The COVID-19 pandemic has impacted the world significantly, causing widespread illness, death, and economic disruption. The virus, also known as SARS-CoV-2, primarily spreads through respiratory droplets when an infected person talks, coughs, or sneezes.
COVID-19 symptoms range from mild to severe and may include fever, cough, fatigue, body aches, loss of taste or smell, and difficulty breathing. While some people may have mild or no symptoms, others may experience severe illness and require hospitalization.
To control the spread of the virus, public health measures such as wearing masks, social distancing, and frequent hand washing have been recommended. Vaccines are also available to protect against COVID-19, and many countries have implemented vaccination campaigns to protect their populations. However, the pandemic continues to present challenges, including the emergence of new variants of the virus and vaccine hesitancy.
The ongoing efforts to control the pandemic require a coordinated global response, including continued research and development of treatments and vaccines, improved access to healthcare services, and effective communication to the public about the importance of preventive measures.
As the COVID-19 pandemic continues to impact the world, the demand for COVID-19 testing has increased significantly. The Centers for Medicare and Medicaid Services (CMS) has established Current Procedural Terminology (CPT) codes to bill for COVID-19 testing services. In this article, we will discuss which CPT codes are used in COVID-19 billing.
What are CPT Codes?
Before discussing the specific CPT codes used for COVID-19 billing, it is essential to understand what CPT codes are. CPT codes are five-digit codes used to describe medical, surgical, and diagnostic services performed by healthcare professionals. These codes help healthcare providers and insurance companies to communicate the services provided and determine the reimbursement amount for those services.
The CPT Codes Used in COVID-19 Billing
The CMS has established several CPT codes that healthcare providers can use to bill for COVID-19 testing services. These codes describe the various aspects of the testing process, from specimen collection to laboratory testing to test kits.
Specimen Collection
The first step in COVID-19 testing is specimen collection. Healthcare providers can use the following CPT codes to bill for specimen collection:
- 99211: This code is used for the evaluation and management of an established patient that requires a straightforward and brief service, such as a COVID-19 test.
- 99212: This code is used for the evaluation and management of an established patient that requires a more complex and lengthy service, such as a COVID-19 test.
Laboratory Testing
After specimen collection, the next step is laboratory testing. The following CPT codes can be used for laboratory testing:
- U0001: This code is used for COVID-19 testing services provided by the Centers for Disease Control and Prevention (CDC).
- U0002: This code is used for COVID-19 testing services provided by laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA).
- 87635: This code is used for the laboratory testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and any pathogenic organisms that cause respiratory illness, including influenza.
- 87426: This code is used for the laboratory testing of SARS-CoV-2 and influenza virus types A and B.
Test Kit
Healthcare providers can bill for the COVID-19 test kit separately from the specimen collection and laboratory testing.
The following CPT code can be used for the COVID-19 test kit:
- 86408: This code is used for the COVID-19 test kit.
COVID-19 Billing Codes FAQ
What are CPT codes and why do they matter for COVID-19 billing?
CPT codes are five-digit codes that describe medical, surgical, and diagnostic services performed by healthcare providers. They let providers and insurance companies communicate exactly what service was given and set the reimbursement amount. For COVID-19 care, they cover each stage of the testing process, from sample collection to lab analysis.
Which CPT codes cover specimen collection for COVID-19 testing?
Specimen collection for an established patient is typically billed using codes 99211 or 99212. Code 99211 applies to a brief, straightforward visit, while 99212 applies when the visit involves more time or a more detailed evaluation. Providers choose between the two based on the level of service given during the collection visit.
What do CPT codes U0001 and U0002 represent?
U0001 is used to bill for COVID-19 testing services performed through the Centers for Disease Control and Prevention. U0002 applies to COVID-19 testing carried out by laboratories certified under the Clinical Laboratory Improvement Amendments. Both codes distinguish who ran the test rather than describing the test method itself.
What does CPT code 87635 cover?
CPT code 87635 is used for laboratory testing that detects SARS-CoV-2, the virus that causes COVID-19, along with other pathogenic organisms tied to respiratory illness such as influenza. It applies to the lab analysis step rather than sample collection or office visits. Labs use this code to bill for the diagnostic detection work itself.
How is CPT code 87426 different from 87635?
CPT code 87426 covers combined laboratory testing for SARS-CoV-2 along with influenza virus types A and B in a single test. This differs from 87635, which centers on SARS-CoV-2 testing alongside other respiratory pathogens generally. The choice of code depends on the specific panel of viruses the lab test is designed to detect.
Why did CMS create specific CPT codes for COVID-19 testing?
CMS created these codes because the rise in COVID-19 testing demand required a clear, standard way to bill for each part of the testing process. Separate codes for specimen collection, lab identification, and testing source allow accurate tracking of who performed which service. This structure supports correct reimbursement for healthcare providers and laboratories alike.
Summary: CPT Codes Used in COVID-19 Billing
COVID-19 testing is essential to control the spread of the virus, and healthcare providers need to understand the appropriate CPT codes to bill for these services. The CMS has established specific CPT codes for COVID-19 testing billing, including codes for specimen collection, laboratory testing, and the test kit itself. Healthcare providers must use these codes to bill accurately and receive appropriate reimbursement for their services.
Co-Founder and COO of Medwave, bringing more than 30 years of hands-on experience in healthcare revenue cycle management, payer contracting, and medical credentialing.