CMS released the payments rates for new Current Procedural Terminology (CPT) codes, which is developed by the American Medical Association (AMA) for COVID-19 diagnostic tests.

The federal agency updated guidance to incorporate Medicare payment details for CPT codes 87635, 86769, and 86328. These can be used by healthcare providers and laboratories to bill payers when they test patients for SARS-CoV2. Medicare is set to pay $51.31, $42.13, and $45.23, respectively, for the codes.

This guidance initially had details of Medicare payment rates for Healthcare Common Procedure Coding Systems (HCPCS) codes U0001 and U0002.

These were created by CMS in February for providers who need to bill for COVID-19 tests developed by the Centers for Disease Control and Prevention (CDC) and also for laboratories utilizing non-CDC test.

The Medicare reimbursement for providers and laboratories is $35.91 for U0001 and $51.31 for U0002. AMA later created the three CPT codes to help providers to bill for COVID-19 tests by making use of its medical billing and coding set.

As per the code set used by third party payers, healthcare providers might use the new CPT code 87635 for respiratory swabs that are collected and sent to the laboratory to test for the novel coronavirus. The CPT codes 86769 and 86328 were later added by the AMA. The codes are meant for COVID-19 antibody tests in which providers test patients for the novel coronavirus using blood, plasma or serum.

Guidance for the AMA states that CPT code 87635 is apt for COVID-19 diagnostic laboratory testing. CPT codes 86769 and 86328 need to be used for serologic laboratory testing for COVID-19.

But providers have to manually upload all three code descriptors into their EHR system. This has to be done as per the standard early release process for CPT codes.

The CPT codes will be a part of the complete CPT code set in the data file for the year 2021, which will be made available in the latter half of this year.

CMS has also come up with HCPCS codes for other COVID-19 tests. But Medicare reimburses providers and laboratories around double the rate for the codes- U0003 and U0004.

A point to note is that the two HCPCS codes have a higher Medicare payment rate since they include the use of high throughput technologies.

These technologies have the capacity of processing more than 200 specimens a day. Though the code should not be utilized to bill for tests that detect COVID-19 antibodies, as stated in the updated guidance of CMS.

CMS wants that for the HCPCS codes and higher Medicare payment rates to respond quickly to COVID-19 outbreaks, primarily in nursing homes, as mentioned by CMS Administrator Seema Verma.