Operational

and Billing

People checking notes

Guidelines and codes for COVID-19 diagnostic testing.

Will Capital BlueCross cover COVID-19 diagnostic testing?

Yes. COVID-19 diagnostic testing that is consistent with the Centers for Disease Control and Prevention (CDC) guidelines and the related visit will be covered in full with no member cost share.

We are also waiving prior authorizations for diagnostic tests and related services consistent with CDC guidance. Please verify eligibility prior to providing services. Any treatment and related services needed once diagnosis of COVID-19 has occurred will be covered consistent with the provisions of the member’s health benefits.

What codes should we use to bill diagnostic testing for COVID-19?

CMS has developed two Healthcare Common Procedure Coding System (HCPCS) codes that the Medicare claims processing systems will be able to accept starting on April 1, 2020, for dates of service on or after February 4, 2020. Capital BlueCross is ready to accept these codes.

  • U0001 - used to bill for tests, tracks new cases of the virus, and is to be used specifically for CDC testing laboratories to test patients for SARS-CoV-2.
  • U0002 - allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID 19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers.
  • 87635 - similar to U0002, the American Medical Association (AMA) created this new Category I code effective 3/13/20 for reporting the novel coronavirus tests: 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.
  • 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 technique, making use of high throughput technologies as described by CMS-2020-01-R. (test dates on or after 4/14)
  • 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 as described by CMS-2020-01-R. (test dates on or after 4/14)

There are two new codes that have been issued for COVID-19 specimen collection. Capital BlueCross in the process of implementing these codes as well as a Medicare set payment for them.

  • 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 skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

When submitting diagnostic tests to Capital BlueCross, please use the newly-created codes.

What are the reimbursement rates for diagnostic testing?

U0001 = $35.92 (test dates on or after 2/4)

U0002 = $51.33 (test dates on or after 2/4)

U0003 = $100.00 (test dates on or after 4/14)

U0004 = $100.00 (test dates on or after 4/14)

87635 = $51.33 (test dates on or after 3/13)

G2023 = $23.46 (test dates on or after 3/1)

G2024 = $25.46 (test dates on or after 3/1)

If the patient is seen by a provider for an office visit and during the visit the provider orders the test for COVID-19, are both services waived of copays?

We are waiving member cost share (copay, coinsurance, and deductible) for the COVID-19 diagnostic testing consistent with the Center for Disease Control and Prevention (CDC) guidelines. We are waiving member cost share for the visit associated with the COVID-19 test whether in an office, emergency room, telehealth, or urgent care.

How is Capital BlueCross handling providers adding additional staff and/or redeployment of existing resources that may be necessary to handle added patient volumes?

Capital BlueCross recognizes that, during the COVID-19 crisis, additional staffing and/or redeployment of existing resources may be necessary to handle added patient volumes.

Until further notice, Capital BlueCross will allow providers to use the Locum Tenens billing guidelines for either:

  • Using a substitute physician who is not contracted with Capital BlueCross for reciprocal billing arrangements when a patient’s regular physician is unable to provide services.
  • Using a substitute physician who is contracted with Capital BlueCross but is providing services in another location not currently loaded into our claims adjudication system.

Using a substitute physician who is contracted with Capital BlueCross but is providing services in another location not currently loaded into our claims adjudication system.

In addition, Capital BlueCross will also allow contracted providers to bill with the current provider record on file, instead of the actual place of service rendered, if this reduces the billing providers’ administrative burden.

The Referral Entry screen will not accept place of service 02. How should this be handled?

Submit the referral request as you normally would, making sure the provider information is accurate. Do not select place of service 02.