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HRSA High Throughput COVID-19 Claims: Correction Timeline

  • Senior Director MDx Support Services, XIFIN

HHS confirmed there was a system error in the reimbursement for high throughput COVID-19 PCR testing claims, with HCPCS U0003 and U0004, for the HRSA COVID-19 Uninsured Patient Program. HHS indicated on their FAQ page they would not implement the add-on reimbursement for HCPCS U0005 on January 1, 2021 and would continue reimbursing independent laboratories at the rate of $100 for COVID-19 PCR testing claims.

There were reports within the industry of a reduction in payments on the HRSA Uninsured Patient Program claims to $75.

As of yesterday, HHS confirmed that UHG updated the reimbursement rates for HCPCS U0003 and U0004 back to $100. Claims that were submitted between the date the issue was identified and fixed, were held and not paid. Those claims should be released for payment today, March 3, 2021, with a reimbursement rate of $100. UHG will begin sending correction notifications via EDI 835 forms by the end of this week for the claims that were paid incorrectly. Independent laboratories reimbursed at $75 in error will receive an additional $25 payment for HCPCS U0003 and U0004.


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Published by XIFIN
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