CMAP COVID-19 Response – Bulletin 47: Updated Billing Guidance Regarding HighThroughput Technology Billed Under Procedure Codes U0003 and U0004

Effective for dates of service January 1, 2021 and forward, the Department of Social Services (DSS) will update the reimbursement for clinical diagnostic laboratory tests (CDLTs) for the detection of SARS-CoV2 or for the diagnosis of the virus that causes COVID-19 when using high-throughput technologies consistent with the modified guidance published by the Centers for Medicare and Medicaid Services (CMS) in Ruling 2020-1- R2. The CMS ruling can be accessed by clicking the following link: https://www.cms.gov/files/document/cmsruling-2020-1-r2.pdf.

Consistent with the guidance issued in the CMS Ruling 2020-1-R2, effective January 1, 2021, DSS will implement the following reimbursement updates for CDLTs that utilize high-throughput technology:

• Reimbursement for high throughput tests billed with procedure codes U0003 and U0004 will be priced at $75.00; and

• Add-on procedure code U0005 will be added to the laboratory fee schedule and priced at $25.00. The add-on code U0005 was created to be billed in combination with procedure codes U0003 or U0004 only when providers meet the specific criteria outlined by CMS.

See the section titled Add-on Code U0005 Criteria and the CMS Ruling 2020-1-R2 for more information on when to bill with add-on code U0005.

Source: https://www.ctdssmap.com/CTPortal/Information/Get Download File/tabid/44/Default.aspx?Filename=pb20_102.pdf&URI=Bulletins/pb20_102.pdf