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.”

X
 

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
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

 

Last Updated Fri, 17 Sep 2021 17:07:36 +0000