do not apply coinsurance . Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine) 91302: endstream endobj startxref With yet another testing code, you may be a little confused as to which code to use for what test. Supplies ; Instructions by Specimen Type ; Microbiology Culture Tests ; . Testing may also be used for screening and determining the length of a . 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: Commercial payers make their own rules. The guidance below addresses options for collecting specimens. G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source They join new HCPCS Level II COVID-19 testing codes and a new CPT COVID-19 testing code. Refer to SPECIAL BULLETIN COVID-19 #151: Laboratory Codes for COVID-19 Testing. hYko+B y4 m70A[-4~PW\Ek3g8Uqfb"25S6jBP,BT:f[LhaLC= +b%hDhF#B#$3)96IQdi^Kl4zSKLL11-ig3 For CHHA use only. multiple specimens, modifier 59 should be used to Transferring serum/plasma to a screw-cap polypropylene vehicle tube. For more information, go to the . The reference to any specimen source also may allow you to continue to use these collection codes as the industry develops new COVID-19 tests that use different specimen sources. Looking at the AMA scenarios (from April 3, 2020, a lifetime ago), HCPCS codes G2023 and G2024 are for specimen collection by an independent lab. These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks. Reimbursement for COVID-19 Specimen Collection CPT Code Update for 2022. Independent laboratories must use one of these We bill these on a UB claim not a 1500. we received the testing kits and BD veritor system to verify results. Our clinic is performing ABBOTT now testing, for our Medicare patients would we use 87635 mod QW and G2023? determine their specific reporting guidelines. 405 0 obj <> endobj 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? 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. See also the CPT Assistant Special Edition April Update for the AMAs guidance on using 86328 and 86769. Further guidance from CMS on the reporting of All four were approved under the FDAs emergency authorization program. service beginning 2/22/2021 for commercial members; prior to 2/22/2021 claims will deny as not a covered benefit.) 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 <. I disagreed with that at the time. o This code will not be reimbursed when it is billed with an office visit or specimen collection code. 443 0 obj <>/Filter/FlateDecode/ID[<088476E6C9A8994AB01CD6250A50F599>]/Index[405 86]/Info 404 0 R/Length 162/Prev 260640/Root 406 0 R/Size 491/Type/XRef/W[1 3 1]>>stream Dee. HCPCS Level II codes can be found at https:// When identifying infectious agents on primary source specimens using antigen detection by immunoassay with direct optical (i.e., visual) observation, see 87802-87899 . Use code G2024 - Specimen collection for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled . Learn more about the benefits of 1790 0 obj <> endobj State Government websites value user privacy. On or after March 13, 2020. 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. But, CMS weighed in on April 30, 2020, in their Interim Final Rule with comment (IFC). Resubmit returned claims as a packaged service to include C9803, as appropriate. ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. A specimen that is not collected correctly may lead to false or inconclusive test results. reported. The reimbursement depends on the E/M code. Molecular tests diagnose COVID-19 based on detection of the virus's genetic material in a sample from the patient's nose or throat. 597 0 obj <> endobj Specimen Collection & Handling of Rapid Tests in Point-of-Care Settings. Proper specimen collection and handling are critical for all COVID-19 testing, including those tests performed in point-of-care settings. endstream endobj startxref Regarding specimen collection, please note Medicares response to the question of who can bill: Independent laboratories can bill Medicare through their MAC for the specimen collection fee. This is not a substitute for current CPT and ICD-9 manuals and payer policies. They join new HCPCS Level II COVID-19 testing codes and a new CPT COVID-19 testing code. 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. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. hb``c``f`e`0ed@ Ai?z+0 uMSS\451sJF'&Nd B#XhXnP95 H `>\7)|gp` QH-[[6hXqs;gk.vP1Z|{>pc`> ECD;)[ eWT; N As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Antibody tests to determine who has developed an immune response to COVID-19 are not widely available yet. 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. UPDATE:Contact your Medicare Administrative Contractor if you did not include modifier CS when you submitted 99211 so they can reopen and reprocess the claim. The antibody test codes come on the heels of a new CPT code for COVID-19 diagnostic testing instituted last month: 87635 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. Effective 2/27/2021. Treatment: Yes, effective April 1, 2020, through January 31, 2021, Anthem and its delegated entities waived cost shares for members undergoing treatment related to a COVID-19 diagnosis. She has explored the ins and outs of coding for multiple specialties, particularly radiology, cardiology, and oncology. CPT codes: 99001 Cost share will be waived for specimen collection, along with the appropriate ICD-10 code of Z03.818 or Z20.828, if not billed with separate E&M charges. 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. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. 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. CPT Assistant SE says: 2021 icd 10 cm guidelines covid 19 specimen . %%EOF (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. Earn CEUs and the respect of your peers. As the descriptors reveal, both G2023 and G2024 apply to collection of any specimen source, which means you should not restrict your use of these codes based on the source of the specimen. endstream endobj 1791 0 obj <. These fees are billable if the specimen is collected by trained lab personnel from a homebound or non-hospital inpatient. This Read More Everyone loves to read the general guidelines at Read More "Breathe in, Breathe out": CPT Coding for Read More Coding for hospital services Not sure you can unbundle those codes. CMS has approved the use of this code . Questions and answers regarding policies described . 117-2), which allocated funding to reimburse providers for COVID-19 testing of the uninsured. 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. CPT 87635. Note: The waiving of member cost sharing, which . 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 . More information on testing codes is available here. 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. Renee, FQHCs bill split claims to Medicare/Medicaid payers with non-FQHC services (such as labs, x-rays, etc) billing on the FFS claim with POS 11. ANTIGEN TESTS CPT/HCPCS Codes: 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). Kent Moore, Senior Strategist for Physician Payment. 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. Such testing should employ either a nucleic acid amplification test (NAAT) or an antigen test to detect SARS-CoV-2. CPT 99070 (supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) should not be reported with E/M and COVID-19 specimen collection codes. 157 0 obj <>/Filter/FlateDecode/ID[<07C2C8A3B4D5AB48AD3CF82D37148FC3><12CBD5111C3A8843A23A5E0E30F7A7E5>]/Index[140 25]/Info 139 0 R/Length 91/Prev 120607/Root 141 0 R/Size 165/Type/XRef/W[1 3 1]>>stream
covid specimen collection cpt code 2021