How to Bill for Medicare Add-On Payment for COVID-19 Diagnostic Tests

What you need to know to maximize reimbursement

Starting January 1, 2021, Medicare will pay $100 to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen collection date—which includes an additional $25 add-on payment per test—in an effort to ensure patients are informed of results faster.

However, this add-on payment will not be automatic. You will need to bill for the additional $25 using HCPCS code U0005. The base payment for these tests (using codes U0003 and U0004) will be lowered to $75, effective January 1, 2021.

At Quadax, our team of laboratory billing experts is here to help. We remain in lockstep with our clients and understand and manage the changing dynamics within laboratory billing so you can focus on delivering exceptional clinical outcomes for your physicians and patients.

Here are some things you need to know when billing for these tests being performed using high throughput technology (i.e., a platform that employs automated processing of more than two hundred specimens a day).

HCPCS Code U0005 for Additional $25 Add-On Payment:

Labs need to use the HCPCS code U0005 beginning on January 1, 2021 to receive the additional $25 payment per test. This code should be billed on the same claim as either HCPCS codes U0003 or U0004 when appropriate.

When To Use HCPCS Code U0005 Defined:

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 2 calendar days from date and time of specimen collection.

Labs should only bill Medicare for U0005 if these two requirements are met:

1. 1. They completed the COVID-19 CDLT in 2 calendar days or less from the date of specimen collection, meaning results must finalized and ready for release.

1. 2. The majority of their COVID-19 CDLTs performed using high throughput technology in the previous calendar month were completed in 2 calendar days or less for all of their patients (not just their Medicare patients).

In order to determine the second requirement, labs need to assess their COVID-19 timeliness in the month prior to the month identified by the line date of service for the corresponding CDLT represented by HCPCS code U0003 or U0004.

CMS provided the following example:

A laboratory is submitting a claim to Medicare for a CDLT performed on high throughput technology using HCPCS code U0003 with a line date of service of May 15, 2021. The laboratory would assess its performance based on those CDLTs completed during the calendar month (April 1, 2021 – April 30, 2021) that precedes the month identified by the CDLT line date of service (May 2021). If the laboratory completed a total of 1,000 of the same CDLTs using high throughput technology (including all tests from non-Medicare patients) in April, and 490 had been completed within 2 calendar days of the specimen being collected, the laboratory would have a 49% test timeliness completion rate and may not bill for the $25 add-on payment represented by HCPCS code U0005.

These CMS FAQs provide more in-depth information about COVID-19 billing.

Quadax’s greatest strength is our experience around implementation and ongoing support given our extensive history of meeting a variety of billing, reimbursement and industry challenges—while you focus on delivering essential diagnostic health information to patients and providers. Contact us today to help you find a solution to ensure compliance with this new requirement and maximize your reimbursement.

Let’s take on the revenue cycle together!