The Centers for Medicare & Medicaid Services (CMS) announced it has issued a second Healthcare Common Procedure Coding System (HCPCS) code that diagnostic laboratories can use to bill for certain COVID-19 tests.
While the first HCPCS testing code released last month (U0001) reimburses CDC testing laboratories, this second code (U0002) reimburses for non-CDC laboratory tests. Specifically, this new code reimburses laboratories that use tests developed through recent guidance from the Food and Drug Administration (FDA) instructing laboratories on how to develop their own COVID-19 diagnostics (WHG summary here).
Medicare claims processing systems will begin accepting these codes on April 1, 2020, for dates of service on or after February 4, 2020.
CMS also released a series of fact sheets educating the public on CMS coverage of diagnostic tests, immunizations, vaccines, telehealth, pharmaceutical drugs, and cost-sharing policies related to COVID-19. This information pertains to those covered under Medicare, Medicaid and CHIP, and the individual and small group markets. Details follow.
- Medicare: Of note, the fact sheet notes the two HCPCS codes (U0001 and U0002) that reimburse for COVID-19 diagnostic tests. CMS also states that it covers all medically necessary inpatient hospitalizations, and discusses its coverage of telehealth services that facilitate “virtual check-ins” for patients receiving care without going to the doctor’s office (p. 3). It also notes that Medicare will cover the COVID-19 vaccine under Part D once it becomes available (p. 6).
- Medicaid & CHIP: While testing and diagnostic coverage vary by state, the fact sheet states children are eligible to receive all medically necessary testing and diagnostic services. For beneficiaries in Medicaid expansion states, all preventive services (e.g., immunizations) are covered without cost-sharing; moreover, Medicaid and CHIP cover recommended vaccines for children without cost sharing. The brief also notes that there is wide flexibility for states to cover telehealth services (p. 4).
- Individual and Small Group Market: While laboratory services are a category in the Essential Health Benefits (EHBs), the fact sheet notesthe particular diagnostic or laboratory services covered vary by plan. The fact sheet also states that further guidance will be issued for individual and small group market coverage of any forthcoming COVID-19 vaccination. Coverage of additional specific services, such as those for telehealth, hospitalizations, and prescription drugs all also vary by plan and based on the specific benchmark plan selected in each state.