COVID-19 Lab Fee Schedule - JE Part A
COVID-19 Lab Fee Schedule
As laboratory tests, Medicare will cover these codes at 100% of their allowed amount with no deductible or coinsurance applied.
Medicare also doesn't require an order or referral for a patient’s initial COVID-19 or Influenza related items. However, providers should still include the ordering information if documented and the FDA requirements for prescriptions and state requirements on ordering tests still apply. Test results should still be shared with beneficiaries and reported to authorities as necessary.”
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The following COVID-19 lab tests require a type 1 or type 9 CLIA certificate unless otherwise noted by CMS. Lab tests will be contractor priced until CMS assigns a price to the code on the Clinical Laboratory Fee Schedule
| HCPCS/CPT | Description | Allowed Amount | Effective Date |
|---|---|---|---|
| U0001 | Coronavirus Real Time RT-PCR Diagnostic Test Panel - CDC base | $35.91 | 2/4/2020 |
| U0002 | Coronavirus, any technique, multiple types or subtypes; includes all targets - Non-CDC | $51.31 | 2/4/2020 |
| U0003 | Infectious agent detection by nucleic acid (DNA or RNA); COVID-19, use of high throughput technologies | $75.00 | 4/14/2020 |
| U0004 | SARS-CoV-2/2019-nCoV any technique, multiple types or subtypes, non-CDC, high throughput technologies | $75.00 | 4/14/2020 |
| U0005 | Add-on to U0003, U0004 when test completed within two calendar days or less of specimen collection | $25.00 | 1/1/2021 |
| 86328 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) | $45.23 | 4/10/2020 |
| 86408 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen | $42.13 | 8/10/2020 |
| 86409 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); titer | $79.61 | 8/10/2020 |
| 86413 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative | $51.43 | 9/8/2020 |
| 86769 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) | $42.13 | 4/10/2020 |
| 87635 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19), amplified probe technique - Non-CDC | $51.31 | 2/4/2020 |
| 87636 | severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
$142.63 | 10/06/2020 |
| 87637 | severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique (For nucleic acid detection of multiple respiratory infectious agents, not including severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] |
$142.63 | 10/06/2020 |
| 87811 | severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
$41.38 | 10/06/2020 |
| 87913 - Not CLIA-waived | Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s) | $257.45 | 02/21/2022 |
| 0240U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected | $142.63 | 10/06/2020 |
| 0241U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected | $142.63 | 10/06/2020 |
| 87426 | Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus | $35.33 | 6/25/2020 |
| 87428 | Infectious agent antigen detection by immunoassay technique qualitative or semiqualitative; severe acute respiratory syndrome coronavirus ( SARS-CoV, SARS-CoV-2) and influenza types A and B | $63.59 | 11/10/2020 |
| 0223U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid, 22 targets including severe acute respiratory syndrome coronavirus 2, qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected | Carrier priced | 6/25/2020 |
| 0224U | Antibody, severe acute respiratory syndrome coronavirus 2, includes titer(s), when performed | $42.13 | 6/25/2020 |
| 0225U | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets (LCD JE: L37301; JF: L37315) | Carrier priced | 8/10/2020 |
| 0226U | Surrogate viral neutralization test (sVNT), severe acute respiratory | $42.28 | 8/10/2020 |
| C9803 Part A only |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease) | $23.00 (national) | 3/1/2020 |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus any specimen source | $23.46 | 3/1/2020 |
| G2024 | Specimen collection for severe acute respiratory syndrome coronavirus 2, from individual in SNF or by lab | $25.46 | 3/1/2020 |
Resources
- CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing
- CMS Emergency Response
- CMS Medicare Learning Network (MLN) Matters (MM) 11681 - Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
- CMS MM 11765 - Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code U0002 and 87635
- COVID-19 Influenza, and RSV Diagnostic Laboratory Tests for which Medicare Does Not Require a Practitioner Order During the PHE
- Medicare Administrative Contractor (MAC) COVID-19 Test Pricing
- Medicare Coverage and Payment Related to COVID-19 Fact Sheet
- SARS-CoV-2 Laboratory Testing Comparison Graphic
Last Updated Tue, 13 Dec 2022 16:34:33 +0000