COVID-19 MAC test pricing worksheet now available

by: Jim Dresbach Mar 13, 2020

On March 13, CMS posted a fact sheet to the cms.gov website to aid Medicare providers, billers and coders with information relating to the pricing of both the CDC and non-CDC coronavirus (COVID-19) tests.

The two-page sheet contains U0001 and U0002 test reimbursement prices for 12 MAC jurisdictions. Starting April 1, labs performing the U0001 and U0002 tests can bill Medicare and other private payers for services that occurred after Feb. 4.

CMS also reaffirmed that it will cover COVID-19 tests, and generally there will be no co-pay when the original Medicare deductible applies.

Medicare’s initial payment for the U0001 test will be about $36 and non-CDC test payment will be around $51, according to CMS. These prices may vary slightly depending on the local Medicare administrative contractor (MAC).

To date, two new HCPCS codes for health care providers have been introduced to test patients for the novel virus. Code U0001 is to bill for a COVID-19 diagnostic test and should be used when specimens are sent to the CDC and CDC-approved local or state health department laboratories.

Code U0002 was recently introduced and can be used by laboratories and practices to bill Medicare as well as by other health insurers where any technique, multiple types or subtypes of testing were completed.

Resource:
• COVID-19 test pricing work sheet: www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

Blog Tags: claims processing, CMS, COVID-19, MACs, primary care, private payers

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KIM SWEET

Apr 14, 2020 11:55 AM

The tests that are reported must be FDA approved. There are a number of them claiming qualitative results but have not been approved. There is only 1 approved so far and it has been used by hospitals.

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