CMS releases COVID-19 CLFS update and billing FAQ

CMS provided updated coding and billing information in its Clinical Laboratory Fee Schedule (CLFS) for organizations performing tests for COVID-19 and providing treatment for confirmed or suspected COVID-19 infections.

On March 6, the agency released an update to the CLFS to add the following HCPCS codes for the COVID-19 diagnostic tests:

• U0001 (CDC 2019 novel coronavirus [2019-nCoV] real-time RT-PCR diagnostic panel)
• U0002 (2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV [COVID-19], any technique, multiple types or subtypes [includes all targets], non-CDC)

These HCPCS codes are retroactively effective February 4. The new codes allow organizations to bill for a specific test rather than using an unspecified code. Medicare Administrative Contractors are responsible for developing payment amounts for these claims. Under Medicare Part A, there is no beneficiary cost sharing for these tests.

Also on March 6, CMS issued an FAQ regarding Medicare payment for tests and other services related to COVID-19. Topics covered in the FAQ include payment and billing for:

• Ambulance services
• Diagnostic laboratory tests
• Drugs and vaccines under Part B
• Hospital services
• Physicians’ services

In general, hospitals will continue to be reimbursed at normal inpatient prospective payment system rates. CMS has not created a special diagnosis-related group for COVID-19. If an inpatient no longer needs acute level care but no beds are available in a skilled nursing facility due to an emergency or other reason, the physician may certify or recertify the need for continued hospitalization. Physicians and nonphysician practitioners may educate beneficiaries on the availability of telehealth services; however, normal telehealth coverage and reimbursement policies continue to apply.

Additional information, including COVID-19-related coverage and payment fact sheets for Medicare, Medicaid and Children's Health Insurance Program, and individual and small group market insurance, can be found on CMS’ current emergencies webpage.