Medicaid Indiana – Billing and Reimbursement Updates for COVID-19 Laboratory Testing Codes, Claims That Paid Incorrectly

Rate decrease for HCPCS codes U0003 and U0004

As a result of changes to the Medicare reimbursement rates, IHCP Medicaid reimbursement of the following Healthcare Common Procedure Coding System (HCPCS) codes associated with coronavirus disease 2019 (COVID-19) testing will decrease from a maximum fee of $100.00 to $75.00, effective retroactively for professional and outpatient claims with DOS on or after January 1, 2021

Claims for codes U0003 and U0004 that paid incorrectly The IHCP identified a claim-processing issue that affects FFS professional and outpatient claims for procedure codes U0003 and U0004, with DOS on or after January 1, 2021. Claims or claim details may have paid incorrectly. The claim-processing system has been updated with the new rate. Claims processed during the indicated time frame for codes U0003 and U0004 will be mass adjusted, as appropriate. Providers should see adjusted claims on Remittance Advices (RAs) beginning April 21, 2021, with internal control numbers (ICNs)/Claim IDs that begin with 52 (mass replacements non-check related).

If a claim was overpaid, the net difference will appear as an accounts receivable on the RA. The accounts receivable will be recouped at 100% from future claims paid to the respective provider number.

Add-on payment using HCPCS code U0005 Effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) released HCPCS code U0005 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of high throughput technologies, completed within two calendar days from date and time of specimen collection.

Claims for add-on payment If a provider met the criteria (above) for billing code U0005 with a claim for procedure code U0003 or U0004 with DOS on or after January 1, 2021, the provider may choose to adjust the original claim by voiding the original and submitting a replacement. CMS guidance states that U0005 must be billed on the same claim as U0003 or U0004. The replacement claim must include the same attachments (if any) as were submitted with the original claim. Providers have 180 days from the date of this banner page publication to adjust claims. Replacement claims submitted beyond the original 180 day filing limit must include a copy of this banner page as an attachment and must be filed within 180 days of the publication date.