CMS recently revealed how much it will pay for new Current Procedural Terminology (CPT) codes developed by the American Medical Association (AMA) for COVID-19 diagnostic tests.
On May 19, the federal agency updated guidance to include Medicare payment details for CPT codes 87635, 86769, and 86328, which can be used by healthcare providers and laboratories to bill payers for testing patients for SARS-CoV2. Medicare will pay $51.31, $42.13, and $45.23, respectively, for the codes.
The guidance previously detailed Medicare payment rates for Healthcare Common Procedure Coding System (HCPCS) codes U0001 and U0002, which were created by CMS in February for providers to bill for COVID-19 tests developed by the Centers for Disease Control and Prevention (CDC), as well as for laboratories using non-CDC tests. Medicare reimburses providers and laboratories $35.91 for U0001 and $51.31 for U0002.
AMA later developed the three CPT codes to enable providers to bill for COVID-19 testing using its medical billing and coding set.
According to the code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus. The full code description is:
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.
CPT codes 86769 and 86328 were added by the AMA later. The codes account for COVID-19 antibody testing in which providers test patients for the novel coronavirus using blood, serum, or plasma. The full code descriptions for the CPT codes are:
- 86769: 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
- 86328: 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
Guidance from the AMA states that CPT code 87635 is most appropriate for COVID-19 diagnostic laboratory testing, while CPT codes 86769 and 86328 should be used for serologic laboratory testing for COVID-19.
However, providers will need to manually upload all three code descriptors into their EHR systems, per the standard early release process for CPT codes, AMA stated. The CPT codes will be included in the complete CPT code set in the data file for 2021, which will be available later this year.
CMS has also established HCPCS codes for other COVID-19 tests. However, Medicare reimburses providers and laboratories about double the rate for the codes (U0003 and U0004).
The two HCPCS codes carry a higher Medicare payment rate because they indicate the use of high throughput technologies. These technologies can process more than 200 specimens a day, although the codes should not be used to bill for tests that detect COVID-19 antibodies, CMS stated in the updated guidance.
CMS intends for the HCPCS codes and higher Medicare payment rates to respond quickly to COVID-19 outbreaks, especially in nursing homes, CMS Administrator Seema Verma said.