SPECIAL BULLETIN COVID-19 #102: Laboratory Codes for Coronavirus (COVID-19) Testing

Monday, June 22, 2020

The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association have announced the release of several new codes to report testing for active cases of Coronavirus (COVID-19) as well as detection of antibodies.   

NC Medicaid is adding the following codes into NCTracks to report medically necessary laboratory testing with retroactive effective dates as follows: 

  • C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source (Effective March 1, 2020)
  • 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, making use of high throughput technologies (Effective March 18, 2020)
  • 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 (Effective March 18, 2020)
  • 86328 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]) (Effective April 10, 2020)
  • 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (Effective April 10, 2020)

NC Medicaid covers serologic antibody testing when it meets medical necessity criteria in the following situations:

  • Serologic testing can be offered as a method to support diagnosis of acute COVID-19 illness for persons who present late, defined as persons who present 9-14 days after illness onset when serologic testing can be offered in addition to recommended direct detection methods such as polymerase chain reaction. This will maximize sensitivity as the sensitivity of nucleic acid detection is decreasing and serologic testing is increasing during this time period.
  • Serologic testing can be offered as a method to help establish a diagnosis when patients present with late complications of COVID-19 illness, such as multisystem inflammatory syndrome in children.

Contact

NCTracks Contact Center: 800-688-6696