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.


COVID-19 new Proprietary Laboratory Analysis (PLA) code for COVID-19 testing

American Medical Association (AMA) released a new PLA code––00202U––used to report infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.

The PROC_INVALID and PROC_SINGLE_DOS rules will be updated to include code 0202U, effective May 20, 2020 per AMA. 

May 2020 Local Coverage Determination (LCD) Release:

The following information applies to ClaimsXten Solutions customers who license the LCD_MED_NEC and LCD_PXDX_FREQ_MULTIDX rules in the National Coverage Determinations, Local Coverage Determinations KnowledgePack.

A Content Manager release will occur Tuesday evening, May 26, 2020 at 6 p.m. EST for these updates. The tentative Content Manager release number is 224.0.

Contact Information For additional information or questions, log in to the Customer Hub and submit a case to Product Support.


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.


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.


DME MACs and CMS COVID-19 Updates

This notification is to inform you of recent published information from the DME MACs and CMS as it pertains to DME claims. It also contains an outline of previously published notifications to help consolidate all COVID-19 items into one reference guide.

Publication from CMS: Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19

Patients Over Paperwork

  • Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable, DME Medicare Administrative Contractors have the flexibility to waive replacements requirements under Medicare such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.
  • Prior Authorization in DMEPOS: CMS is pausing the national Medicare Prior Authorization program for certain DMEPOS items. (CGS DME MAC references this pertains to certain power mobility devices (PMDs) and pressure reducing support surfaces (PRSS).)
  • DMEPOS Accreditation: CMS is not requiring accreditation for newly enrolling DMEPOS and extending any expiring supplier accreditation for a 90-day time period.
  • Signature Requirements: CMS is waiving signature and proof of delivery requirements for Part B drugs and Durable Medical Equipment when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.


Following a recent Webinar hosted by both DME MACs: Audits which include TPE, CERT’s, RAC and SMERCs are being suspended. Claims currently under TPE Audit review will be released for processing. Previously published CSA’s related to COVID-19:

CSA Title CSA Publication # CSA Date
COVID-19 Medicare
Day Supply Adjustment
CSA 032020d March 20, 2020
Financial Payment Changes CSA 040220e April 2, 2020

Change Healthcare continues to monitor this rapidly evolving situation and will provide updates as circumstances change. If you have any questions regarding this notification, please contact Pharmacy Support at 866.379.6389.


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.


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

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 or by phone at 1-888-474-4262.