Revenue Performance Advisor and COVID-19
Change Healthcare has been closely monitoring coding changes related to COVID-19 to provide general guidance specific to codes used within healthcare transactions involving patient diagnosis, care, or treatment. The following are ICD-10, HCPCS, and AMA code additions relative to COVID-19, along with actions required and links to additional information.
New AMA CPT Codes for COVID-19
- On March 13, 2020, the American Medical Association (AMA) announced the addition of CPT code 87635 for laboratory testing services that detect the presence of COVID-19.
- On April 10, 2020, the American Medical Association (AMA) announced a revision to code 86318 and two new CPT codes 86328 and 86769 for reporting of novel coronavirus antibody tests.
All changes are effective immediately.
Use of Condition Code DR – Disaster Related: On March 24, 2020, the NUCC announced effective immediately Condition Code “DR” is valid for use for COVID-19 related claims on the CMS-1500 claim form and electronic HIPAA X12N 837 Professional claims.
Also, several special use LOINC codes related to SARS Coronavirus 2 have been developed that are currently in pre-release status.
Code Set Updates Specific to COVID-19
ICD-10 Code addition for COVID-19: On February 20th, 2020, the CDC released a notification for a new ICD-10 code for the 2019 Novel Coronavirus (COVID-19) for reporting. On March 18th, they announced an off-cycle change to the effective date for the new ICD-10 diagnosis code U07.1, COVID-19 from Oct. 1, 2020 to April 1, 2021.
New HCPCS code additions for COVID-19
There have been multiple HCPCS code announcements related to COVID-19. They include:
- HCPCS Code U0001: Feb. 13, 2020, the CMS announced the addition of code U0001 for providers and laboratories to bill laboratory testing of patients for SARS-CoV-2.
- HCPCS Code U0002: March 5, 2020, the CMS announced the addition of code U0002 for providers and laboratories to bill laboratory testing of patients for COVID-19. Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020.
- HCPCS Codes G2023 and G2024: March 31, 2020, the CMS announced the addition of codes G2023 and G2024 to bill for specimen collections related to COVID-19 diagnosis effective with line item date of service on or after March 1, 2020.
- HCPCS Modifier Code CS: March 31, 2020, the CMS announced the modification of code “CS” description to “Cost-sharing for specified covid-19 testing-related services that result in an order for or administration of a COVID-19 test”. Effective with line item date of service on or after March 1, 2020.
Please ensure your clinical and administrative provider software systems are updated to support these recent code set updates. Reach out to your software vendor(s) as applicable. New information is being published frequently in response to COVID-19. Please continue to monitor payer communications and billing guidelines as to when each payer will be ready to accept and process transactions with the new codes and determination of service coverage.
Change Healthcare obtained all code set updates specific to SARS-CoV-2 and COVID-19 for immediate deployment across all Change Healthcare systems, solutions, and services. As the coronavirus situation continues to evolve, Change Healthcare is taking swift action to protect your information and the integrity of business operations. We are committed to protecting the data and people that help inspire a better healthcare system. The safety and well-being of our employees, our partners, and our customers are of critical importance to us. We continue to monitor this situation and will respond accordingly as conditions change.
COBVA Alert--Updated Information Regarding COVID-19-Related Systems Changes and Additional Issues and Impacts For COBA Trading Partners
Through recent COBVA broadcasts, the Centers for Medicare & Medicaid Services (CMS) and Benefits Coordination & Recovery Center (BCRC) alerted all Coordination of Benefits Agreement (COBA) trading partners to upcoming systems changes that would be needed to ensure that 071x (Rural Health Clinic), 077x (Federally Qualified Health Clinic), and 85x (Critical Access Hospital) Type of Bill (TOB) claims correctly waived coinsurance amounts when a modifier “CS” was included on the claims. Earlier, we mentioned that the actions to correct this issue would not begin until July 1, 2020.
Latest Update: The CMS and BCRC COBA teams have been advised that the systems fix-tied to the above issue has been implemented and that associated mass adjustment/claims reprocessing actions will be starting, potentially as early as this week.
Certain Clinical Lab Tests Showing Coinsurance
Additionally, some of our COBA trading partners have provided examples of COVID-19-related testing codes (e.g., U0002 and 87635) where coinsurance had been applied in error. This issue now has been corrected at the Medicare Administrative Contractors (MACs). Additionally, the affected MACs have been adjusting the COVID-19-related clinical lab claims that incorrectly applied coinsurance amounts on them.
COBVA Alert--Additional Important Information Regarding Medicare Claims and COVID-19
The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Agreement (COBA) wants to make all COBA trading partners aware of additional information regarding Medicare claims in relation to COVID-19 that was brought to the COBA team’s attention May 7, 2020. This additional information includes the following:
1) Not all services billed to Medicare result in the waiver of deductible and coinsurance amounts.
Please see the March 23, 2020 CMS COVID-19 Facts Sheet.
Some key examples covered in this documentation include, but are not limited to:
- Inpatient hospital admissions are exempted from the waiver of cost sharing. (In other words, inpatient deductibles and applicable coinsurance amounts continue to apply.)
- Additionally, Part B deductible and coinsurance amounts still apply to emergency ambulance transports.
2) New Modifier Used in Certain Billing Situations
In a recent MLN Matters article, Medicare announced its acceptance of a new modifier in conjunction with certain COVID-19 billed services.
- Medicare now permits the billing of modifier “QW” in association with HCPCS code U0002 and code 87635 for claims submitted by facilities with a valid and current Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver for dates of service March 20, 2020, and after.
Action Required: Payers should ensure that their claims adjudication systems will accept the HCPCS/Modifier combination.
COBVA Alert--CORRECTION--Actions Involving 071x, 85x, and FQHC Medicare Claims Relating to COVID-19 Considerations
The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Agreement (COBA) team recently received corrected and updated information relating to the handling of Rural Health Clinic (RHC; type of bill (TOB) 071x), Critical Access Hospital (CAH; TOB 85x), and Federally Qualified Health Clinic (FQHC; TOB 077x) claims on which a modifier “CS” would apply.
This new information revises our previously-issued COBVA notice dated April 22, 2020.
The following portions of our April 22nd COBVA notice remain correct:
- During March 2020, CMS directed its Part A Medicare Administrative Contractors (MACs) to suspend/hold all Rural Health Clinic [(RHC); type of bill (TOB) 071x], Critical Access Hospital [(CAH); TOB 85x], and Federally Qualified Health Clinic [(FQHC); TOB 077x] claims that contained services lines subject to waiver of cost sharing in association with the COVID-19 pandemic, as denoted by a “CS” modifier for the reported service code.
- On April 22, 2020, CMS issued direction to its Part A MACs to release all RHC and CAH claims currently suspended/held with (a) service line(s) with the “CS” modifier for dates of service on/or after 03/18/2020.
- Note: The COBA trading partner impact statement was also true, though not fully complete, as it did not mention the impact of Medicare FQHC claims being released.
The following are corrections/additions to our April 22nd COBVA announcement:
- (New) Effective with April 22, 2020, Part A MACs are also no longer holding FQHC (TOB 077x) claims that had been suspended/held with (a) service line(s) with the “CS” modifier for dates of service on/or after 03/18/2020.
- (New) There is currently an existing systems issue affecting the 071x, 077x, and 85x TOB claims involving use of the “CS” modifier. As a result of this issue, CMS may have issued, or may be issuing, adjudicated claims on which coinsurance amounts were applied, or are being applied, in error.
- (Revised/Updated) Following the July 1, 2020 implementation of the Integrated Outpatient Code Editor (I/OCE) changes needed to support the use of modifier “CS” on the claim types mentioned above, our Part A Medicare Administrative Contractors (MACs) will mass adjust all RHC, CAH, and FQHC claims having service lines with the “CS” modifier reflected for dates of service on/or after March 18, 2020, through June 30, 2020.
- All indications are that these claims will be treated as “mass adjustment claims, other” when they are reprocessed.
COVID-19 Impacts on COBA Crossover Claims
This notice is for Coordination of Benefits Agreement (COBA) trading partner representatives from the CMS and Benefits Coordination & Recovery Center (BCRC) COBA teams regarding CMS MLN Matters Special Edition, released on March 18. Although this outreach information is targeted towards providers, it will also be useful to our COBA trading partners.
COBA trading partners may be seeing 837 institutional coordination of benefits (COB) claims containing a “DR” (disaster-related) condition code, and 837 professional COB claims containing a “CR” (catastrophe/disaster-related) modifier, for situations where Section 1812(f) waivers have been announced. Additionally, the publication includes useful information regarding Medicare’s coverage of telehealth/telemedicine in association with the COVID-19 pandemic.
For questions regarding this notification, please contact your designated BCRC COBA EDI representative using the following contact information:
Tel. # 646-458-6740
Fax # 646-458-6761
ICD-10 Code Addition for COVID-19
On February 20, 2020, the CDC released a notification for a new ICD-10 code for the 2019 Novel Coronavirus (COVID-19) for reporting that will be effective October 1, 2020. For more information read the CDC Announcement: New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), October 1, 2020.
New HCPCS Code Additions for COVID-19
There have been two HCPCS code announcements from the CMS related to COVID-19 additions, including:
- HCPCS Code U0001: On February 13, 2020, the CMS announced the addition of code U0001 for providers and laboratories to bill for laboratory testing of patients for SARS-CoV-2.
- HCPCS Code U0002: On March 5, 2020, the CMS announced the addition of code U0002 for providers and laboratories to bill for laboratory testing of patients for COVID-19.
For more information visit the CMS Fact Sheet: Coverage and Payment Related to COVID-19 Medicare.
New AMA CPT Code 87635 for COVID-19
On March 13, 2020, the AMA announced the addition of CPT code 87635 for laboratory testing services that detect the presence of COVID-19 effective immediately.
For more information visit the AMA Press Release: New CPT code announced to report novel coronavirus test.
Action Required: Please ensure your clinical and administrative provider software systems are updated to support these recent code set updates. Reach out to your software vendor(s) as applicable. New information is being published daily as a response to COVID-19; please continue to monitor CMS and your payer sites for the latest information. Refer to your MAC and payer guidelines to determine if services are covered.
Action Taken: Change Healthcare has obtained all code set updates specific to COVID-19 for immediate deployment across all Change Healthcare systems, solutions, and services. We continue to monitor this situation and will respond accordingly as conditions change.
- CDC: Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
- Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)
- CMS: Public Health News Alert: CMS Develops New Code for Coronavirus Lab Test
- CMS: CMS Develops Additional Code for Coronavirus Lab Tests
- CMS Fact Sheet: Coverage and Payment Related to COVID-19 Medicare
- AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing
- CMS booklet: Telehealth Services
- CMS Press Release: Telehealth Fact Sheet for Providers and Patients