The Centers for Medicare and Medicaid Services (CMS) updated its Medicare payment factsheet for COVID-19 diagnostic tests to add additional codes that laboratories may bill Medicare for. The factsheet now includes CPT codes developed by the American Medical Association (AMA) for nucleic acid tests and serology tests.
Prior to this update, laboratories could bill for COVID-19 diagnostic tests using the code U0001 for tests developed by the Centers for Disease Control and Prevention (CDC) and code U0002 for non-CDC developed tests. The payment rate for CDC tests is $35.91 and non-CDC tests is $51.31.
The updated factsheet details that the AMA developed CPT code 87635 for infectious agent detection by nucleic acid tests and codes 86769 and 86328 for serology tests. CMS notes that local Medicare Administrative Contractors (MACs) are responsible for developing payment amounts for the newly created codes in their respective jurisdictions until Medicare establishes national payment rates. Local MACs have set the payment rate for code 87635 (nucleic acid test) at $51.31, code 86769 (serology test) at $42.13, and code 86328 (serology test) at $45.23. There is no cost-sharing for Medicare patients.