COVID19 Test Pricing Left to MACs -Cheapskates
Mar 11, 2020 12:56:59 GMT
sgard434, miamianne67, and 2 more like this
Post by icemandios on Mar 11, 2020 12:56:59 GMT
Friday, March 6, 2020
CMS Announces Special New Codes for Coronavirus Testing
CMS has announced two special codes for Coronavirus testing, both effective April 1, 2020. U0001 will represent CDC-kit testing, and U0002 will represent other testing.
See the March 5, 2020 CMS press release here:
www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
"CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) announced today allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)."
In transmittals on the Clin Lab Fee Schedule here and outpatient fee schedule here:
Code: U0001
Short Descriptor: 2019 –nCoV diagnostic P
Long Descriptor: CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
Code: U0002
Short Descriptor: COVID-19 lab test non-CDC
Long Descriptor: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
Codes Not Priced
CMS adds, "Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them."
Medicare MACs will simply set a price they pay, reagardless of the inbound charge. Options may include Options include 87797 (direct probe, per organism), 87798 (amplified probe, per organism), and 87799 (quantitative DNA/RNA probe, per organism.) CMS pays $30, $35, and $43 respectively.
Retroactive
The codes can be billed retroactive to February 4, but do not submit the claim until April 1 or later.
Hospital Outpatient Bundling?
In general, virology tests are "bundled" in the ER or hospital clinic outpatient setting.
In Transmittal T4544, CR11691, CMS states that the new U-codes for coronavirus are NOT BUNDLED but are PAID SEPARATELY (status "A"). This is an exception to the usually bundling of hospital outpatient chemistry and virology codes.
CMS Announces Special New Codes for Coronavirus Testing
CMS has announced two special codes for Coronavirus testing, both effective April 1, 2020. U0001 will represent CDC-kit testing, and U0002 will represent other testing.
See the March 5, 2020 CMS press release here:
www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
"CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) announced today allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)."
In transmittals on the Clin Lab Fee Schedule here and outpatient fee schedule here:
Code: U0001
Short Descriptor: 2019 –nCoV diagnostic P
Long Descriptor: CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
Code: U0002
Short Descriptor: COVID-19 lab test non-CDC
Long Descriptor: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
Codes Not Priced
CMS adds, "Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them."
Medicare MACs will simply set a price they pay, reagardless of the inbound charge. Options may include Options include 87797 (direct probe, per organism), 87798 (amplified probe, per organism), and 87799 (quantitative DNA/RNA probe, per organism.) CMS pays $30, $35, and $43 respectively.
Retroactive
The codes can be billed retroactive to February 4, but do not submit the claim until April 1 or later.
Hospital Outpatient Bundling?
In general, virology tests are "bundled" in the ER or hospital clinic outpatient setting.
In Transmittal T4544, CR11691, CMS states that the new U-codes for coronavirus are NOT BUNDLED but are PAID SEPARATELY (status "A"). This is an exception to the usually bundling of hospital outpatient chemistry and virology codes.
One would almost think they don't "get it". Contrast with Germany, just posted by moi in General Health discussion.