This article is for all professional providers, acute care hospitals, freestanding clinical labs, and urgent care centers caring for our members
Consistent with the American Medical Association and the Centers for Medicare & Medicaid Services, we have made the following updates concerning high-throughput COVID-19 testing technologies, effective for dates of service on or after January 1, 2021:
Scenario | Use these codes to bill | |
---|---|---|
1 | COVID-19 diagnostic tests run on high-throughput technologies NOT completed within two calendar days of the date and time of specimen collection | U0003 or U0004 only |
2 | COVID-19 diagnostic tests run on high-throughput technologies completed within two calendar days of the date and time of specimen collection | U0003 or U0004 with U0005
Note: You must retain all records to demonstrate compliance with the requirement for billing code U0005. |
Code | Description | Effective |
---|---|---|
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 as described by CMS-2020-01-R | January 1, 2021 |
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 as described by CMS-2020-01-R | January 1, 2021 |
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 2 calendar days from date of specimen collection (list separately in addition to either HCPCS code U0003 or U0004) as described by CMS-2020-01-R2 | January 1, 2021 |
The following temporary COVID-19 professional fee schedules have been updated on Provider Central:
To view your fee schedule, log in to Provider Central, then go to Office Resources>Billing & Reimbursement>Fee Schedules.
For information about hospital outpatient fee schedule updates, please contact your network representative.