Reimbursement Policy Effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)

Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), will be effective January 1, 2021. This policy aligns with the Centers for Medicare & Medicaid Services’ approach.

Effective January 1, 2021, and throughout the period of the COVID-19 public health emergency as declared by the Governor of New Jersey, we will:

• Consider an additional add-on payment (U0005) of $25 for COVID-19 diagnostic testing run on high throughput technology, when billed with procedure code U0003 or U0004, and when the following conditions are met:
  1. Procedure codes U0003 or U0004 COVID-19 testing is completed in two calendar days or less for the specific test billed, and
  2. The laboratory can certify that 51% of the previous months’ U0003 and U0004 COVID-19 diagnostic testing was completed within two calendar days or less.
• Reduce our reimbursement for U0003 and U0004 from $100 to $75.

The clinical laboratory must maintain self-certification of the above conditions.

Failure to adhere to the above requirements while continuing to bill U0005 shall be considered inappropriate billing with this policy and may result in add-on payments not being reimbursed.

Source: https://www.horizonblue.com/providers/covid-19-information/reimbursement-policy-effective-january-1-2021-add-payment-covid-19-diagnostic-testing-run-high