The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").
MHD continues to monitor the Centers for Medicare and Medicaid Services (CMS) guidance related to COVID-19 testing and specimen collection. The tables below list the COVID-19 testing and specimen collection procedure codes MO HealthNet currently covers as well as who can bill each code, effective dates, max units, and rates.
Effective for dates of service on or after March 1, 2020, and through the end of the public health emergency, claims submitted by independent laboratories for COVID-19 testing will not require a referring physician. Providers that perform other laboratory services on the same date as the COVID-19 test must bill for the COVID-19 test on a separate claim in order to be reimbursed. MO HealthNet will recycle all claims submitted by independent laboratories for COVID-19 tests that did not include a referring provider.
Effective for dates of service on or after January 1, 2021, pharmacists and pharmacies are included in the providers that can bill COVID-19 testing codes.
Effective for dates of service on or after January 1, 2021, providers can bill COVID-19 testing code U0005 in addition to either HCPCS code U0003 or U0004 only after receiving results within two calendar days from date and time of specimen collection.
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COVID-19 Testing Codes |
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|---|---|---|---|---|---|
|
Code |
Description |
Who can bill this code? |
Effective with dates of service on or after: |
Max Units |
Rate |
|
U0001 |
CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
Providers with the appropriate CLIA Certificate type for the test |
02/01/2020 |
2 |
$36.00 |
|
U0002 |
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets) |
Providers with the appropriate CLIA Certificate type for the test |
02/01/2020 |
2 |
$51.00 |
|
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 |
Providers with the appropriate CLIA Certificate type for the test |
03/13/2020 |
2 |
$51.00 |
|
86328 |
Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). |
Providers with the appropriate CLIA Certificate type for the test |
04/10/2020 |
3 |
$45.23 |
|
86769 |
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). |
Providers with the appropriate CLIA Certificate type for the test |
04/10/2020 |
3 |
$42.13 |
|
87426 |
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]). |
Providers with the appropriate CLIA Certificate type for the test |
06/25/2020 – 01/24/2021 01/25/2021 |
3 |
$45.23 $35.33 |
|
86408 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen |
Providers with the appropriate CLIA Certificate type for the test |
08/10/2020 |
1 |
$42.13 |
|
86409 |
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer |
Providers with the appropriate CLIA Certificate type for the test |
08/10/2020 |
1 |
$79.61 |
|
86413 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), antibody, quantitative |
Providers with the appropriate CLIA Certificate type for the test |
09/08/2020 |
3 |
$51.43 |
|
87636 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
Providers with the appropriate CLIA Certificate type for the test |
10/06/2020 |
3 |
$142.63 |
|
87637 |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
Providers with the appropriate CLIA Certificate type for the test |
10/06/2020 |
3 |
$142.63 |
|
87811 |
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
Providers with the appropriate CLIA Certificate type for the test |
10/06/2020 |
3 |
$41.38 |
|
87428 |
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzymelinked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B |
Providers with the appropriate CLIA Certificate type for the test |
11/10/2020 |
1 |
$63.59 |
|
U0003 |
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, making use of high throughput technologies as described by CMS-2020-01-R. |
Providers with the appropriate CLIA Certificate type for the test |
03/18/2020 – 12/31/2020 01/01/2021 |
2 |
$100.00 $75 |
|
U0004 |
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. |
Providers with the appropriate CLIA Certificate type for the test |
03/18/2020 – 12/31/2020 01/01/2021 |
2 |
$100.00 $75 |
|
U0005 |
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, CDC or non-CDC, making use of high throughput technologies, completed within two calendar days from date and time of specimen collection. |
Providers with the appropriate CLIA Certificate type for the test |
01/01/2021 |
1 |
$25 |
|
COVID-19 Specimen Collection Codes |
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|---|---|---|---|---|---|
|
Code |
Description |
Who can bill this code? |
Effective with dates of service on or after: |
Max Units |
Rate |
|
99211 |
Medicare suggests using the Level 1 evaluation and management code for assessment and specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
Physician office |
03/01/2020 |
1 |
$15.31 |
|
C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
Hospital outpatient department |
03/01/2020 |
1 |
Percent of billed charges |
|
G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
Independent Laboratories |
03/01/2020 |
1 |
$23.46 |
|
G2024 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source |
Independent Laboratories |
03/01/2020 |
1 |
$25.46 |