Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a minor procedure. hbbd```b``k@$bu0,9 &g`P0"K$6@QoR,H7O ? HCPCS Level II codes can be found at https:// They join new HCPCS Level II COVID-19 testing codes and a new CPT COVID-19 testing code. The reimbursement depends on the E/M code. Question: Can C9803 be billed when the patient comes to an outpatient hospital department and is observed by trained personnel while they self-collect a specimen for COVID testing? We will not reimburse for specimen collection if billed with separate E&M codes. performed? Medicare will allow payment for COVID-19 specimen collection billed by qualifying practitioners with CPT code 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. These special editions, however, are free and available for download on the AMAs website.). The effective date for 0202U, per the AMA, is May 20, 2020. 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. 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. Can we bill for example a 99213 for the virtual visit plus the 99211 for the collection? 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. Reimburses $9.35 each way. For instance, you should not assume the codes apply only to nasal swabs. Molecular diagnostic tests that detect the . 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? That depends on the specific tests used and who her insurance is with. HCPCS/CPT Description DHCS rate . CMS has also established HCPCS codes for other COVID-19 tests. 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. Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing 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. 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 . The MAC adjudicates the FFS claim at physician fee schedule reimbursement. For each state, we searched for COVID-19 test prices posted on public websites of the two largest hospitals. HCPCS Level II specimen collection codes G2023 and G2024 aren't the only recent additions related to COVID-19. testing and specimen collection? Learn more about the benefits of Typically, 5 minutes are spent performing or supervising these services. The COVID-19 public health emergency will expire on May 11, 2023. 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. o This code will not be reimbursed when it is billed with an office visit or specimen collection code. Can a PCP office bill for a Rapid Detection SARS CoV-2? Find guidelines for healthcare providers and local and state physical departments to collecting, handling, and testing clinical specimens by COVID-19. 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: . [1] CMS-5531-IFC, released April 30, 2020 page 188. All four were approved under the FDAs emergency authorization program. Depending on the nature of the encounter and payer, you may be able to consider an E/M code and/or handling code 99000. as specified in California Business and Professions Code section 1288. . For example, if a nurse administers the collection of the sample, there is no separate Medicare payment for that specimen collection. 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. http://www.cms.gov/files/document/03092020-covid-19- C9803. 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. State Government websites value user privacy. 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? Answer: The appropriate code to be reported is we are getting a lot of denials for 99202/99212 and g2023 for our collection or the specimens. 1818 0 obj <>stream Specimen collection and testing personnel requirements. code, or both be reported if the test for COVID-19 is endstream endobj 563 0 obj <>stream Labcorp examine details available Bilirubin, Total and Direct The place of service code for FQHCs is 50. thank you for your response Renee , It was very helpful. hbbd```b``"H Rdl`6XMX}7d ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. Wisconsin. Inpatient claims do not apply coinsurance . a CodingIntel membership, Last revised April 18, 2022 - Betsy Nicoletti Tags: telehealth. those residents in Medicare-covered stays (whose bundled lab tests would be covered All rights reserved. Thank you. Was the sample for the test personally collected 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. 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). 0 Supplies ; Instructions by Specimen Type ; Microbiology Culture Tests ; . HCPCS Level II code, the HCPCS Level II code what can i do to fix this issue. An official website of the State of North Carolina, SPECIAL BULLETIN COVID-19 #207: Medical Office Specimen Collection and CPT 99070 & 99072, SPECIAL BULLETIN COVID-19 #151: Laboratory Codes for COVID-19 Testing. %PDF-1.6 % 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. 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. Copyright 2023, AAPC Note:HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. Thank. December 30, 2021. CHHAs providing specimen collection for homebound patients may bill rate code "4921" and rate code "4922" (travel each way) if specimen collection is the only service performed. CPT/HCPCS Codes: 86328, 86408, 86409, 86413, . All comments are moderated and will be removed if they violate our Terms of Use. Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. 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. CPT code 99001: Handling and/or conveyance of a specimen for transfer from the patient in a setting other than an office to a laboratory . 2021. II HCPCS codes effective March 1, 2020. HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. Two new HCPCS Level II codes were created for specimen collection, effective March 1, 2020 . Note: The waiving of member cost sharing, which . You cannot bill for specimen collection when it is collected by an untrained individual. The guidance below addresses options for collecting specimens. If the claim is submitted to a payer The American Rescue Plan Act of 2021 (ARPA, P.L. we received the testing kits and BD veritor system to verify results. Earn CEUs and the respect of your peers. Such testing should employ either a nucleic acid amplification test (NAAT) or an antigen test to detect SARS-CoV-2. Mary. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. instead under Part As SNF benefit at 1861(h) of the Act). International multicenter examination of MOG . Or can I use this code in place of service 81? Standard Diagnostic COVID-19 Testing Combined with Flu A and B : On or after October 6, 2020. These codes should only be used when the provider or facility is NOT running the test. A lock icon or https:// means youve safely connected to the official website. 0 testing code. 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 Usually, the presenting problem(s) are minimal. Question: What are the new level II HCPCS codes for specimen collection for COVID-19 Plasma from a PPT capacity be frozen and shipped in situ. Thanks, So i see alot of medicare denials with 99203, 99214 with mod CS and a z code for the dx why is that ? Can Indepndant lab bill for this specimen collection service for G2023 and G2024. HCPCS code G2024: Specimen collection for COVID19 from an individual in a skilled nursing facility or by a . A specimen that is not collected correctly may lead to false or inconclusive test results. :N=?A CPT 87635. Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine) 91302: Entering incorrect codes will only compromise data accuracy. During the COVID-19 public health emergency, effective with dates of service on or after March 1, 2020, the state plan allowed MO HealthNet to reimburse all providers 100% of the Medicare rate for COVID-19 testing and specimen collection codes. specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])), any specimen source retroactive to March 1, 2020. 2019. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Does anyone know what we should bill in in place of the 99211-CS for collecting a specimen in the office to send to an outside lab for testing after 1/1/21? The G2023 code is only for homebound? 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? This would all be coming from the ED. S%!oP\O&%|T) y( ?I 6l >`s1^H;NPy>JDO,d{d7&;X@wH=]. You may bill for both the collection and test if you meet the requirements. 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 The manual . 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 The American Medical Association (AMA) recently released expedited CPT updates that include two new codes, effective April 10, for COVID-19 antibody tests: 86328 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 [COVID-19]). Molecular tests diagnose COVID-19 based on detection of the virus's genetic material in a sample from the patient's nose or throat. The interim final rule states the second code, G2024, is necessary because the Social Security Act and CMS regulations require a higher fee for collecting a specimen from an individual in a SNF [skilled nursing facility] or by a laboratory on behalf of an HHA [home health agency]. ? s"LZR8`WQ #eL[S6x-gwgX2-qlre`;j@ k Reimbursement for COVID-19 Specimen Collection. Providers of diagnostic tests for COVID-19 are required to post on their website how much they will charge a patient for the service. COVID-19 Vaccines CPT codes are developed as needed for the reporting of immunizations for the novel coronavirus (SARS-CoV-2). 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 . specimen collection for COVID-19 testing using the G2023 or G2024 Level II HCPCS codes noted below. 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 The specimen collection codes listed below are eligible for the IHS (Indian Health Service) encounter rate if rendered A FQHC is not a physicians office (11) and G2023 isnt performed via telehealth (02). dependent upon the payer to which the claim is Question: Should CPT code 87635, a HCPCS Level II 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 Coding for telehealth is everchanging. However, Medicare reimburses providers and laboratories about double the rate for the codes (U0003 and U0004). (MLN Connects June 18, 2020). 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. be included in the CPT 2021 code set in the Microbiology subsection of the Pathology and Laboratory section. These fees and expenses are not billable if the patient collects their own specimen and a messenger service picks it up. do not constitute an exhaustive list of all state and federal regulatory requirements applicable to a drive-through COVID-19 specimen . 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. . 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. 1790 0 obj <> endobj Sign up for our monthly newsletter to download the reference sheet. 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. The reimbursement is included in the level of office visit E/M selected. I have a scenario where the PCP office is collecting the swab but then sending the specimen to outside lab for processing. However, if the specimen is collected during a routine office visit, it would not be separately payable. 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. For swabs in saline: OP, NP or anterior nasal swabs may be placed in 1 to 3 mL of sterile saline (0.85 to 0.9%) in a sterile screw cap container. These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks. Further guidance from CMS on the reporting of 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. If I understand your second question, the answer is yes. 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-. testing for the duration of the PHE for the COVID-19 pandemic. CMS has approved the use of this code . 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. But, I didnt see that it followed coding rules. Hospital outpatient departments should bill for symptom assessment and specimen collection for COVID-19 using HCPCS code C9803. G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source