ClaimsXten™ Solutions and COVID-19

The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) created new procedure codes and a diagnosis code to respond to COVID-19. The following information applies to ClaimsXten Solutions, which include ClaimsXten and ClaimsXten Select, and pertains to the new procedure codes and diagnosis code. It is designed to help our customers more effectively document and track claims associated with this critical healthcare issue.

New CMS and AMA Procedure and Diagnosis Codes

CMS: CMS developed the HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).  These codes are effective 02/04/2020 and are now available in Content Manager category VALID_PROC for the PROC_INVALID rule.  Additionally, CMS created one new diagnosis code U07.1. This code is currently available in Content Manager category VALID_DIAG_ICD_10 for the DIAG_INVALID_ICD10 rule.

AMA: CPT released code 87635 on March 13, 2020.  This Category I Pathology and Laboratory code is to report the testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]). The code is effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s healthcare system.

This code is being added to Content Manager category VALID_PROC for the PROC_INVALID rule and is available as of March 19.

Editing: The new CPT and HCPCS codes will be edited for once per day testing frequency.  Additional edits will not be added at this time. Procedure codes U0001, U0002, and 87635 will pend for review if submitted more than once per date of service.

Should there be any additional information, an update will be provided in the ClaimsXten 2Q 2020 quarterly summary of updates communication.

Code Description
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
U0001 CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL
U0002 2019-NCOV CORONAVIRUS, SARS-COV-2/2019-NCOV (COVID-19), ANY TECHNIQUE, MULTIPLE TYPES OR SUBTYPES (INCLUDES ALL TARGETS), NON-CDC
U07.1 2019-NCOV ACUTE RESPIRATORY DISEASE

4/20/2020
CMS Guidance Related to NCD/LCD Policies 

ClaimsXten™ and ClaimsXten™ Select customers who use the National and Local Coverage Determinations (NCD/LCD) KnowledgePack will want to review the latest CMS guidance on these policies. Download the announcement to see which NCD and LCD updates will be provided in the upcoming Content Manager release.

4/13/2020
COVID-19 Updates to MUE and PTP Files

On April 8, CMS updated the Practitioner and Outpatient Medically Unlikely Edits (MUE) files, as well as the National Correct Coding Initiatives (NCCI) quarterly procedure-to-procedure (PTP) files for practitioner and outpatient hospitals. This document provides information about the impact of these replacement files on ClaimsXten rules, as well as information about an impending Content Manager release designed to address the changes.

4/8/2020
COVID-19 CPT Codes and Telephone Services

This document is a detailed list of CPT codes that were recently revised by CMS and which became effective on March 1, 2020. Download the list of codes and physician fee schedule status indicator changes.


Contact Information

For additional information or questions, log onto the Customer Hub and submit a case to Product Support. Product support is also available by email at cacd.support@changehealthcare.com or by phone at 1-888-474-4262.