OHCA/Soonercare is reimbursing laboratory testing for COVID 19 using codes established by CMS


OHCA is reimbursing laboratory testing for COVID 19 using the following codes established by CMS:

Provider Types: 01, 08, 28

U0001 – CDC 2019 Novel Coronavirus (2019-NCOV) real-time RT-PCR Diagnostic Panel (This code to be used for CDC developed tests).
 
  • U0002 – 2019-NCOV Coronavirus, SARS-COV-2/2019-NCOV (COVID-19), any technique, multiple types or subtypes (includes all targets), Non-CDC (This code to be used for non CDC developed tests, i.e. private labs).
  • 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.
  • 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.
As per CMS-2020-01-R, 

Laboratories are only eligible to bill for U0003 and U0004 if they run COVID-19 testing via high throughput technology that uses a platform that employs automated processing for more than two hundred specimens a day. Examples of high throughput technology as of April 14, 2020 include but are not limited to technologies marketed on that date as the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System GeneXpert Infinity System and NeuMoDx 288 Molecular.

OHCA will be monitoring laboratories billing services for U0003 and U004 and may request information on testing equipment and systems as warranted. 

We are unable to reimburse testing billed with new AMA CPT 87635 because CMS has not set pricing guidelines.  If this changes, we will send an update. Providers who have already billed claims for 87635 may rebill their claim using one of the above U-codes. 

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.