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COVID-19 Laboratory Resource Center

During these turbulent times, COVID-19 information is changing quickly. XIFIN is committed to helping laboratories and diagnostics providers obtain the information they need, including the latest on testing, testing supply needs, and payor billing requirements.
Updated 10/19/20 11:05 AM PDT

 

Lab Volume Index

The Lab Volume Index synthesizes billing volume data into a measurement of testing volumes as compared to a pre-Coronavirus testing average ("baseline"). XIFIN analyzed its vast stores of data, representative of four out of five top integrated delivery networks (IDNs) and seven out of the top ten independent laboratories nationwide, to craft the Lab Volume Index.

View Index

COVID-19 Test Billing Updates

With information changing frequently, XIFIN is in daily discussions with each of the major payors, to confirm billing code assignment, any billing specific requirements, and reimbursement information. We will continue to provide live updates as we receive them.

UPDATED Oct 15, 2020 |  CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing

CMS is announcing that starting January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected.  Also effective January 1, 2021, for laboratories that take longer than two days to complete these tests, Medicare will pay a rate of $75. CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment.

Source:  CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing

UPDATED Oct 7, 2020 |  Two New CPT Codes Added for COVID-19 Multi Virus Tests: 87636 and 87637

The CPT Editorial Panel approved two new Category I codes for immediate use, and also revised codes to remove the undefined term "multi step moethod" from code descriptors, and published these changes on Wednesday, October 7, 2020. For a list of the new and revised codes specific to laboratory testing for SARS-CoV-2 and the new and revised parenthetical notes and guidelines to correct and clarify reporting of infectious agent antigen studies, see AMA's CPT Assistance October Update.

For quick reference, the new category I CPT codes and long descriptors are:

87636 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

The CPT Editorial Panel also revised CPT codes ranging from 87301 to 87430 by removing the undefined term “multi step method” from code descriptors. The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. This revision affects the newly developed descriptor for CPT code 87426.

87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

In accordance with the above revision, the CPT Editorial Panel approved a new category I code, 87811, to report infectious agent antigen detection by immunoassay with direct visual observation.

87811 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Source: New CPT codes for multi-virus tests detect COVID-19 and flu

UPDATED Sep 8, 2020 |  Two New CPT Codes Added for COVID-19: 86413 and 99072

The CPT Editorial Panel approved two new Category I codes and expedited the publication of these new codes to the AMA website on Tuesday, September 8, 2020, at https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians These codes are effective immediately.

CPT code 86413: established to report quantitative antibody detection for SARS-CoV-2.

CPT code 99072: established to report additional practice expenses incurred during a Public Health Emergency, including supplies and additional clinical staff time. It represents a new practice expense code specifically intended for use during a declared Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease. This new code is established in response to the significant additional practice expenses related to activities required to safely provide medical services to patients in person during such an emergency over and above those usually included in a medical visit or service. This code should only be reported when the service is rendered in a non-facility place of service (POS) setting, and in an area where it is required to mitigate the transmission of the respiratory disease for which the PHE was declared.

 

 

Aug 10, 2020 |  Four New CPT Codes Added for COVID-19: 86408, 86409, 0225U, 0226U86413 and 99072

The CPT Editorial Panel approved four new codes and expedited the publication of these new codes to the AMA website on Monday, August 10, 2020. These codes are effective immediately.

CPT code 86408 NEUTRALIZING ANTIBODY SARS-COV-2 SCREEN.

CPT code 86409 NEUTRALIZING ANTIBODY SARS-COV-2 TITER

CPT code 0225U NFCT DS DNA&RNA 21 TARGETS SARSCOV-2 AMP PROBE

Code 0226U SUROGAT VIR NEUTRLZJ TST SARSCOV2 ELISA PLSM SRM

For more information: AMA Code Assist August Update

UPDATED Jul 30, 2020 |  CMS Modifies Relaxed Billing Reqts for COVID-19 Laboratory Tests, Adds CPT 87426

During the COVID-19 Public Health Emergency (PHE), CMS relaxed requirements for a limited number of laboratory tests required for a COVID-19 diagnosis. These tests do not require a practitioner order during the PHE. CMS added a new test to this list: CPT 87426 (Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).

Any health care professional authorized under state law may order these tests. Medicare will pay for these tests without a written order from the treating physician or other practitioner:

  • If an order is not written, you do not need to provide the National Provider Identifier (NPI) of the ordering or referring professional on the claim
  • If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

MLN Matters Article on Code 87426

List of Laboratory Tests andf Modified Requirements

Interim Final Rule

July 15, 2020 | Updated 7/17: Hospitals Ordered to Bypass CDC for COVID Data Reporting

The Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and send all Covid-19 patient information to a central database in Washington beginning on Wednesday, July 15, 2020. As stated in a COVID Guidance for Hospital Reporting document posted on the HHS website, "As of July 15, 2020, hospitals should no longer report the Covid-19 information in this document to the National Healthcare Safety Network site." Concerns have been expressed about data transparency, and on July 17, a letter signed by more than 100 organizations was sent to Vice President Pence, Ambassador Birx and Secretary Azar recommending that the administration immediately reverse its decision to bypass the Centers for Disease Control and Prevention (CDC) for data collection.  

Resources:

COVID-19 Guidance for Hospital Reporting and FAQs For Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting

Trump Administration Strips CDC of Control of Coronavirus Data, NYTimes

Jun 26, 2020 |  AMA Unveils New Category I CPT 87426 for COVID-related Antigen Testing

In its announcement, the American Medical Association (AMA) stated that the new code is meant for “use as the industry standard for accurate reporting and tracking of antigen tests using immunofluorescent or immunochromatographic technique for the detection of biomolecules produced by the SAR-CoV-2 virus.” 

Resources:

AMA Announcement

RevCycleIntelligence article with additional background and information about descriptors

Jun 4, 2020 |  HHS Stipulates Additional Reporting of Demographic Data for COVID Testing

New federal guidance released today indicates labs will be required to submit a much broader range of demographic COVID-19 testing data, including age, race, ethnicity, sex, patient zip code, type of test performed and the test's result. By August 1, all labs must be able to submit the new data fields to relevant state and local health departments within 24 hours of the results being determined to help with COVID-19 tracking, contact tracing, supply allocation and research. De-identified data will then be sent to the Centers for Disease Control and Prevention on a daily basis. Labs will not be required to report retroactive data. 

Labs can report through three electronic mechanisms: directly to state and local governments through existing channels, which will then get de-identified data to the CDC; through a centralized platform, such as the Association of Public Health Labs' AIMS platform, which routes the data to appropriate state and local government and the CDC; and through state and regional health information exchanges.

During the briefing, Admiral Brett Giroir, M.D., assistant secretary for health and lead for COVID-19 testing efforts, added that labs (not manufacturers or distributors) that fail to report the required data could face penalties, enforced by the FDA under Emergency Use Authorization. Penalties could take the form of warning letters or fines, or – in extreme cases – imprisonment.

Resources:

Laboratory Data Reporting Guidance

Laboratory Data Reporting FAQ

May 19, 2020 |  CMS Publishes MAC COVID-19 Test Pricing

Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. See the Medicare tab in the Payor Information and Updates section, below.

May 14, 2020 |  OIG Updates its COVID-19 FAQs

FAQs address application of OIG's Administrative Enforcement Authorities to arrangements directly connected to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency.  

https://oig.hhs.gov/coronavirus/authorities-faq.asp

April 30, 2020 | HRSA COVID-19 Uninsured Program Portal Is Now Open

The Health Resources and Services Administration has opened its COVID-19 Uninsured Program Portal, which provides additional information as well as the ability for providers to register.  A recorded webinar is available: Getting Started with the HRSA COVID-19 Uninsured Program 

Please note the program timelines:

•    April 22 – Program Details launch
•    April 27 – Sign up period begins for the program
•    April 29 – On Demand training starts
•    May 6 – Begin submitting claims electronically
•    Mid-May – Begin receiving reimbursement

Program FAQs

April 26, 2020 | CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program 

On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to health care providers and suppliers through these programs and in light of the $175 billion recently appropriated for health care provider relief payments.

CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund

CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-reevaluates-accelerated-payment-program-and-suspends-advance-payment-program

For an updated fact sheet on the Accelerated and Advance Payment Programs, visit:https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

April 15, 2020 | CMS Announces Increased Payments for COVID-19 Testing, Introduces Two New Codes 

Today CMS announced Medicare will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of 2019 Novel Coronavirus (COVID-19) cases. Medicare will pay laboratories for the tests at $100 effective April 14, 2020, through the duration of the COVID-19 national emergency. 

More information can be found on the Medicare tab, below.

CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-increases-medicare-payment-high-production-coronavirus-lab-tests-0

ACLA commentary: https://www.acla.com/cms-takes-decisive-action-to-support-laboratories-responding-to-covid-19-pandemic/

April 13, 2020 | Expanded Coverage Announced for Essential Diagnostic Services for COVID Testing, Including Antibody Testing, and Certain Related Services without Cost Sharing for Enrollees in Private Health Coverage

Specifically, today’s announcement implements the requirement for group health plans and group and individual health insurance to cover both diagnostic testing and certain related items and services provided during a medical visit with no cost sharing. This includes urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. Covered COVID-19 tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, and COVID-19 diagnostic tests developed in and authorized by states. It also ensures that COVID-19 antibody testing will also be covered. 

To see the guidance, visit: https://www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf

April 13, 2020 | AMA CPT Editorial Panel had an emergency meeting on Friday, April 10, 2020, and expedited two new CPT codes for the COVID-19 Antibody Tests
  • 86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19] 

https://www.ama-assn.org/press-center/press-releases/ama-announces-expedited-updates-cpt-covid-19-antibody-tests

AMA also published a Special Edition of the CPT Assistant: SARS-CoV-2 Serologic Laboratory Testing, which provides additional guidance on how to code the two new antibody tests for COVID-19. https://www.ama-assn.org/system/files/2020-04/cpt-assistant-guide-coronavirus-april-2020.pdf 

March 31, 2020 | CMS Releases Waivers for COVID-19

The waivers apply nationwide and are retroactive to March 1, 2020. The American Hospital Association has provided its take and a summary of the waivers, accessible here

COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
Relevant information for laboratories begins on p. 18: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

Waivers regarding the Stark Law
https://www.cms.gov/files/document/covid-19-blanket-waivers-section-1877g.pdf

March 31, 2020 | CMS Issues New HCPC Codes

New Specimen Collection Codes for Laboratories Billing for COVID-19 Testing--see Medicare tab below for details.

May 29, 2020 | Hospital Labs: Report Your Results to FEMA

Vice President Pence sent a letter to hospital administrators requiring laboratories performing testing for SARS-CoV-2 to report their in-house test results in aggregate via an email to FEMA. Hospitals do NOT need to report testing sent to specific commercial labs. See this link for the contents of the letter. You can access the spreadsheet template, here.

Payor Information and Updates

Updated 4/21/20

Payor COVID-19 Billing Guidelines Acceptable CPT Code(s)/HCPCS Code(s)
View Guidelines U0001, U0002, 87635
Click on BCBS tab for info Click on BCBS tab for info

View Guidelines

Diagnostic COVID-19 related laboratory tests (other than COVID-19 test) 

  • For other laboratory tests when COVID-19 may be suspected
  • Cost-share will be waived
  • Paid per contract

U0001, U0002, U0003, U0004, 87635, 86328 , 86769, G2023, G2024

View Guidelines
When testing patients for other viral respiratory conditions to rule out COVID-19, select the most appropriate code for the test performed.

U0001, U0002, 87635

The following CPT codes are accepted for other viral testing to rule out COVID-19:

  • CPT 87804 – Infectious agent antigen detection by immunoassay with direct optical observation; influenza
  • CPT 87633 – Respiratory virus panel [Infectious agent detection by nucleic acid (DNA or RNA)]
  • CPT 87486 – C. pneumoniae [Infectious agent detection by nucleic acid (DNA or RNA)]
  • CPT 87581 – M. pneumonia [Infectious agent detection by nucleic acid (DNA or RNA)]

The applicable COVID-19-related ICD-10 code, or code combination, as appropriate for the date of service, must also be reported on the claim.

View Guidelines

UHC accelerated payments program information can be found here

U0001, U0002, 87635

Updated 5/3/20

Blue Cross Blue Shield State COVID-19 Billing Guidelines Acceptable CPT Code(s)/HCPCS Code(s)
Alabama View Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024
Alaska View Guidelines U0001, U0002, 86328 , 86769, 87635
Arizona View Guidelines U0001, U0002
Arkansas VIew Guidelines 87635
California View Anthem Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
California View Coding Billing Guidelines U0001, U0002, 87635, G2023, G2024
Colorado View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Connecticut View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Delaware View Guidelines U0001, U0002, 87635
District of Columbia View Guidelines U0002, U0003, U0004, 87635
Florida View Guidelines U0002, U0003, U0004, 87635, G2023, G2024
Georgia View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Hawaii View Guidelines U0001, U0002, U0003, U0004, 87635, G2023, G2024
Idaho View Guidelines U0001, U0002, U0003, U0004, 87635, G2023, G2024
Illinois View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635, CS Modifier
Indiana View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Iowa View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635, G2023, G2024, CS Modifier
Kansas

View Nucleic Acid Testing Guidelines

View Specimen Code Info

View Rapid Detection Info

U0001, U0002, U0003, U0004, 87635, G2023, G2024
Kentucky View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Louisiana View Guidelines U0002, 87635
Maine View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Maryland View Guidelines U0002, U0003, U0004, 87635 
Massachusetts View Guidelines U0001, U0002, U0003, U0004, 87635, G2023
Michigan

View Guidelines

View recommendations

View drive through recommendations

U0001, U0002, 87635, G2023, G2024
Minnesota View Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, CS Modifier
Mississippi View Guidelines U0001, U0002, 87635
Missouri View Anthem Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Missouri View Blue KC Guidelines U0001, U0002, 86328 , 86769, 87635
Montana View Guidelines U0001, U0002, 87635
Nebraska Confirmed via Provider Relations call. U0001, U0002, 87635
Nevada View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
New Hampshire View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
New Jersey

View Guidelines

View Modifier Guidelines

U0001, U0002, U0003, U0004,  86328 , 86769, 87635, G2023, G2024, CS Modifier
New Mexico View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635, CS Modifier 
New York View Empire BC Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635
New York View Western NY Guidelines U0001, U0002, 86328, 86769, 87635
New York View Northeastern NY Guidelines U0001, U0002, 86328, 86769, 87635
New York View Excellus Guidelines U0001, U0002, 86328, 86769, 87635 
North Carolina

View Guidelines

View FAQ

 U0002, 86328, 86769, 87635 
North Dakota View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635, G2023, G2024, CS Modifier 
Ohio View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Oklahoma View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635 
Oregon View Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, CS Modifier
Pennsylvania View Capital Blue Guidelines U0001, U0002, 87635, G2023, G2024
Pennsylvania View Highmark HBS Guidelines U0001, U0002, 87635
Pennsylvania View Highmark BCBS Guidelines U0001, U0002, 87635
Pennsylvania View Independence Guidelines U0001, U0002, 87635
Puerto Rico Confirmed via Provider Relations call. U0001, U0002, 87635
Rhode Island View Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, QW Modifier
South Carolina View Guidelines U0001, U0002, 86328, 86769, 87635 
South Dakota View Guidelines U0003, U0004, 86318, 86328, 86769, 87635, G2023, G2024, CS Modifier
Tennessee View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635
Texas View Guidelines U0001, U0002, U0003, U0004, 86318, 86328, 86769, 87635, G2023, G2024, CS Modifier 
Utah View Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, CS Modifier
Vermont View Guidelines U0001, U0002, 87635
Virginia View Anthem VA Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Virginia View Carefirst Guidelines U0002, U0003, U0004, 87635 
Washington View Premera Guidelines U0001, U0002, 86328 , 86769, 87635
Washington View Regence Guidelines U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, CS Modifier
West Virginia View Guidelines U0001, U0002, 87635
Wisconsin View Guidelines U0001, U0002, U0003, U0004,  86328 , 86769, 87635
Wyoming

View Guidelines

View 4-3 update

U0001, U0002, 87635, G2023, G2024

 

October 15, 2020 |CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing

CMS is announcing that starting January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected.  Also effective January 1, 2021, for laboratories that take longer than two days to complete these tests, Medicare will pay a rate of $75. CMS is working to ensure that patients who test positive for the virus are alerted quickly so they can self-isolate and receive medical treatment.

Starting January 1, 2021, the amended Administrative Ruling (CMS 2020-1-R2) will lower the base payment amount for COVID-19 diagnostic tests run on high-throughput technology to $75 in accordance with CMS’s assessment of the resources needed to perform those tests. Also starting January 1, 2021, Medicare will make an additional $25 add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory: a) completes the test in two calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month. Laboratories that complete a majority of COVID-19 diagnostic tests run on high throughput technology within two days will be paid $100 per test by Medicare, while laboratories that take longer will receive $75 per test.  CMS established these requirements to support faster high throughput COVID-19 diagnostic testing and to ensure all patients (not just Medicare patients) benefit from faster testing. These actions will be implemented under the amended Administrative Ruling (CMS-2020-1-R2) and coding instructions for the $25 add-on payment (HCPCS code U0005) released today.

Source: CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing

September 25, 2020 | LCD policies adding COVID-19 codes U0003 and U0004

Two existing policies L37348/A56974 and L37713/A56851, have added the procedure codes U0003 and U0004 with diagnostic codes that limit the covered codes. Published in September, they are retroactively effective to 7/30/2020. 

May 19, 2020 | CMS Publishes Medicare Administrative Contractor (MAC) COVID-19 Test Pricing

Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. The payment amounts are identified below. Source: https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf (published 5-19-20)

Jurisdiction U0001 U0002 U0003 U0004 87635 86769 86328
ALL 12 MAC Jurisdictions $35.91 $51.31 $100.00 $100.00 $51.31 $42.13 $45.23

 

May 7, 2020 | CMS Relaxes Billing Requirements for Laboratory Tests Required for COVID-19 Diagnosis

Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:

  • If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required on the claim
  • If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

List of Laboratory Tests andf Modified Requirements

Interim Final Rule

April 17, 2020 | ACLA obtains clarifications regarding use of new U-code for high throughput COVID-19 diagnostic testing

4/17/20 ACLA obtains clarifications regarding use of new U-code for high throughput COVID-19 diagnostic testing. 

  • The effective date of the CMS Ruling and the codes is April 14, 2020.  It is not retroactive, so reimbursement for claims submitted to date using HCPCS code U0002 will remain $51.
  • A technology that can process more than 200 specimens a day using automatic processing qualifies as a “high-throughput technology,” even if it is used for LDTs and with a manufacturer’s kit, and even if the actual number of tests processed in a given day using the technology is below 200 total (because of low order volume or servicing of the platform).  The technologies included in the Ruling were examples, and there was not an intent to exclude a technology that otherwise would meet the definition.
  • The expectation is that in almost all cases, a lab using a high-throughput technology for COVID-19 testing would use U0003 (used to “identify tests that would otherwise be identified by CPT code 87635 but for being performed with high throughput technologies”).  CMS created U0004 (used to “identify tests that would otherwise be identified by U0002 but for being performed using high throughput technology”) just in case it is needed.
  • CMS does not know how the MACs will monitor the appropriate use of U0003 and U0004.  The expectation is that laboratories already maintain information that would allow them to “connect the dots at the back end” to support the use of U0003 or U0004, if they were subject to an audit.  As usual, it is each laboratory’s responsibility to ensure it codes appropriately.
  • CMS representatives said they do not know what would happen when the public health emergency is terminated and whether the codes (and the higher reimbursement) would “switch off.”
  • CMS is developing FAQs on these codes and will release them soon.
April 15, 2020 | CMS announces increased reimbursement rates for COVID-19 related testing, introduces two new codes

CMS announces new rate of $100 and provided the following guidance for the two newly introduced codes:

CMS's PAYMENT FOR LABORATORY TESTS FOR THE DETECTION OF SARS–COV–2 OR THE DIAGNOSIS OF THE VIRUS THAT CAUSES COVID–19 MAKING USE OF HIGH THROUGHPUT TECHNOLOGIES

CDLTs making use of high throughput technologies (as defined in this Ruling) and administered during the ongoing emergency period defined in paragraph (1)(B) of section 1135(g) of the Act beginning on or after March 18, 2020, for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, are new and involve high throughput machines (which are highly sophisticated equipment) which require more intensive technician training (to ensure the role of extremely skilled personnel) and more time intensive processes (to assure quality). A high throughput technology uses a platform that employs automated processing of more than two hundred specimens a day. Examples of high throughput technology as of April 14, 2020 include but are not limited to technologies marketed on that date as the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System, GeneXpert Infinity System, and NeuMoDx 288 Molecular. This training and these processes represent an increase in resources, bringing the total resources required for these tests to $100 (a more accurate payment than the one currently in use via contractor pricing).

These tests are a type of CDLT currently paid for under 3 CMS-Ruling 2020-1-R Medicare Part B. Specifically, the following codes would identify these tests:

U0003: 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, making use of high throughput technologies as described by CMS-2020-01-R.

U0004: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.

It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies. It is further noted that U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.

Finally, it is noted that neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies. CMS intends to promptly evaluate payment for relevant CDLTs for COVID-19 testing that make use of high throughput technologies developed after this issuance upon request for payment at an appropriate rate.

CONCLUSION With regard to CDLTs that make use of high throughput technologies (as defined in this Ruling), are administered during the ongoing emergency period defined in paragraph (1)(B) of section 1135(g) of the Act beginning on or after March 18, 2020, for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and are a type of CDLT currently paid for under Medicare Part B using CPT code 87635 or U0002, such tests, as identified using U0003 or U0004 as appropriate, shall be paid for at the rate of $100. Payment for all other CDLTs remains at the current level. CMS intends to promptly evaluate payment for relevant CDLTs for COVID-19 testing that make use of high throughput technologies developed after this issuance upon request for payment at an appropriate rate.

Source: https://www.cms.gov/files/document/cms-2020-01-r.pdf

CMS press release: https://www.cms.gov/newsroom/press-releases/cms-increases-medicare-payment-high-production-coronavirus-lab-tests-0

March 31, 2020 | To identify specimen collection for COVID-19 testing, CMS is establishing two new level II HCPCS codes

Independent laboratories must use one of these HCPCS codes when billing Medicare for the nominal specimen collection fee for COVID-19 testing for the duration of the PHE for the COVID-19 pandemic. These new HCPCS codes are: 

  • G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

CMS has stated, "we created the second Level II HCPCS code, G2024, because section 1834A(b)(5) of the Act and our regulations at § 414.507(f) require a higher fee for collecting a specimen from an individual in a SNF or by a laboratory on behalf of an HHA, as described previously in this section of the IFC. We will issue guidance when the PHE for the COVID-19 pandemic is over and when these codes are no longer valid and terminated in the HCPCS file and/or the CLFS as appropriate. In addition, Medicare payment for transportation and expenses for trained personnel to CMS-1744-IFC 99 collect specimens from homebound patients (as discussed in section II.F. of this IFC, relating to the clarification of homebound status under the Medicare home health benefit) and inpatients (not in a hospital) for purposes of COVID-19 testing will be made in accordance with existing instructions found in the Medicare Claims Processing Manual.

"Independent laboratories must use the existing level II HCPCS codes when billing for the travel allowance, that is, the per mile travel allowance as described by HCPCS code P9603 and the flat rate travel allowance as described by HCPCS code P9604. Additionally, we are clarifying that paper documentation of miles traveled is not required and laboratories can maintain electronic logs with that information. However, laboratories will need to be able to produce these electronic logs in a form and manner that can be shared with MACs."

Source: HHS federal register document, Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the
COVID-19 Public Health Emergency
 see definitions of code use on pages 98-99.

Source: cms.gov mln connects special edition 3/31/20

 

States Website Accepted CPT/HCPCS Code(s)
Alabama View Resource U0001, U0002
Alaska View Resource U0001, U0002
Arizona View Resource U0001, U0002, U0003, U0004, 86328, 86769, 87635, G2023, G2024, CR Modifier
Arkansas View Resource U0001, U0002
California

NEW: MediCal Rate Update 10-5-20. Effective for dates of service on or after August 10, 2020, CPT® codes 86408 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; screen) and 86409 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; titer) have updated reimbursement rates.
Additionally, the Department of Health Care Services (DHCS) is establishing the reimbursement rates at 100 percent of the Medicare rate for 86408 and 86409. These codes are exempt from the ten percent payment reductions in Welfare and Institutions Code (W&I Code) Section 14105.192.
Upon expiration of the Public Health Emergency or National Emergency, these rates will be amended to correspond with the clinical laboratory services methodology in W&I Code Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.
Updated rates are Code 86408: $42.13   Code 86409: $79.61

View Resource 

——— 

NEW: Medicaid California is accepting new code 87426, but has not yet published a rate. 

——— 

As of 4/22 Medi-Cal is pricing U0003 and U0004 at 100% of Medicare rate without cuts or reductions View Resource 

View News Release

View Specimen collection info

 

U0001, for providers using the CDC's 2019-nCoV Real-Time RT-PCR Diagnostic Panel test =  $35.91

U0002, for providers performing COVID-19 testing by other techniques, not making use of high throughput technologies as described by CMS-2020-01-R = $51.31

U0003, for providers performing COVID-19 testing by DNA or RNA amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R = $100

U0004, for providers performing COVID-19 testing by other techniques, making use of high throughput technologies as described by CMS-2020-01-R = $100

87635, for providers performing COVID-19 testing by DNA or RNA amplified probe technique, not making use of high throughput technologies as described by CMS-2020-01-R = $51.31

G2023, G2024, QW Modifier

Colorado View Resource U0001, U0002, U0003, U0004, 87635, G2023, G2024
Connecticut View Resource U0001, U0002
Delaware View Resource U0001, U0002
Florida View Resource

U0001, U0002, U0003, U0004, 86328, 86769, 87635

Georgia View Resource U0001, U0002, 87635
Hawaii View Resource U0001, U0002, 87635
Idaho View Resource U0001, U0002, 87635
Illinois View Resource U0001, U0002, U0003, U0004, 87635
Indiana View Resource U0001, U0002, 87635
Iowa

Billing Related to Covid-19

Provider Toolkit

U0001, U0002, 87635
Kansas View Resource U0001, U0002, 87635
Kentucky View Resource U0001, U0002, U0003, U0004, 87635
Louisiana View Resource U0002
Maine View Resource U0001, U0002, 87635
Maryland View Resource U0002, 87635
Massachusetts View Resource U0002, 87635
Michigan View Resource U0001, U0002, 87635
Minnesota View Resource U0001, U0002, 87635
Mississippi View Resource U0001, U0002, U0003, U0004, 87635, G2023, G2024
Missouri View Resource U0001, U0002, U0003, U0004, 87635, G2023, G2024
Montana View Resource U0001, U0002, 87635
Nebraska View Resource U0001, U0002
Nevada View Resource U0001, U0002, 87635
New Hampshire View Resource U0001, U0002, 87635
New Jersey View Resource U0002
New Mexico View Resource U0001, U0002, 87635
New York View Resource U0001, U0002
North Carolina View Resource U0001, U0002, 87635
North Dakota View Resource U0001, U0002, U0003, U0004, 87635
Ohio View Resource U0001, U0002, 87635
Oklahoma View Resource U0001, U0002, U0003, U0004
Oregon View Resource H0001, U0002, 86328, 86769, 87635
Pennsylvania

View Resource

U0001, U0002, U0003, U0004, 86328, 86769, 87635, QW Modifier

Pricing for antibody tests: 

86328 $5.58

86769 $11.16

Rhode Island View Resource U0001, U0002, 87635
South Carolina View Resource U0001, U0002
South Dakota View Resource U0001, U0002, U0003, U0004
Tennessee View Resource U0001, U0002, 87635
Texas View Resource U0001, U0002
Utah View Resource U0001, U0002, 86318, 86328, 86769, 87635
Vermont View Resource U0001, U0002, 87635
Virginia View Resource U0001, U0002
Washington View Resource U0001, U0002
West Virginia

Vew Instructions

View Update

U0001, U0002, 87635, G2023, G2024
Wisconsin View Resource U0001, U0002, 87635
Wyoming View Resource U0001, U0002, U0003, U0004, 87635, G2023, G2024

 

COVID-19 Billing Background

Due to the emergent nature of the public health concern surrounding the novel coronavirus testing, both the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) developed specific billing codes to help increase testing and track new cases.

 On February 13, 2020, CMS developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories to test patients for SARS-CoV-2.  HCPCS code U0001 is used for CDC testing laboratories.  On February 29, 2020, the Food and Drug Administration (FDA) issued a new policy for certain laboratories to develop their own validated COVID-19 diagnostic test.  HCPCS code U0002 was announced on March 5, 2020, which allows these laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).   

 On March 13, 2020, the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel convened in a special meeting and approved a new code to describe the laboratory test for severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2).  Although, not included in the 2020 CPT publication, CPT code 87635 (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; is effective immediately for use to report this test service.  It will be included in the 2021 code set in the Microbiology subsection under the Pathology and Laboratory section of the CPT manual.

CARES Act Loan Programs, Laboratory Impact

On Friday March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act was signed into law. It has many sections, but a few in particular affect diagnostic providers. Click the expander button to see information about Medicare’s accelerated/advanced payments, provider eligibility and process, and also access fact sheets and other resources:

October 8, 2020: CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19

New recoupment terms allow providers and suppliers one additional year to start loan payments.

CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. In addition, the interest rate applied to outstanding balances after 29 months has also been lowered to 4% instead of 10.25%.

For more information:

Webinar: Received COVID-19 Funding? How to Mitigate & Respond to Enforcement Risks and Government Actions

On Wednesday, July 15, law firm Mintz is hosting a webinar about enforcement risks stemming from COVID-19 relief and stimulus funds. The global pandemic has caused many businesses to apply for grants and/or loans or accept and retain federal funds under the CARES Act and other federally funded relief programs. Mintz’s COVID-19 Compliance & Enforcement Defense Task Force will review how to avoid risk and how to address enforcement when it arises. Learn more and register

CARES Act Requires Providers of COVID-19 Testing to Post Test Rates

One CARES act provision of note is the requirement for providers of COVID-19 diagnostic testing to publish the cash price for the test on their website. The requirement appears to last for the duration of the emergency declaration. The requirement also applies to any “provider of diagnostic testing” for the COVID-19 virus and is not limited to clinical laboratories. Test providers who do not publish the cash price for their testing can be subject to imposition of civil monetary penalties of up to $300 per day. 

CARES Act Section 4202

Coronavirus Aid, Relief, and Economic Security (CARES) Act Establishes New Loan Opportunities

Paycheck Protection Program

Businesses with less than 500 employees (full and part time, including broadly defined affiliates), and certain companies with more than 500 employees, are eligible for up to $10 million in loans to cover expenses.  Loan amount is up to 2.5 times the last year’s average monthly payroll costs (with some limitations), with a two year term, 1% annual interest, and six month interest deferral.  No collateral or personal guarantees are required.  Loan forgiveness is equal to the expenditures during the first eight weeks of the loan, reduced by certain reductions in employee pay or workforce.  Only available through June 30, 2020.    

Emergency Injury Disaster Loan Program (EIDL) Grants

Businesses with less than 500 employees (full and part time, including broadly defined affiliates) are eligible for up to $2 million in loans with below market interest rates and up to 30 year terms, with a $10,000 loan advance within 3 days of application. 

Mid-Market Loan Program

The CARES Act authorizes the U.S. Treasury Department to make mid-market loans at no more than 2% interest and a term not longer than 5 years, with limitations on staffing changes, stock buybacks and dividends, and imposes other limitations.  The program has not yet been established, and businesses should monitor the Treasury Department’s website.

CMS has expanded the Accelerated and Advance Payments Program for Providers and Suppliers during the COVID-19 emergency: 

  • A broader group of qualified Part A providers and Part B suppliers are eligible for accelerated or advanced payments
  • Most eligible providers and suppliers can request up to 100% of Medicare payments for a three month period
  • Requests will be processed quickly, with a seven day turnaround goal
  • Repayment over 210 days

https://www.cms.gov/files/document/Accelerated-and-Advanced-Payments-Fact-Sheet.pdf

Additional CARES Act funding can be expected; health care businesses should monitor the HHS and Treasury Department websites for further announcements and prepare by documenting losses arising from COVID-19 circumstances. 

The CARES Act also provides a number of tax benefits for eligible employers:

Retention credit for employees retained but not working because of the coronavirus Section 2301
Deferment of certain social security payments due on wages through 2020 Section 2302
Modification to net operating losses for prior years Section 2303
AMT revisions Section 2305
Increased deductions for certain business interest charges Section 2306
Bonus depreciation for certain real estate improvements Section 2307
Advance refunding of certain credits for paid sick time and leave Section 3605
Provider Emergency Relief Fund

NEW 10-6-20: Phase 3 Provider Relief Funding — $20 billion in new funding for providers on the front lines of the coronavirus pandemic.

Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

Providers can begin applying for funds on Monday, October 5, 2020.

Payment Methodology – Apply Early

All eligible providers will be considered for payment against the below criteria.

  1. All provider submissions will be reviewed to confirm they have received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue from prior general distributions. Applicants that have not yet received Relief Fund payments of 2 percent of patient revenue will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
  2. With the remaining balance of the $20 billion budget, HRSA will then calculate an equitable add-on payment that considers the following:
    • A provider’s change in operating revenues from patient care
    • A provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus
    • Payments already received through prior Provider Relief Fund distributions.

We know providers want to receive payments shortly after submitting their information. However, this distribution requires cooperation on the part of all applicants. Again, HHS is urging all eligible providers to apply early; do not wait until the last day or week of the application period. Applying early will help to expedite HHS’s review process and payment calculations, and ultimately accelerate the distribution of all payments.

All payment recipients will be required to attest to receiving the Phase 3 General Distribution payment and accept the associated Terms and Conditions.

Application Deadline

Providers will have from October 5, 2020 through November 6, 2020 to apply for Phase 3 General Distribution funding. HHS’s top priority is ensuring as many providers possible have an opportunity to apply. HHS will continue to host webinars to assist providers through the application process and the call center is also available to address questions.

HHS recognizes the multifaceted challenges of this pandemic cannot be won without frontline healthcare providers focused on containing the virus and delivering holistic care. Funding for this Phase 3 General Distribution was made possible through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers.

For updates and to learn more, visit:https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html.

Provider Emergency Relief Fund: Immediate infusion of $30 billion into healthcare system https://www.hhs.gov/provider-relief/index.html

Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for the initial $30B rapid distribution.

  • Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
    • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
  • As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
  • This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
  • If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

How are payment distributions determined

  • Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
  • A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
  • As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
    • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

What to do if you are an eligible provider

  • HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.
  • Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
    • The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
    • Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
  • Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.
  • HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions - PDF, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed.  Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?

Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. 

Priorities for the remaining $70 billion

Targeted distributions are being worked on that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.

Other CARES Act Sections Relevant to Laboratories and Diagnostics Providers

Section 3709 - Increasing Provider Funding through Immediate Medicare Sequester Relief

  • This section provides prompt economic assistance to health care providers on the front lines fighting the COVID-19 virus, helping them to furnish needed care to affected patients. Specifically, this sectionwould temporarily lifts the Medicare sequester, which reduces payments to providers by 2%, from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care. The Medicare sequester will be extended by one year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.

Section 3716 - Clarification Regarding Uninsured Individuals

  • This section clarifies a section of the Families First Coronavirus Response Act of 2020 (Public Law 116-127) by ensuring that uninsured individuals can receive a COVID-19 test and related service with no cost-sharing in any state Medicaid program that elects to offer such enrollment option.

Section 3717 - Clarification Regarding Coverage of Tests

  • This section clarifies a section of the Families First Coronavirus Response Act of 2020 (Public Law 116-127) by ensuring that beneficiaries can receive all tests for COVID-19 in Medicare Part B with no cost-sharing.

Section 3718 - Preventing Medicare Clinical Laboratory Test Payment Reduction

  • This section prevents scheduled reductions in Medicare payments for clinical diagnostic laboratory tests furnished to beneficiaries in 2021. It also delays by one year the upcoming reporting period during which laboratories are required to report private payor (PAMA) data.

You can see the full Bill, here.

CMS has issued a Fact Sheet with more information: Expansion of the Accelerated and Advance Payments Program for Providers and suppliers During COVID-19 Emergency 

The American Clinical Laboratory Association (ACLA) has issued a statement criticizing the Act's failure to assure fair reimbursement for testing efforts. You can read it and related statements on the association's COVID response efforts page.

COVID-19 Billing Resources and Updates


CPT Coding Guidance and SARS-CoV-2 Test Reporting

ICD-10 coding for
COVID-19 FAQ

Medicare Administrative Contractor (MAC) COVID-19 Test Pricing

Health Insurance Providers Respond to Coronavirus

Testing Resources, Lab Collaboration Info, and Advocacy Updates

Testing Resources for
COVID-19

Additional Laboratory Resources


COVID-19 Tracking Project Testing Data by State

Private Sector Collaboration and Resources

Interim Guidance and Resources for Laboratory Professionals

COVID-19 Testing Volumes and Advocacy Efforts

COVID-19 Business Intelligence, Briefings, and Analysis

Federal Funding Available for Labs Developing COVID-Related Tests

Supplies Needed for COVID-19 Testing

XIFIN is organizing a "Call For Action" to laboratories that are not performing COVID-19 testing who may have extra inventory of specimen collection swabs and transport media, and who are willing to sell them to laboratories that need them. Click to see the full list of needed supplies and direct contact information.

Learn More

COVID-19: Steps XIFIN Is Taking

With the Coronavirus Disease 2019 (COVID-19) continuing its spread around the world, we at XIFIN recognize the responsibility we have to our employees, customers, and partners during this critical time. The health and well-being of our team, our clients, and our clients’ employees are of the utmost importance to us.

As a critical partner to your business, we understand that limiting the impact of this health event on our service is imperative. We are keenly focused on our business continuity planning efforts to maintain a safe work environment for our associates and to sustain our business operations.

Security and safety are integral to our products, business processes, and infrastructure. We have a robust, global, integrated Business Continuity Program in place that is managed by a dedicated team of experts who are working hard to keep our operations running smoothly so that we can provide you with the best possible service.

As such, we have activated our Business Continuity Plan, which includes:

  • Enabling work from home capabilities
  • Deploying a global strategy to coordinate the delivery of services and support to our clients
  • Providing our teams with information and best practices to prevent the spread of any illness
  • Coordinating global and local communications with our employees, clients, and partners
  • Limiting all non-essential business travel
  • Initiated voluntary employee testing

XIFIN has initiated its own employer-testing protocol for employees who have been deemed essential personnel. Partnering with a leading California laboratory and XIFIN’s health insurer, voluntary testing was offered to XIFIN employees by physician order. With plans in place to maintain a routine COVID-19 and antibody testing program for its employees, XIFIN’s framework can act as a model to enable the type of monitoring that will maintain employee and public confidence.

We will continue to monitor this fluid situation and will shift workloads as necessary to do what we can to ensure essential services remain fully operative. XIFIN has demonstrated support to our clients in past emergency situations, and in dealing with the present circumstances, we remain unwavering in our efforts to deliver essential services to all our clients. We are keeping those directly affected by this virus in our thoughts, and send our best wishes for health and safety.