CurrentimperialinsurancecompanyofutahPolicy N/A

Medicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

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This document lists local Medicare Administrative Contractor (MAC) payment amounts for the newly created HCPCS codes U0001 (CDC-developed SARS-CoV-2 test) and U0002 (non-CDC SARS-CoV-2 tests) for services billed retroactive to February 4, 2020; it applies to Medicare claims processed by the listed MAC jurisdictions.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyMedicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 12, 2020

Next Review DateN/A

Key ActionBill Medicare and other insurers for SARS-CoV-2 testing using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests for services performed on or after February 4, 2020.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$35.91 - $35.92U0001 payment range across MACs

$51.31 - $51.33U0002 payment range across MACs

Since Feb 4, 2020Effective billing date for tests

MultipleNumber of MAC jurisdictions enumerated

MAC Payment Amounts and Coverage Notes

MAC payment amounts

MAC-specific payment amounts for U0001 and U0002 are listed below; Original Medicare typically imposes no beneficiary cost sharing for laboratory tests.

ALL of the following

Per‑MAC payment amounts for HCPCS U0001 (CDC-developed SARS-CoV-2 test) and U0002 (non-CDC SARS-CoV-2 test) are listed by MAC jurisdiction below.
ALL of the following
- J6 - National Government Services (NGS) — IL, MN, WI: U0001 = $35.91; U0002 = $51.31.
- JK - National Government Services (NGS) — CT, NY, ME, MA, NH, RI, VT: U0001 = $35.91; U0002 = $51.31.
- JH - Novitas Solutions — AR, CO, NM, OK, TX, LA, MS: U0001 = $35.92; U0002 = $51.33.
- JL - Novitas Solutions — DE, DC, MD, NJ, PA, (parts of VA including Arlington, Fairfax, and Alexandria): U0001 = $35.92; U0002 = $51.33.
- JN - First Coast Service Options (FCSO) — FL, PR, VI: U0001 = $35.92; U0002 = $51.33.
- JJ - Palmetto Government Benefits Administrators (PGBA) — AL, GA, TN: U0001 = $35.91; U0002 = $51.31.
- JM - Palmetto Government Benefits Administrators (PGBA) — NC, SC, VA, WV: U0001 = $35.91; U0002 = $51.31.
- JE - Noridian Healthcare Solutions — CA, HI, NV, AS, GU, MP: U0001 = $35.91; U0002 = $51.31.
- JF - Noridian Healthcare Solutions — AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY: U0001 = $35.91; U0002 = $51.31.
- J5 - Wisconsin Physician Services (WPS) — IA, KS, MO, NE: U0001 = $35.92; U0002 = $51.31.
- J8 - Wisconsin Physician Services (WPS) — IN, MI: U0001 = $35.92; U0002 = $51.31.
- J15 - CGS — KY, OH: U0001 = $35.92; U0002 = $51.31.

Effective billing date: laboratories may bill Medicare and other insurers for tests performed on or after February 4, 2020 using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests.

COVID-19 Testing HCPCS Codes

COVID-19 testing HCPCS codesHCPCSCovered

U0001	CDC-developed SARS-CoV-2 test (HCPCS)
U0002	Non-CDC laboratory SARS-CoV-2 test (HCPCS)

Billing Instructions and Retroactive Dates

Billing Rule

Bill U0001/U0002 for tests back to Feb 4, 2020

Bill Medicare and other insurers for SARS‑CoV‑2 testing using HCPCS code U0001 for CDC‑developed tests and U0002 for non‑CDC laboratory tests for services performed on or after February 4, 2020.

Use U0001 only for tests developed by the Centers for Disease Control and Prevention (CDC).
Use U0002 for non‑CDC laboratory SARS‑CoV‑2/2019nCoV (COVID‑19) tests.
MACs have set local payment amounts for these codes until national rates are established.

Code Definitions

inv-04: U0001 — HCPCS code for CDC-developed SARS-CoV-2 tests

CodeU0001

DescriptionHCPCS code only to be used for tests developed by the Centers for Disease Control and Prevention (CDC).

Billing effective dateServices performed on or after February 4, 2020 may be billed using this code.

Coverage stanceCovered by Medicare; local MACs set payment amounts until national rates are established.

inv-05: U0002 — HCPCS code for non-CDC laboratory SARS-CoV-2 tests

CodeU0002

DescriptionHCPCS code to be used for non-CDC laboratory tests for SARS-CoV-2/2019nCoV (COVID-19).

Billing effective dateServices performed on or after February 4, 2020 may be billed using this code.

Coverage stanceCovered by Medicare; local MACs set payment amounts until national rates are established.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyMedicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 12, 2020

Next Review DateN/A

Key ActionBill Medicare and other insurers for SARS-CoV-2 testing using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests for services performed on or after February 4, 2020.

SourceLink

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CurrentimperialinsurancecompanyofutahPolicy N/A

Medicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

Customize your policy alerts

Sign up for all imperialinsurancecompanyofutah policy alerts

Know when imperialinsurancecompanyofutah releases new policies or updates existing guidance.

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Policy Summary

Payerimperialinsurancecompanyofutah

PolicyMedicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 12, 2020

Next Review DateN/A

Key ActionBill Medicare and other insurers for SARS-CoV-2 testing using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests for services performed on or after February 4, 2020.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$35.91 - $35.92U0001 payment range across MACs

$51.31 - $51.33U0002 payment range across MACs

Since Feb 4, 2020Effective billing date for tests

MultipleNumber of MAC jurisdictions enumerated

MAC Payment Amounts and Coverage Notes

MAC payment amounts

MAC-specific payment amounts for U0001 and U0002 are listed below; Original Medicare typically imposes no beneficiary cost sharing for laboratory tests.

ALL of the following

Per‑MAC payment amounts for HCPCS U0001 (CDC-developed SARS-CoV-2 test) and U0002 (non-CDC SARS-CoV-2 test) are listed by MAC jurisdiction below.
ALL of the following
- J6 - National Government Services (NGS) — IL, MN, WI: U0001 = $35.91; U0002 = $51.31.
- JK - National Government Services (NGS) — CT, NY, ME, MA, NH, RI, VT: U0001 = $35.91; U0002 = $51.31.
- JH - Novitas Solutions — AR, CO, NM, OK, TX, LA, MS: U0001 = $35.92; U0002 = $51.33.
- JL - Novitas Solutions — DE, DC, MD, NJ, PA, (parts of VA including Arlington, Fairfax, and Alexandria): U0001 = $35.92; U0002 = $51.33.
- JN - First Coast Service Options (FCSO) — FL, PR, VI: U0001 = $35.92; U0002 = $51.33.
- JJ - Palmetto Government Benefits Administrators (PGBA) — AL, GA, TN: U0001 = $35.91; U0002 = $51.31.
- JM - Palmetto Government Benefits Administrators (PGBA) — NC, SC, VA, WV: U0001 = $35.91; U0002 = $51.31.
- JE - Noridian Healthcare Solutions — CA, HI, NV, AS, GU, MP: U0001 = $35.91; U0002 = $51.31.
- JF - Noridian Healthcare Solutions — AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY: U0001 = $35.91; U0002 = $51.31.
- J5 - Wisconsin Physician Services (WPS) — IA, KS, MO, NE: U0001 = $35.92; U0002 = $51.31.
- J8 - Wisconsin Physician Services (WPS) — IN, MI: U0001 = $35.92; U0002 = $51.31.
- J15 - CGS — KY, OH: U0001 = $35.92; U0002 = $51.31.

Effective billing date: laboratories may bill Medicare and other insurers for tests performed on or after February 4, 2020 using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests.

COVID-19 Testing HCPCS Codes

COVID-19 testing HCPCS codesHCPCSCovered

U0001	CDC-developed SARS-CoV-2 test (HCPCS)
U0002	Non-CDC laboratory SARS-CoV-2 test (HCPCS)

Billing Instructions and Retroactive Dates

Billing Rule

Bill U0001/U0002 for tests back to Feb 4, 2020

Use U0001 only for tests developed by the Centers for Disease Control and Prevention (CDC).
Use U0002 for non‑CDC laboratory SARS‑CoV‑2/2019nCoV (COVID‑19) tests.
MACs have set local payment amounts for these codes until national rates are established.

Code Definitions

inv-04: U0001 — HCPCS code for CDC-developed SARS-CoV-2 tests

CodeU0001

DescriptionHCPCS code only to be used for tests developed by the Centers for Disease Control and Prevention (CDC).

Billing effective dateServices performed on or after February 4, 2020 may be billed using this code.

Coverage stanceCovered by Medicare; local MACs set payment amounts until national rates are established.

inv-05: U0002 — HCPCS code for non-CDC laboratory SARS-CoV-2 tests

CodeU0002

DescriptionHCPCS code to be used for non-CDC laboratory tests for SARS-CoV-2/2019nCoV (COVID-19).

Billing effective dateServices performed on or after February 4, 2020 may be billed using this code.

Coverage stanceCovered by Medicare; local MACs set payment amounts until national rates are established.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyMedicare MAC COVID-19 test pricing (HCPCS U0001, U0002)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 12, 2020

Next Review DateN/A

Key ActionBill Medicare and other insurers for SARS-CoV-2 testing using HCPCS U0001 for CDC-developed tests and U0002 for non-CDC tests for services performed on or after February 4, 2020.

SourceLink

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