Medicaid Illinois – Update to COVID-19 Diagnostic Testing Codes and Rates Effective March 1, 2021

This notice informs providers of an update to coding and reimbursement for COVID-19 diagnostic tests run on high-throughput technology in accordance with guidance from the Centers for Medicare & Medicaid Services (CMS), which is intended to incentivize expedited COVID-19 test results. This billing guidance applies to claims for participants covered under both traditional Medicaid fee-for-service and the HealthChoice Illinois Medicaid managed care plans.

Effective with dates of service March 1, 2021, reimbursement rates for HCPCS codes U0003 and U0004 will be reduced from $100.00 to $75.00 in accordance with CMS’ assessment of the resources needed to perform those tests and the corresponding Medicare rate reduction. Also effective with dates of service March 1, 2021, reimbursement will be available for the HCPCS add-on code U0005 at a rate of $25.00, provided the following requirements established by CMS are met:

1. the test is completed in two calendar days or less, and
2. the lab completes the majority (51% or more) of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients in the previous month

Source: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn210226a.aspx