How to bill for COVID-19 testing
In the past month, CMS and the AMA have created three new CPT and HCPCS codes for COVID-19-related testing. These codes are currently active for all U.S. hospitals, health systems, and laboratories.
HCPCS codes announced by CMS:
- U0001 describes COVID-19 testing using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel; and
- U0002 describes validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
Read more about these new HCPCS codes in the CMS fact sheet
CPT codes announced by the AMA:
- 86328 describes, "Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])";
- 86769 describes, "Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])"; and
- 87635 describes, "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."
Read more about the new CPT code in the AMA fact sheet
How to bill for COVID-19 treatment
As of April 1, hospitals that are paid through Medicare’s Inpatient Prospective Payment System (IPPS) should utilize the new ICD-10 code, U07.1, for all confirmed COVID-19 diagnoses. This marks an unprecedented off-cycle code update in contrast to what was originally announced.
According to CDC guidance, as of April 1, for patients with confirmed COVID-19 status and …
- Pneumonia confirmed as due to COVID-19: assign codes U07.1, COVID-19, and J12.89, other viral pneumonia.
- Acute bronchitis confirmed as due to COVID-19: assign codes U07.1, and J20.8, acute bronchitis due to other specified organisms.
- Bronchitis not otherwise specified (NOS) due to COVID-19: assign codes U07.1 and J40, bronchitis, not specified as acute or chronic.
- COVID-1-associated lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, not otherwise specified (NOS): assign codes U07.1 and J22, unspecified acute lower respiratory infection.
- COVID-19-associated respiratory infection, NOS: assign codes U07.1 and J98.8, other specified respiratory disorders
- Acute respiratory distress syndrome (ARDS) confirmed as due to COVID-19: assign codes U07.1, and J80, acute respiratory distress syndrome.
Additional treatment codes:
- For patients with possible COVID-19 exposure but no positive COVID-19 status, assign code Z03.818, encounter for observation for suspected exposure to other biological agents ruled out.
- For patients with actual exposure to confirmed COVID-19 carrier but no positive COVID-19 status, report code Z20.828, contact with and (suspected) exposure to other viral communicable diseases.
- For patients presenting COVID-19 symptoms but have not yet been tested, assign codes for each of the presenting symptoms such as: cough (R05); shortness of breath (R06.02) or fever unspecified (R50.9). For asymptomatic patients who test positive for COVID-19, assign code U07.1, COVID-19.
Why this matters
With each new case, hospital resources are stretched further. Initial analysis by the Peterson-KFF Health System Tracker estimates the cost of an inpatient COVID-19 admission could range from $9,700-$20,300, depending on patient acuity. The diagnosis and treatment of COVID-19 patients remains the clinical priority. However, understanding how to appropriately document, track, and manage reimbursement for these cases is vital in order for hospitals to remain open and financially solvent.
Your top resources for coronavirus readiness
You're no doubt being inundated with a ton of information on how to prepare for possible patients with COVID-19. To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.