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Updated billing guidelines and fees for COVID-19 lab testing codes
February 4, 2021

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:

  • We have updated the fees for high-throughput testing codes U0003 and U0004 to align with industry guidance.
  • We have also included the add-on code U0005 to applicable fee schedules; please note:
    • Diagnostic tests that run on high-throughput technologies completed within two calendar days of the date and time of the specimen collection are eligible for separate reimbursement when billed with add-on code U0005.
    • Please do not bill add-on code U0005 for COVID-19 diagnostic tests that don’t meet the criteria noted in italics above. These services are not eligible for separate reimbursement.

Billing scenarios

 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.

Codes and descriptions

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

Professional fee schedule updates

The following temporary COVID-19 professional fee schedules have been updated on Provider Central:

Freestanding clinical lab fee schedule update

View your fee schedule

To view your fee schedule, log in to Provider Central, then go to Office Resources>Billing & Reimbursement>Fee Schedules.

Acute care hospital fee schedule updates

For information about hospital outpatient fee schedule updates, please contact your network representative.

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