Revised Editing for Ordering/Referring Providers on Lab Claims
May 10, 2021Issue
Because of the COVID-19 public health emergency (PHE), CMS previously amended regulations to remove the requirement that certain diagnostic tests are covered only when ordered by the treating physician. With this revised policy, Medicare beneficiaries may receive coverage for one COVID-19 and related test without the order of a physician or non-physician practitioner. This revised policy includes the following codes: U0001-U0004, 87635, 86769, 86328, 87275, 87276, 87279, 87400, 87501-87503, 87631, 87804, 87280, 87420, 87634, and 87807.
Resolution
CMS has revised this editing to remove the ordering requirement from additional codes. This revised editing will be applicable to the following codes for dates of service on or after March 1, 2020: U0005, 86408, 86409, 86413, 87426, 87811, 0224U, 0226U, 87428, 87636, 87637, 0240U, 0241U, G2023, and G2024. The relaxation of the referring provider for the listed codes is effective for dates of service on or after March 1, 2020.
The referring/ordering provider NPI will be required for procedure codes 87632 and 87633 effective for claims processed on or after May 4.
Source: https://medicare.fcso.com/Processing_Issues/0483168.asp