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Diagnosis Coding and Reimbursement Updates

Last update: March 18, 2020, 9:06 p.m. CDT

UnitedHealthcare is monitoring the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS) and other national and local resources to establish and update coding guidelines and reimbursement amounts.

Diagnosis Codes

When submitting COVID-19 related claims, follow the appropriate CDC guidance on diagnosis coding for the date of service. The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report until a new code becomes effective Oct. 1, 2020:

Laboratory Testing Codes

Lab care providers should use the newly created HCPCS codes when billing for COVID-19 testing. Centers for Medicaid & Medicare (CMS) created the following HCPCS codes for testing performed on or after Feb. 4, 2020:

  • HCPCS U0001: This code is used for the laboratory test developed by the CDC.
  • HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC.

UnitedHealthcare will have HCPCS codes U0001 and U0002 loaded by April 1, 2020, in our claims system for dates of service on or after Feb. 4, 2020, for all plans and ready for processing and payment.

New CPT® Code

CPT released a new COVID-19 code and description for COVID-19 testing. American Medical Association (AMA) released code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2).

You can find more information at: AMA Resource Center for Physicians or download the CPT Assistant guide.

COVID-19 Laboratory Testing Reimbursement 

This information will apply to claims for dates of service on or after Feb. 4, 2020. We ask that care providers hold claims for processing until April 1, 2020. 

COVID-19 laboratory tests must be done at approved locations in accordance with CDC guidelines.

To enable a swift response to this public health crisis, to increase access to testing and to simplify reimbursement, UnitedHealthcare will reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the member’s benefit plan:

  • HCPCS U0001: $35.92 per test
  • HCPCS U0002: $51.33 per test
  • CPT 87635:  $51.33 per test

These reimbursement rates are based upon rates that were recently announced by the Centers for Medicare and Medicaid Services for COVID-19 testing. 

By submitting a claim to UnitedHealthcare for COVID-19 testing, providers acknowledge that the above amounts will be accepted as payment in full for each COVID-19 test performed, and that they will not seek additional reimbursement from members

We’re listening.

We are monitoring the inquires we’re receiving on an ongoing basis and working hard to answer your questions. We will be making daily updates to UHCprovider.com/covid19. Be sure to check back often for the latest information. 

No. Our daily processing operations and standard policies for fee schedule rates, credentialing and claims review will continue to function as normal, across all network plans and lines of business. We will follow national reimbursement determinations, policies and contracted rates as outlined in a care provider’s Participation Agreement. Expedited credentialing processes for unique situations will be communicated on UHCprovider.com/covid19.

As we receive updates from the Centers for Disease Control and Prevention (CDC), local and global organizations and the federal government, we may have to adjust our business practices, processes and policies accordingly.  Any changes, updates or interruptions will be posted on UHCprovider.com/covid19 as quickly as possible.

Care providers can continue to take advantage of our Link self-service tools for questions around billing, claims, eligibility and more. 

At this time there’s no plan to extend timely filing deadlines. However, we want to be mindful of the rapid changes occurring daily, that’s why we’re closely monitoring all COVID-19 related updates from industry partners. Our standard processes, policies and procedures across all network plans and lines of business will continue to apply.

Any changes or updates will be posted on our care provider website as quickly as possible. For questions around billing, claims, and/or eligibility, you can continue to take advantage of our Link self-service tools.

Stay Connected

Please check this site frequently for any COVID-19 diagnosis coding and reimbursement updates updates

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