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 Watch for CMS to issue additional guidance once the PHE is over and when the codes are no longer valid for reporting. 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? Can outpatient hospital lab bill for this collection service for G2023 and G2024. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. If not what code needs to bill for mobile unit. 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. 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? 2021. So far, I have found some reference to this here https://www.bcbsnd.com/coronavirus/covid-19providers/billing. The only variation between the G2023 and G2024 code descriptors is this wording in G2024: from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. what can i do to fix this issue. 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. Usually, the presenting problem(s) are minimal. 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 Molecular tests diagnose COVID-19 based on detection of the virus's genetic material in a sample from the patient's nose or throat. 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]. Here is a review of the codes: Codes and Descriptions: U0001 . Covid Rapid Test Cpt Codes - Apr 2023 - bestcouponsaving.com I have a scenario where the PCP office is collecting the swab but then sending the specimen to outside lab for processing. Typically, 5 minutes are spent performing or supervising these services. for Commercial & Medicare payor. 6. HCPCS Level II specimen collection codes G2023 and G2024 arent the only recent additions related to COVID-19. Clinics should bill the codes outlined in this guidance via the ordered ambulatory fee schedule. multiple specimens, modifier 59 should be used to Deborah Marsh, JD, MA, CPC, CHONC, is a senior development editor at AAPC. Updated May 5, 2021 . CMS will automatically reprocess claims billed for 99211 that were denied due to place of service editing. However, if the specimen is collected during a routine office visit, it would not be separately payable. Since the current CPT . Or can I use this code in place of service 81? She holds a Bachelor of Science degree in Media Communications - Journalism. 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. 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. 490 0 obj <>stream hb``c``f`e`0ed@ Ai?z+0 uMSS\451sJF'&Nd B#XhXnP95 H `>\7)|gp` QH-[[6hXqs;gk.vP1Z|{>pc`> ECD;)[ eWT; N Best to ask her insurance company that question. This code is to be used specifically to report the BioFire Respiratory Panel 2.1 test. 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 Optum360 Coding for Coronavirus (COVID-19) - OptumCoding o This code will not be reimbursed when it is billed with an office visit or specimen collection code. Imran. (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. 2021 Cpt Code Set Simplifies E/m Coding, Adds Covid-19 Tests. Additionally, it is expected that additional CPT or HCPCS codes may be released as vaccination efforts proceed and potential new vaccines are approved. We will not reimburse for specimen collection if billed with separate E&M codes. The place of service code for FQHCs is 50. thank you for your response Renee , It was very helpful. 2>m "hpU4tF5"ymYbG\^^ P8c9j| BlY@Z"2. CPT Code & Test Classification Updates ; DEX Z-Codes CMS Date of Service ; References. should be reported. For more about Betsy visit www.betsynicoletti.com. But, CMS weighed in on April 30, 2020, in their Interim Final Rule with comment (IFC). 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. Copyright 2023, AAPC Effective 2/27/2021. (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source PDF MEDICARE PAYMENT FOR COVID -19 VIRAL TESTING: Skilled Nursing - CMS PDF New York State Medicaid Billing Guidance for COVID-19 Testing and ICD-10-PCS Code(s) The Centers for Medicare and Medicaid Services (CMS) has added 12 new procedure codes to the International . Effective March 9, 2021, MLabs will offer saliva as specimen type for SARS-CoV-2 (COVID-19), PCR (COVID) testing. Proper specimen collection and handling are critical for all COVID-19 testing, including those tests performed in point-of-care settings. endstream endobj startxref 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. hbbd```b``"H Rdl`6XMX}7d See also the CPT Assistant Special Edition April Update for the AMAs guidance on using 86328 and 86769. 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. Specimen Collection For COVID-19. Labcorp examine details available Bilirubin, Total and Direct 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). (02) Telehealth as of Jan. 1, 2021 Specimen collection HCPCS codes: G2023 and G2024 Cost share will be waived for COVID-19-specific specimen collection. The effective date for 0202U, per the AMA, is May 20, 2020. COVID -19 Related Codes . 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. All Provider Bulletin 344: Update Concerning Coverage of and Payment for the Administration of (1) Remdesivir in an Outpatient Setting (2) COVID-19 Vaccines; and (3) Rapid Antigen Testing for COVID-19 for MassHealth Limited Members supersedes previous bulletins and describes an updated guidance for the three listed items. instead under Part As SNF benefit at 1861(h) of the Act). 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 . We do the collection in our office and send to the lab. Web: mayocliniclabs.com: Email: mcl@mayo.edu: Telephone: 800-533-1710: International: +1 855-379-3115: Values are valid only on day of printing You will need to check their individual policies. Note:HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. 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 codes are for labs to bill when performed by certified techs. The manual . CPT Code: 87635. CPT/HCPCS Codes: 86328, 86408, 86409, 86413, . 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]. CA PREP RFA 2021 Addendum #1; CA PREP Questions and Answers for 2021 RFA . Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) You may bill for both the collection and test if you meet the requirements. 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. 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). %PDF-1.6 % 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. 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. This is not a substitute for current CPT and ICD-9 manuals and payer policies. 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. Privacy Policy | Terms & Conditions | Contact Us. 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 This requirement, enacted in section 3202(b) of the CARES Act, is effective for the duration of the PHE for COVID-19. what is the correct code to use for the COLLECTION of the COVID 19 test. determine their specific reporting guidelines. They join new HCPCS Level II COVID-19 testing codes and a new CPT COVID-19 testing code. Copyright 2023, CodingIntel 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. COVID-19 Information for Health First Colorado and CHP+ Providers and hbbd```b`` "H1D&E"@$K/XX ,[&| ;XM850[ 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. 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. 3/14/23: The FDA amended the EUA of the Pfizer-BioNTech COVID-19 Vaccine, Bivalent to provide for a single booster dose of the vaccine in children 6 months through 4 years of age at least 2 months . We were able to find COVID-19 diagnostic test prices for 93 out of 102 hospitals, ranging from $20 - $1,419 per single test, not including the price of a provider visit, facility fee, or specimen collection. All four were approved under the FDAs emergency authorization program. Copyright American Medical Association. What is the fee schedule of G2023 and G9818? CPT Assistant SE says: Anyone who will be reporting G2023 and G2024 should review the interim final rule, particularly starting around page 95, to be sure they have viewed the official requirements, including the definition of homebound. Answer: The appropriate code to be reported is COVID -19 G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source . hb```f`` ~Abl,/&`z` vM:`07y,j*Z&]6BYHo} hb```f`` Ab@qax H00Ttt|xY@ ``Z 63*J/XOcab=aNsUX`cPd -$YTY$]2&^ 3 G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source endstream endobj startxref In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. Outpatient hospital specimen collection, HCPCS code C9803, is not allowable in the FQHC or RHC setting. 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. do not constitute an exhaustive list of all state and federal regulatory requirements applicable to a drive-through COVID-19 specimen . CPT had previously recommended this. Louella. The specimen collection codes listed below are eligible for the IHS (Indian Health Service) encounter rate if rendered . Follow her on Twitter @dustman_aapc. For specimen collection use *99000, *99001 or G2023. February 19, 2021 E-MAIL NOTIFICATIONS Attention: All Providers - New HCPCS and CPT Codes for COVID-19 Testing . testing code. 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. The COVID-19 public health emergency will expire on May 11, 2023. }*3p~Q` g 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. Thank. 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 Medical coding resources for physicians and their staff. . BioFire Respiratory Panel 2.1 (RP2.1) - Instructions for Use To avoid delays by turnaround time when requesting multiple tests up frozen samples, please submit separate frozen specimens to each test . Medicaid and CHIP Services Information for Providers The nominal specimen collection fee for COVID-19 testing for homebound and non-hospital inpatients generally will be $23.46, according to the interim final rule. 631 0 obj <>/Filter/FlateDecode/ID[<8F0CAA201BCE5847AB5A081652A0D9EA><0EC2751726C8A545BED302916B35158C>]/Index[597 76]/Info 596 0 R/Length 147/Prev 446964/Root 598 0 R/Size 673/Type/XRef/W[1 3 1]>>stream SPECIAL BULLETIN COVID -19 #207: Medical Office Specimen Collection and Our clinic is performing ABBOTT now testing, for our Medicare patients would we use 87635 mod QW and G2023? But, I didnt see that it followed coding rules. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. HCPCS code 0240U CPT code 87636: Standard Diagnostic COVID-19 Testing Combined with Flu . What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? CMS Reimbursement FAQs COVID-19 | The National Law Review 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 This would all be coming from the ED. ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines. Refer to SPECIAL BULLETIN COVID-19 #151: Laboratory Codes for COVID-19 Testing. Coronavirus (COVID-19) Information for Providers | Anthem 237 0 obj <>/Encrypt 215 0 R/Filter/FlateDecode/ID[<75989C3348299A4AA54869724C868AC4><93F59F8A5A95D54F9FF32F74EA23353A>]/Index[214 38]/Info 213 0 R/Length 112/Prev 233903/Root 216 0 R/Size 252/Type/XRef/W[1 3 1]>>stream Can we bill for example a 99213 for the virtual visit plus the 99211 for the collection? (https://www.cms.gov/files/document/covid-19-laboratories.pdf). Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role. a CodingIntel membership, Last revised April 18, 2022 - Betsy Nicoletti Tags: telehealth. HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. 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 %%EOF Virginia. PDF Bulletin Number: MSA 21-03 - Michigan If I understand your second question, the answer is yes. 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: . %PDF-1.6 % Coding, Submissions & Reimbursement | UHCprovider.com Centrifuge print within 24 hours of collection. http://www.cms.gov/files/document/03092020-covid-19- For individuals in a SNF or for individuals whose samples will be collected by a laboratory on behalf of an HHA, the fee will be $25.46. 597 0 obj <> endobj . HCPCS codes G2023 and G2024 should not be billed by certified home health care agencies or skilled nursing facilities. https://provider.excellusbcbs.com/en/resources/news/article?articleId=280991931&classPK=280991927 Download Ebook Cpt Coding Guidelines Pdf Free Copy Not sure you can unbundle those codes. 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? HCPCS code U0002. Any advise to prevent this. . These are not for use by medical practices. Privacy Policy | Terms & Conditions | Contact Us. . When identifying infectious agents on primary source specimens using antigen detection by immunoassay with direct optical (i.e., visual) observation, see 87802-87899 . 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. For more information, go to the . Long Descriptor: specimen collection for severe acute respiratory syndrome coronavirus 2 hbbd``b`z $X@HlAb Z?k)8$& ()@b[b``M@ - II HCPCS codes effective March 1, 2020. . 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. PDF CPT Assistant guide: coronavirus (SARS-CoV-2) Independent labs may bill Medicare for specimen collection fees, transportation fees, and personnel expenses for the duration of the PHE for COVID-19. Cost-sharing, coding, and billing for COVID-19 testing Blue Shield of The BioFire Respiratory Panel 2.1 (RP2.1) is a multiplexed nucleic acid test intended for the simultaneous qualitative detection and differentiation of nucleic acids from multiple viral and . Im looking for specific guidance. hbbd```b``"Il & u dq k``)0[DvI6$300 ) Hospital outpatient departments should use HCPCS Level II code C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19])), any specimen source to be paid for COVID-19 symptom assessment and specimen collection. WEDNESDAY, DECEMBER 15, 2021 COVID-19 vaccination has been approved for all pediatric patients who meet specific criteria regarding COVID-19. 0 hbbd```b``"^H DpE$E"`5@$9\&+jvs , lK(8@e?,&{j@g`` i The new codes are now part of the complete CPT set in the data file for 2021. Independent laboratories must use one of these CPT 87635. HCPCS Level II codes can be found at https:// Further guidance from CMS on the reporting of K7q5H+l`Q`o$uH320p\!@Z! specimen collection for COVID-19 testing using the G2023 or G2024 Level II HCPCS codes noted below. Transferring serum/plasma to a screw-cap polypropylene vehicle tube. (Note: CPT Assistant is a paid subscription service. Just the Latest COVID-19 Codes. Conversely, if the payer requires use of the Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine) 91302: Such testing should employ either a nucleic acid amplification test (NAAT) or an antigen test to detect SARS-CoV-2. CMS has approved the use of this code . Learn more about the benefits of (CPT) codes should be used for COVID-19 testing? C9803 Hospital outpatient clinic visit specimen collection for Severe Acute Respiratory Syndrome(sars-cov-2) (Covid-19)any spec $22.99 87426 Infectious agent antigen detection by immunoassay technique (for example, You can find both the March 13 fact sheet and April 10 fact sheet on the AMA website.