The Centers for Medicare and Medicaid Services (CMS) has issued a change request (CR 11640) to inform Medicare administrative contractors about new Healthcare Common Procedure Coding System (HCPCS) codes for 2020 that are subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits.
The agency particularly noted that on March 5, CMS released information about developing a second HCPCS billing code (U0002) that laboratories can use to bill for certain 2019-novel coronavirus (COVID-19) and SARS-CoV-2 diagnostic tests to help increase testing and track new cases, in addition to a previous HCPCS billing code (U0001), which laboratories can use to test for SARS-CoV-2.

CLIA regulations require facilities to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level. HCPCS codes that are considered a laboratory test under CLIA change annually.

Access the complete change request via the CMS Medical Learning Network.