SPECIAL BULLETIN COVID-19 #155: Laboratory Codes for COVID-19 Testing

NOTE: This Bulletin has been updated regarding Lab Code 87428 in SPECIAL BULLETIN COVID-19 #158. 

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

Please note, effective Jan. 1, 2021, tests U0003 and U0004 will be reimbursed at $75 when not completed within two calendar days of the specimen being collected. A new add-on payment of $25 as identified by HCPCS code U0005 may be billed with either HCPCS code U0003 or U0004 when the applicable test is completed within two calendar days of the specimen being collected.

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

Effective March 13, 2020

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

Effective Aug. 10, 2020

• 86408 - Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]); screen
• 86409 - Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); titer
• 0225U - ePlex® Respiratory Pathogen Panel 2, GenMark Dx, GenMark Diagnostics, Inc Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
• 0226U - Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum PCR/Antigen Testing.

Effective Oct. 6, 2020

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

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

0240U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected

0241U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected

Effective Nov. 1, 2020

U0005 - 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 of specimen collection (list separately in addition to either HCPCS code U0003 or U0004)

Effective Nov. 10, 2020

NOTE: This Bulletin has been updated regarding Lab Code 87428 in SPECIAL BULLETIN COVID-19 #158. 
87428 - Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19])

Providers should regularly check NC Medicaid COVID-19 webpage for the most up-to-date information and resources.

CONTACT

NCTracks Contact Center: 800-688-6696