Wednesday, November 11, 2020

Very Brief Blog; Yet More AMA COVID Codes; So Far, Few Codes Under CMS's 2-Day Penalty

 On November 10, 2020, AMA again increases the number of codes available for COVID services.  

  • See the AMA COVID home page here.
  • See the latest update of COVID code listings here.
  • See a November 10 special coding instructions update (for 87428) here
As AMA explains, there is an existing influenza antigen code 87400 and a CoV-2 antigen code 87426.   A new code, 87428, describes multiple testing for both CoV-2 and INF A/B.  

Other parts of the new codemaking are related to COVID Vaccines, and there are quite a few codes.  See the AMA COVID home page.

CMS Proposed Penalty for Slow Testing

In mid-October, CMS posted a new rule that beginning January 1, 2021, payments for high throughput testing drop from $100 to $75 if the test is not completed in a two-day turnaround time.   Here, here.  The $25 penalty applies only to CMS codes U0003, U0004, and not to any of the other numerous COVID codes.   CMS's rationale is likely that only its own codes CMS U0003 U0004 contain (contained) a bonus payment for "high throughput technology," so only those two codes of all the COVID codes should get a clawback penalty for slower performance.   

In any case, for example, you can get $100 for a COVID high throughput test performed quickly, before a discount hits you, but you can get $142 for a COVID + Influenza PCR test (87637), which is more money to start with, and with no risk of a time based penalty in 2021.