New CPT Code Available for Reporting and Tracking COVID-19

By David White

March 16, 2020

A new CPT® code, 87635, has been released for immediate use for novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States.  The code became effective Friday, March 13, 2020, for reporting of novel coronavirus tests across the entire healthcare system. Because of the immediate release and use of the code, clinicians will need to manually upload this code descriptor into their electronic health record (EHR) system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year in the Microbiology subsection of the Pathology and Laboratory section.

The American Medical Association (AMA) Current Procedural Terminology (CPT®) Editorial Panel convened a special meeting on March 13 and approved the new CPT code to describe laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes COVID-19. The new CPT code is on the AMA website.

For Medicare claims, the Centers for Medicare & Medicaid Services (CMS) has established two new Healthcare Common Procedure Coding System (HCPCS) codes for coronavirus testing. HCPCS code U0001 is specifically for CDC testing laboratories to test patients for SARS-CoV-2 and to track new cases of the virus. HCPCS code U0002 is intended for laboratories to report non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

While code 87635 is available effective immediately in the CPT code set and became active March 13, clinicians should contact their third-party payer to determine their guidelines regarding retroactive billing and reimbursement. Some individuals have asked if they should use CPT code 87635, a HCPCS Level II code, or both when reporting the test for COVID-19. The short answer is that CPT and HCPCS codes should not both be reported on the same claim. The longer answer is that the appropriate code to be reported is dependent upon the payer. If the claim is submitted to a payer that requires CPT codes, then code 87635 should be reported. Conversely, if the payer requires use of the HCPCS Level II code, the HCPCS Level II code should be reported.

Some ASN members have also asked the difference between the new code 87635 and the other CPT codes that state coronavirus in their descriptor (such as 87631, 87632, 87633, 0098U, 0099U, 0100U). The existing codes 87631, 87632, and 87633 are used for nucleic acid assays that detect multiple respiratory viruses in a multiplex reaction (such as single procedure with multiple results). Similarly, proprietary laboratory analyses (PLA) codes 0098U, 0099U, and 0100U are used to identify multiple types or subtypes of respiratory pathogens. In contrast, code 87635 is for the detection of SARS-CoV-2 (COVID-19) and any pan-coronavirus types or subtypes using an amplified probe technique.

Further guidance from CMS on the reporting of HCPCS Level II codes is available at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.

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David White
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A new CPT® code, 87635, has been released for immediate use for novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States.  The code became effective Friday, March 13, 2020, for reporting of novel coronavirus tests across the entire healthcare system. Because of the immediate release and use of the code, clinicians will need to manually upload this code descriptor into their electronic health record (EHR) system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year in the Microbiology subsection of the Pathology and Laboratory section.

The American Medical Association (AMA) Current Procedural Terminology (CPT®) Editorial Panel convened a special meeting on March 13 and approved the new CPT code to describe laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes COVID-19. The new CPT code is on the AMA website.

For Medicare claims, the Centers for Medicare & Medicaid Services (CMS) has established two new Healthcare Common Procedure Coding System (HCPCS) codes for coronavirus testing. HCPCS code U0001 is specifically for CDC testing laboratories to test patients for SARS-CoV-2 and to track new cases of the virus. HCPCS code U0002 is intended for laboratories to report non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

While code 87635 is available effective immediately in the CPT code set and became active March 13, clinicians should contact their third-party payer to determine their guidelines regarding retroactive billing and reimbursement. Some individuals have asked if they should use CPT code 87635, a HCPCS Level II code, or both when reporting the test for COVID-19. The short answer is that CPT and HCPCS codes should not both be reported on the same claim. The longer answer is that the appropriate code to be reported is dependent upon the payer. If the claim is submitted to a payer that requires CPT codes, then code 87635 should be reported. Conversely, if the payer requires use of the HCPCS Level II code, the HCPCS Level II code should be reported.

Some ASN members have also asked the difference between the new code 87635 and the other CPT codes that state coronavirus in their descriptor (such as 87631, 87632, 87633, 0098U, 0099U, 0100U). The existing codes 87631, 87632, and 87633 are used for nucleic acid assays that detect multiple respiratory viruses in a multiplex reaction (such as single procedure with multiple results). Similarly, proprietary laboratory analyses (PLA) codes 0098U, 0099U, and 0100U are used to identify multiple types or subtypes of respiratory pathogens. In contrast, code 87635 is for the detection of SARS-CoV-2 (COVID-19) and any pan-coronavirus types or subtypes using an amplified probe technique.

Further guidance from CMS on the reporting of HCPCS Level II codes is available at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.

Date:
Monday, March 16, 2020