Provider Alerts

In response to the Novel Coronavirus (COVID-19), the Centers for Medicare & Medicaid Services (CMS) established the following HCPCS codes for COVID-19 diagnostic testing services:

• U0003: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]), 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

Overview – The Department of Health Care Services (DHCS) established rates for the new codes. These rates are based on the most recent corresponding Medicare rates, and are reimbursed at 100 percent of the Medicare flat rate. Upon expiration of the public health emergency or national emergency, these rates will be amended to amounts that correspond with the clinical laboratory services methodology in Welfare and Institutions Code (W&I Code) Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.

During this period, HPSJ identified a system error where claims paid more than 100% of the Medicare flat rate.

• There is nothing for providers to do at this point.
• We will be conducting a claims review and requesting refunds on any overpaid
  claims.