New CPT Code for Reporting COVID-19 Test

New CPT Code for Reporting COVID-19 Test

On Jan. 30, the World Health Organization (WHO) declared the 2019 novel coronavirus (COVID-19) disease outbreak a public health emergency of international concern. The outbreak has since been elevated to a pandemic and President Trump has declared the coronavirus pandemic a national emergency in the United States. Communities across the country are shutting down to limit public gatherings. The goal is to prevent COVID-19 from infecting the masses, for which our healthcare system is not prepared.
In the interim, new procedure and diagnosis codes and associated guidance have been released. Medical coders and billers in all settings must be ready to use these codes.
Don’t miss AAPC’s webinar: Telehealth and other Remote Services from a Physician’s Office, March 31, presented by Jill M. Young, CPC, CEDC, CIMC. She will discuss the diagnosis and testing codes for COVID-19, explain the guidelines for remote patient care while the telehealth waiver is in force for Medicare patients, and much more!

New CPT® Code

Most recently, the CPT Editorial Panel approved a new Category I Pathology and Laboratory code for novel coronavirus testing. This code is effective March 13, 2020.
87635 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
This is an early release code, so you will need to manually upload this code descriptor into your electronic health record system.
CPT® 87635 will be a child code under parent code 87471 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique in the 2021 CPT® code set.
A special edition CPT® Assistant is publicly available, which provides guidance for using this new code.
Visit the AMA website for more information about this new code.

Medicare Guidance

The Centers for Medicare & Medicaid Services (CMS) has released numerous press releases to convey information and guidance to healthcare providers in specific settings. Click here to go to the CMS webpage that contains a compilation of links to all of these resources.

New HCPCS Level II and ICD-10-CM Codes

There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19, and a new diagnosis code for reporting confirmed cases of COVID-19. It is essential that healthcare systems begin using these codes to report all COVID-19 testing and confirmed diagnoses. This critical data could potentially save the lives of millions.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

29 Responses to “New CPT Code for Reporting COVID-19 Test”

  1. Yunita C Tjiadi says:

    Hello, do you know if the PCP office can bill any codes for the collection of the specimen (swab) of Covid19 testing? I have a scenario where the PCP office is collecting the swab but then sending the specimen to outside lab for processing. What code can the PCP bill? Thank you.

  2. Paolo Angelini, MD says:

    We, cardiologists in Houston, tried to organize the collection of data on Covid19 screening in our local Hospitals, but no support. This is the time to act and learn from a unique time experience that should not go by without understanding!
    I would be available for co-starting a simple and realistic study especially centered about ACE2 receptors and use of ACE2 receptors inhibitors.

  3. Jeff Schreier says:

    How will a claim get billed for a Covid-19 test performed as a physician office POC test? Will there be a different HCPCS code for this?

  4. peggy K Stark says:

    I have the same situation as Dr. Angelini. Does any one have the answer?

  5. Renee Dustman says:

    CPT 99211 is typically reported by physician practices when the patient only sees clinical office staff for services like acquiring a routine specimen sample. To identify specimen collection for COVID-19, CMS is establishing for independent labs: G2023-G2024.

  6. Brandy Ellis says:

    Do you know if the PCP office can bill any codes for the collection of the specimen (swab) of Covid19 testing? I have a scenario where the PCP office is collecting the swab but then sending the specimen to outside lab for processing. What code can the PCP bill? And do you know what the reimbursement will be? Thank you

  7. Vicente says:

    Does anybody know how much CMS would reimburse for CPT 87635 in house for Professional Providers?

  8. Renee Dustman says:

    87635 is for independent labs only

  9. Karen J says:

    New collection codes G2023 and G2024

  10. Michael Hughes says:

    We are performing the COVID-19 Antibody Test (IgG and IgM). The AMA just provided CPT guidance to use CPT 86769. Has CMS or the MAC established a reimbursement rate yet?

  11. Kristen Williams says:

    Do we have a list of add on codes needed for procedures to determine that a patient needs a Covid test before the procedure is performed? They are referred to as AGP codes.

  12. Renee Dustman says:

    Kristen: I have not come across any reference to that. I do know that Medicare does not require an order from a treating physician or non-physician practitioner as a condition of Medicare coverage of COVID-19 testing during the public health emergency.

  13. Renee Dustman says:

    Brandy: Per a CMS fact sheet dated 4.29.20, “Practitioners can be paid for assessment and specimen collection for COVID-19 testing using the level 1 evaluation and management code CPT code 99211” for both new and established patients. Check the MPFS for rates.

  14. SELINA says:

    Hello. We are an urgent care, seeing testing patient for covid19 and sending out specimen to an outside lab. How would I bill? What CPTs can be used?

  15. Renee Dustman says:

    Medicare will allow payment for COVID-19 specimen collection billed by qualifying practitioners with CPT® code 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

    Use CPT® 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physician’s or NPP’s services.

    Hospital outpatient departments should use HCPCS Level II code C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19])), any specimen source to be paid for COVID-19 symptom assessment and specimen collection.

  16. Jose poblete says:

    We’re getting denied for cpt 87635 billed under a by a nurse practitioner who is par under the provider group with horizon blue cross of New Jersey. It’s denied due to licensing agreement between the provider and the payer.
    We rebilled as corrected by adding QW but it’s denied again for same reason. Is this a clia waived test?

  17. Renee Dustman says:

    Based on the denial, you will need to contact your payer for an answer.

  18. Michelle says:

    The specimen collection code is G2023, and the MCR reimbursement is $25.46. You can bill U0001 for specimens sent to a CDC or CDC approved State or Local Public Health office. U0002 is billed for specimens sent to a Commercial Lab

  19. Abeer Sadduq says:

    Great information. Will you please give me some information of how to bill code U0003? is there a break down on the payment or they pay full amount on the code alone? meaning, Do in need to include another code to support it or i can bill it by itself? Your inputs and feed back are greatly appreciate it.

  20. Renee Dustman says:

    Perhaps this information will help

  21. Karin Croce says:

    is covid19 rapid antigen test covered by Medicare and what is the procedure code?

  22. Renee Dustman says:

    Yes, either HCPCS Level II code U0001 for CDC tests or U0002 for non-CDC tests. Alternatively, labs can bill CPT 87635 if that is the method being used. Use U0003 or U0004 for high-throughput tests of this nature.

  23. Denise Leonard says:

    I am working with a dental practice that does antigen Covid-19 testing, What codes should I use for the collection of the sample and for administering the test? Can I bill telehealth for the doctor calling the patient with the results?

  24. Renee Dustman says:

    That is beyond the scope of our knowledge; however, you may find your answer here

  25. Ruth Tavares says:

    Can a private surgical practice bill Medicare for a rapid COVID19 test performed prior to an office surgery and if so what code can be billed?

  26. Renee Dustman says:

    Not in the global period of the surgery. CMS says in a recently-updated FAQ (
    The CS modifier should not be used when pre-surgery examination services are not paid separately, for example if particular services are considered to be part of services with a global surgical period ….”

  27. Danielle says:

    My physicians practice is performing the swab for COIVD-19 and we then send it off to the lab we contact the patient with the test results after we receive them back from the lab. What CPT code do we bill U0002 or 99211? I keep seeing you can bill U0002 or 99211.

  28. Renee Dustman says:

    U0002 is a lab code. 99211 is appropriate if the collection is conducted in the physician’s office.