CMS to Reduce Payments for Some COVID-19 Tests

Starting January 1, 2021, these codes will be reimbursed at a base rate of $75.

A version of this article was first published October 21, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS will reduce payments to laboratories that take longer than two days to complete high-throughput COVID-19 diagnostic tests effective January 1, 2021, according to an October 15 press release.

Currently, laboratories are paid $100 for high-throughput COVID-19 tests using the following HCPCS codes:

• U0003, 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, making use of high-throughput technologies
• U0004, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high-throughput technologies

Starting January 1, 2021, these codes will be reimbursed at a base rate of $75.

However, laboratories that are able to complete high-throughput COVID-19 diagnostic tests within two calendar days of specimen collection will be able to bill the following $25 add-on code:

U0005, 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 high-throughput technologies, completed within two calendar days from date and time of specimen collection

According to an update in Section D of CMS’ COVID-19 billing FAQs, U0005 is effective January 1, 2021, and should be listed separately in addition to either U0003 or U0004.

The payment change is intended to support faster testing and more timely notification of patients who test positive for COVID-19, Seema Verma, CMS administrator, said in the press release.