SPECIAL BULLETIN COVID-19 #156: Clinical Policy 1E-7, Family Planning Services, COVID-19 Lab Testing for MAFDN Beneficiaries

Monday, February 15, 2021

Effective June 1, 2020, NC Medicaid began reimbursing COVID-19 testing for “Be Smart” Family Planning (MAFDN) beneficiaries through the NC Medicaid Optional COVID-19 Testing (MCV) Program.

NC Medicaid is adding the following codes into NC Tracks for lab testing coverage for MAFDN beneficiaries with retroactive effective dates as follows: 

Effective June 1, 2020

U0001

2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel – CDC

U0002

2019 Novel Coronavirus Test – Non-CDC

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

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

C9803

Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.

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])

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

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

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

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

Effective Sept. 1, 2020

87426

Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19])

Effective Oct. 6, 2020

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

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

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])

   

Effective Nov. 10, 2020

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]) and influenza virus types A and B]

Effective Jan. 1, 2021

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)

Office Visit and Collection Services Payable with Lab Testing Codes

99211

Practitioner to use for specimen collection

36415

Collection of venous blood by venipuncture

Note:  Outpatient hospital claims billed with the above lab testing codes require an FP modifier to be submitted with the code. With the exception of hospital outpatient claims, the FP modifier should not be billed on the claim.

One of the following ICD-10-CM diagnosis codes should be billed in conjunction with the MAFDN approved CPT codes above.

  • U07.1 - 2019-nCoV Acute Respiratory Disease
  • Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
  • Z11.52 - Encounter for screening for COVID-19
  • Z11.59 - Encounter for screening for other viral diseases
  • Z20.822 - Contact with and (suspected) exposure to COVID-19
  • Z20.828 - Contact with and (suspected) exposure to other viral communicable diseases
  • Z86.16 - Personal history of COVID-19


System Updates for Claims Denials

NC Medicaid is aware of claim denials that providers have been receiving for COVID-19 lab testing for MAFDN beneficiaries. System updates are now in place to correct the issues causing these denials.

Providers who have received denials should now resubmit their claims for reprocessing following the guidelines in this bulletin.

CONTACT

NCTracks Contact Center: 800-688-6696

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