For more member-focused information, view our What to know about the COVID-19 vaccine page. The swab and the submission of the coronavirus test is included in the evaluation and management code. To better understand the procedures and protocols we follow to help to ensure your privacy, please review the following information: ” Indicates an Add-On Code to be reported with primary service/base code. Laboratory receives physician order and patient specimen for testing, Laboratory performs testing and reports test results. Shared Decision-Making Program – Say Y.E.S. ], [Tim Kaja, Chief Operating Officer, UnitedHealthcare Networks]. <> This billing requirement and associated reimbursement applies to claims submitted on CMS 1500 claims forms, UB04 or electronic equivalent only. For dates of service on or after Sept. 8, 2020, UnitedHealthcare will accept CPT 99072: Use code 99072 when reporting services that include additional supplies and clinical staff time, above those usually included in an office visit or other non-facility service(s), to perform described safety protocols during a national public health emergency period due to respiratory-transmitted infectious … UnitedHealthcare will require the use of a 'GP' modifier for all billed physical medicine services effective 04/01/2020. CPT codes are five digit numeric codes describing everything from surgery to radiology to psychotherapy. Let us know how we’re doing. These new codes will effectively replace HCPCS code G0515, which will be deleted, effective January 1, 2020. Tim Kaja – How Practices Bill Detailed Video Transcript, [Covid-19 Provider Update: Office Billing for Initial Coronavirus Test], [How should practices bill for the Coronavirus (COVID-19) office visits?]. You may recall that UHC had planned to implement this policy for their Community Based health plans only; however, we have confirmed that United will be requiring the use of the GP modifier for all lines of business (including Optum plans). Patient presents for an office visit, urgent care visit or emergency room visit. Blood pressure codes for use when patient is self-reporting. 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We had an opportunity to confer with the American Medical Association, their CPT experts, and the Federation of Medicine a short while ago. 1 0 obj Benefit enhancements for Maryland dual special needs plan (DSNP), Fourth Quarter 2020 Preferred Drug List Update, Managing Appointment Times and Member Expectations, Radiology and Cardiology Prior Authorization Requests. Use CPT code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2). Telehealth and virtual visit providers can order a COVID-19 antibody test. UHC will deny any submitted claims for clinical and pathology testing that do not contain the laboratory’s unique test code. ICD DX: Z03.818 – Suspected exposure to COVID-19 or ICD Dx: Z20.828 – Exposure to confirmed case of COVID-19 or DX: Z20.822 – Contact with and (suspected) exposure to COVID-19. Good for you. If the patient has only been suspected of having contact with someone with coronavirus, go with ICD-10 code Z03.818. HCPCS U0001: This code is used for the laboratory test developed by the CDC. W�S�0�١��?W���=�9=�����8��K5�B.��߆�Z� �0�J�A�h�@�n�=�9�J��,Myr���ήF�u,X�i��. We will also accept the following HCPCS codes for COVID-19 testing performed for dates of service listed below, as outlined by the Centers for Medicare & Medicaid Services (CMS): *Effective dates of codes were determined by reference to CMS Ruling No. Maternity Support for UnitedHealthcare Community Plan Members, Home Health and Hospice Telehealth Services, Physical Health, Occupational and Speech Therapy Telehealth, COVID-19 Treatment and Cost Share Guidance, Accumulator Adjustment – Medical Benefit Program Delay, Arizona, Missouri and Pennsylvania Care Provider Manuals Update, Avoid Billing Issues – Laboratory Services, Avoid Denial of National Drug Code (NDC) Claims, Billing for Off-Label or Unproven Indication, Breast Pump Coverage for GEHA Benefit Plans, CDC Best Practices for Your Fight Against the Flu, Clarification: Prior Authorization and Site of Service Review, Colorado - You’re Invited. endobj CPT® is a registered trademark of the American Medical Association. Comments: Deleted code as of Jan. 1, 2020 (Use 78803 effective Jan. 1, 2020) Code: 78647. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM diagnosis codes. In this case, for how to bill for the coronavirus when the patient presents in an in-office setting. Let’s start with the little guys: 99473 & 99474. This applies to all Medicare Advantage, Medicaid and Individual and Group Market health plans. ����Kڢd�YFR[� +$-���sϥ=y�P-����};yWU�즜�����w_&������b�\�r��\� �4�>�@V����p09�$���:pX�'��L�S�*ry�>\�d�h�2M�I Current Procedural Terminology, more commonly known as CPT®, refers to a medical code set created and maintained by the American Medical Association — and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Physician/practice staff collect nasal specimen for COVID-19 testing OR physician/practice staff oversees FDA-approved self-administered collection. The ICD-10 codes submitted are consistent with the reason why the patient visited the physician and the diagnosis but also includes whether or not the patient had previous confirmed exposure to coronavirus, or only suspected exposure to someone with coronavirus. ©2021 United HealthCare Services, Inc. Careers - Opens in a new window. UHC3/14/2020 thru 4/30/2020, may be extended UHC Provider Telehealth Policies March 14, 2020 (1) Codes recognized by CMS and appended with modifiers GT or GQ (2) Codes recognized by the AMA included in Appendix P of CPT® and appended with modifier 95 for Commercial plans Our commercial and Medicare Advantage plans currently reimburse for “virtual check-in” patients to … 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 [COVID-19]), 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), Use code 99072 when reporting services that include additional supplies and clinical staff time, above those usually included in an office visit or other non-facility service(s), to perform described safety protocols during a national public health emergency period due to respiratory-transmitted infectious disease. Not sure if it has something to do with the diagnosis or a missing modifier. This code is used when billing for independent laboratories when specimens are collected from patients in skilled nursing facilities (SNF) and specimens collected on behalf of home health agencies (HHA). Details: The evaluation and management category has a number of 2020 CPT code changes, some small and some large. Crosswalk for 2020 Health ehavior Assessment and Intervention CPT® Codes. 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