CMS-2020-1-R2 Effective 1/1/2021

Beginning January 1, 2021, for such tests that are completed within 2 calendar days of the specimen being collected, the payment amount will be $100 per test. For such tests that are not completed within 2 calendar days of the specimen being collected, the payment amount will be $75 per test. Beginning January 1, 2021, the revised payment amounts will be effectuated as follows:

• CMS will establish a payment amount of $75 per test for CDLTs making use of high throughput technologies for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID19, as identified by HCPCS codes U0003 and U0004.
• CMS will establish a new add-on payment of $25 as identified by HCPCS code U0005. As required by the HCPCS code U0005 descriptor, this add-on payment may be billed with either HCPCS code U0003 or HCPCS code U0004 when the applicable test is completed within 2 calendar days of the specimen being collected.
• Laboratories that do not complete the CDLT making use of high throughput technologies for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 within 2 calendar days may not bill HCPCS code U0005 and will not receive the $25 add-on payment. Payment for these CDLTs will be $75.
  • Under the amended Administrative Ruling (CMS-2020-1-R2), CMS will lower the base payment amount for both HCPCS codes to $75, effective January 1, 2021. CMS will make an additional $25 add-on payment to laboratories if they meet the following two requirements to bill for HCPCS code U0005: a) they completed the COVID-19 CDLT in 2 calendar days or less from the date of specimen collection, and b) the majority of their COVID-19 CDLTs performed using high throughput technology in the previous calendar month were completed in 2 calendar days or less for all of their patients (not just their Medicare patients). As a result, laboratories that complete these CDLTs within 2 days of the date the specimen is collected may bill for HCPCS code U0005 and will be paid $100 while laboratories that take longer will receive a $75 payment.
  • Laboratories would assess their COVID-19 CDLT timeliness in the month preceding the month identified by the line date of service for the corresponding CDLT represented by HCPCS code U0003 or U0004. In the circumstance that the laboratory has not completed 51% of CDLTs for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19 (for all patients) in 2 calendar days from the date the specimen was collected Updated: 10/16/2020 pg. 16 during the applicable month, then it may not bill for HCPCS code U0005 with either HCPCS code U0003 or U0004

Source: https://www.cms.gov/files/document/cms-ruling-2020-1-r2.pdf