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COVID-19 Testing Billing Guidance

Date: 03/17/20

Heritage Health (Medicaid):

Nebraska Total Care is closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 testing.

HCPCS Codes for COVID-19 Testing Services

Starting April 1st, 2020, providers performing the COVID-19 test can begin billing Nebraska Total Care for services that occurred after February 4, 2020, using the following newly created HCPCS codes:

o   U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.

o   U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.

o   Code (87635) effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”

Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.

  • All cost share (co-pay, coinsurance, and deductible) will be waived across all products for any claim billed with the new COVID-19 testing codes.
  • Nebraska Total Care has configured its systems to apply $0 member liability for those claims submitted utilizing these new COVID-19 testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • Adjudication of claims is currently planned for the first week of April 2020.

Reimbursement Rates for COVID-19 Testing Services for All Provider Types

Nebraska Total Care is complying with the rates published on 3/12/20 by CMS:

o   U0001 = $35.91

o   U0002 = $51.31

Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.