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:
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Effective June 1, 2020 |
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U0001 |
2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel – CDC |
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U0002 |
2019 Novel Coronavirus Test – Non-CDC |
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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 |
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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 |
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C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
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G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source |
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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. |
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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]) |
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86769 |
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
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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. |
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Effective Aug. 10, 2020 |
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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 |
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0226U |
Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum PCR/Antigen Testing |
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86408 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen |
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86409 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); titer |
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Effective Sept. 1, 2020 |
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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]) |
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Effective Oct. 6, 2020 |
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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 |
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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 |
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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 |
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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 |
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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]) |
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Effective Nov. 10, 2020 |
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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] |
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Effective Jan. 1, 2021 |
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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) |
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Office Visit and Collection Services Payable with Lab Testing Codes |
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99211 |
Practitioner to use for specimen collection |
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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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