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Billing for COVID-19 Tests


On April 8, 2020, HHS Secretary Azar announced new guidance authorizing pharmacists to order and administer FDA-authorized COVID-19 tests to their patients. Secretary Azar’s statement is available here.

The guidance, however, does not inform pharmacists and pharmacies of which billing codes to use, where to submit claims, and how to be reimbursed. With so many unanswered questions, we hope the resources below can help you navigate patient care services related to COVID-19 testing. As always, please follow your organization’s policies and consult with health plans regarding contractual requirements.

Using Appropriate Billing Codes

The American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) recently established new codes for COVID-19 tests. Please review the resources listed below and the AMA’s COVID-19 Coding Advice which presents different patient encounter scenarios and coding information.

Codes

Description

U0001

Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC can also be used by laboratories and healthcare facilities

87635

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

86318

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip)

86328

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

(For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using multiple-step method, use 86769)

86602

Antibody; actinomyces

86635

Coccidioides

(For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing, see 86328, 86769)

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

(Coronavirus disease [COVID-19]) (For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using single step method, use 86328)

 

Billing for Patient-Care Services

Pharmacists with Existing Contracts

Washington State requires commercial health plans to include pharmacists in their participating medical provider networks. In addition, pharmacists can order and interpret laboratory tests. For those with existing contracts, please contact each health plan to determine the appropriate billing codes to use and any specific plan requirements related to COVID-19 testing.

Pharmacists can bill for COVID-19 tests in at least two ways.

  • Administer COVID-19 tests to patients and use the appropriate billing codes when submitting claims.
  • Provide patient counseling and coordination of care services, and test for COVID-19 during patient visits. Based on your contracts with health plans, pharmacists may bill for (1) visits using Evaluation and Management codes; (2) sample collection; and (3) test administration.

Pharmacists without Contracts

For those without contracts and seeking opportunities to bill for these services, please contact WSPA’s business partners to discuss options to get credentialed and contracted with health plans, document services and submit claims, and receive payments. While there are alternate ways to submit claims, pharmacists must document appropriately.

WSPA’s Pharmacy Practice Guidebook

To learn about medical billing, please use the WSPA’s Pharmacy Practice Guidebook as your reference book to understand the importance of documenting patient encounters and using billing codes. This reference book connects clinical services you provide and document with billing codes you report when submitting claims. Visit https://www.wsparx.org/page/ProvStatus to learn more or place your order here.

 

 

 

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