covid specimen collection cpt code 2021

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. 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. More information on testing codes is available, Tech & Innovation in Healthcare eNewsletter, Check ICD-10-CM Official Guidelines Without Leaving Codify, Simplify Calculating Global Days for Procedure Codes in Codify, Coronavirus: What Every Medical Coder Needs to Know, New COVID-19 Test Codes Effective Immediately, Telehealth Coverage Expanded for Medicare Patients, https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf, https://www.ama-assn.org/system/files/2020-04/cpt-reporting-covid-19-testing.pdf, https://www.ama-assn.org/system/files/2020-04/covid-19-coding-advice.pdf, https://www.cms.gov/files/document/covid-19-laboratories.pdf, https://provider.excellusbcbs.com/en/resources/news/article?articleId=280991931&classPK=280991927, http://www.cms.gov/files/document/03092020-covid-19-. Note:HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. For this scenario would it be appropriate to bill 99214-25 with 99000 (since the sample will be sent to an outside lab)? Use the CPT code(s) for in-office visit for the particular service(s) rendered. CMS has approved the use of this code for new patients, as well as established patients, when used for specimen collection. Additionally, it is expected that additional CPT or HCPCS codes may be released as vaccination efforts proceed and potential new vaccines are approved. Kent Moore, Senior Strategist for Physician Payment. Wisconsin. CA PREP RFA 2021 Addendum #1; CA PREP Questions and Answers for 2021 RFA . She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. COVID-19 Test Date of Service Code(s) Standard Diagnostic COVID-19 Testing : On or after February 4, 2020. Unless COVID-19 is the primary diagnosis for the admission, no portion of this . But, I didnt see that it followed coding rules. Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing There is no separate Medicare payment for the collection of the sample for the test. We do the collection in our office and send to the lab. Can the medical office use G2023 for the collection of the specimen being sent to LabCorp? HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. Effective March 9, 2021, MLabs will offer saliva as specimen type for SARS-CoV-2 (COVID-19), PCR (COVID) testing. The Heres a rundown of the COVID-19 clinical diagnostic laboratory testing codes, with effective dates and Medicare payment rates. that requires CPT codes, then code 87635 should be So far, I have found some reference to this here https://www.bcbsnd.com/coronavirus/covid-19providers/billing. 6. That depends on the specific tests used and who her insurance is with. 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. 'Bbc53T h`!3Z8QOC R{p2r>-. %%EOF Proper specimen collection and handling are critical for all COVID-19 testing, including those tests performed in point-of-care settings. Antibody tests to determine who has developed an immune response to COVID-19 are not widely available yet. CPT had previously recommended this. The reimbursement depends on the E/M code. Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine) 91302: 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]. CPT Code & Test Classification Updates ; DEX Z-Codes CMS Date of Service ; References. 0 . Further guidance from CMS on the reporting of 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 These HCPCS codes are: The data file will also include new CPT codes for other recent digital medicine innovations Questions and answers regarding policies described . 559 0 obj <> endobj The American Medical Association (AMA) released a new proprietary laboratory analysis (PLA) code for novel coronavirus testing. The reimbursement is included in the level of office visit E/M selected. These fees and expenses are not billable if the patient collects their own specimen and a messenger service picks it up. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos. However, effective March 1, 2020, Medicare allows reporting of code 99211 (appended with modifier CS to waive cost-sharing) when clinical staff collects COVID-19 specimens for new or established patients. For use by independent clinical diagnostic labs: Specimen collection for severe acute respiratory syndrome coronavirus 2 . (MLN Connects June 18, 2020). Trained personnel must collect the sample. Reimbursement for COVID-19 Specimen Collection. Usually, the presenting problem(s) are minimal. Are you a coder, biller, administrator, However, if the specimen is collected during a routine office visit, it would not be separately payable. endstream endobj startxref Ship frozen (preferred). 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. CPT and HCPCS codes should As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. 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. . 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. 2>m "hpU4tF5"ymYbG\^^ P8c9j| BlY@Z"2. 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. 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. Can a SNF bill Medicare for G2024 if the nurses are the ones doing the swabs? For example, if a nurse administers the collection of the sample, there is no separate Medicare payment for that specimen collection. 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. 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). 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. 0 S%!oP\O&%|T) y( ?I 6l >`s1^H;NPy>JDO,d{d7&;X@wH=]. Can G2023 is billable under POS 15? However, Medicare reimburses providers and laboratories about double the rate for the codes (U0003 and U0004). The effective date for 0202U, per the AMA, is May 20, 2020. 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. 2021 icd 10 cm guidelines covid 19 specimen . Best to ask her insurance company that question. 140 0 obj <> endobj Note: The waiving of member cost sharing, which . hbbd```b``k@$bu0,9 &g`P0"K$6@QoR,H7O ? specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])), any specimen source retroactive to March 1, 2020. I disagreed with that at the time. (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by Check NCCI edits. ANTIGEN TESTS CPT/HCPCS Codes: 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 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 following specimen collection guidelines follow standard recommended procedures. The two HCPCS codes carry a higher Medicare . 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 Centers for Medicare & Medicaid Services (CMS) has not weighed in on this new code, as yet. 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. Reimbursement for COVID-19 Specimen Collection CPT Code Update for 2022. Increased fees for COVID-19 lab & specimen collection codes : June 19: COVID-19: Latest news (March 24) updated: June 19: COVID-19-We're extending our prior authorization waiver updated: June 15: . The new codes are now part of the complete CPT set in the data file for 2021. vI-i? 1790 0 obj <> endobj Code 86769 should be used for antibody tests with multi-step methods. 672 0 obj <>stream CPT/ HCPCS Code Laboratory Code Long Descriptor Target 1. The lab cannot bill for specimen collection or travel. (As of 05/27/2021) . Specimen Collection & Handling of Rapid Tests in Point-of-Care Settings. Sign up for our monthly newsletter to download the reference sheet. HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. CMS has approved the use of this code . Just the Latest COVID-19 Codes. 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 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. testing for the duration of the PHE for the COVID-19 pandemic. These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks. 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. The Centers for Medicare & Medicaid Services (CMS) has not weighed in on this new code, as yet. . CPT Code: 87635. You can find both the March 13 fact sheet and April 10 fact sheet on the AMA website. State Government websites value user privacy. Providers who are already receiving payment, from another source, for either lab specimen collection or for COVID-19 testing should not bill . %%EOF Since the current CPT . a laboratory on behalf of a HHA, any specimen source Would they ever be . 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.

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