Tuesday, November 3, 2020

CMS Releases Text of U0005, Speedy Payment for COVID Adds $25

 In mid-October, CMS announced a new policy that would cut the rate for high-throughput COVID testing (U0003,U0004) from $100 to $75, but simultaneously, create an add-on code for reporting in less than 48 hours, which adds back the missing $25.   Entry point and links here.

At the time, CMS did not appear to release the text of the new add-on code U0005.   However, U0005 appears inside an October 28 COVID billing update at CMS, on the bottom of page 12 of 152 pages.  Here.

CMS states:

On October 15, 2020, CMS released an amended Ruling (CMS 2020-1-R2) that created an add-on payment for COVID-19 CDLTs performed using high throughput technology (as described by HCPCS codes U0003 and U0004). This add-on payment can be billed using HCPCS code U0005 effective January 1, 2021, and is described as follows:

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. (List separately in addition to either HCPCS code U0003 or U0004)

"Completed" is defined in Administrator's Ruling as, the test report is ready for release.  The start time is stated within the code as "time of specimen collection."  The timing is two days, not 48 hours, so I am assuming a specimen at 8 am on Monday could be completed by 11 pm on Wednesday.


Meanwhile, I missed on the first go-round that on October 1, several Representatives in the House released a bill called SPEEDY, which would pay a bonus for COVID tests under 24 hours, a basic rate after that, and drop to "no payment" after 72 hours.  See press here.  I haven't identified the full text of the legislative proposal.


Dark Report (subscription), October 26, has a detailed article with multiple interviews with lab stakeholders who are opposed to the payment cuts.


In addition to concerns about the payment cuts, National Independent Laboratories Association (NILA) recently complained to CMS about the burden, confusion, and complexity of required COVID reporting for public health purposes (here).