COVID-19 Specimen Collection Codes
- By Deborah Marsh
- In Coding
- April 8, 2020
- 35 Comments
Clinical diagnostic laboratories can identify specimen collection for COVID-19 testing using two new HCPCS Level II codes, effective March 1, 2020.
Check Patient Location Before Coding
Medicare posted these new specimen collection codes in a March 31, 2020, special edition MLN Connects and in a last-minute revision to the April 2020 HCPCS Level II quarterly update file:
G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
As the descriptors reveal, both G2023 and G2024 apply to collection of “any specimen source,” which means you should not restrict your use of these codes based on the source of the specimen. For instance, you should not assume the codes apply only to nasal swabs. The reference to “any specimen source” also may allow you to continue to use these collection codes as the industry develops new COVID-19 tests that use different specimen sources.
In an interim final rule related to COVID-19 policy and regulatory revisions, the Centers for Medicare & Medicaid Services (CMS) explains that tests that allow patients to collect the specimen would not be eligible for the specimen collection fee. Trained personnel must collect the sample.
Expect Higher Fee for G2024
The only variation between the G2023 and G2024 code descriptors is this wording in G2024: “from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency.”
The interim final rule states the second code, G2024, is necessary because the Social Security Act and CMS regulations “require a higher fee for collecting a specimen from an individual in a SNF [skilled nursing facility] or by a laboratory on behalf of an HHA [home health agency].”
The nominal specimen collection fee for COVID-19 testing for homebound and non-hospital inpatients “generally will be $23.46,” according to the interim final rule. For individuals in a SNF or for individuals whose samples will be collected by a laboratory on behalf of an HHA, the fee will be $25.46. These fees are higher than the typical specimen collection fees of $3 to $5, reflecting the higher costs required to minimize exposure risks.
Anyone who will be reporting G2023 and G2024 should review the interim final rule, particularly starting around page 95, to be sure they have viewed the official requirements, including the definition of homebound.
G2023 and G2024 Are Required but May Be Temporary
Independent labs must use G2023 and G2024 to bill Medicare for the specimen collection fee for COVID-19 testing during the public health emergency (PHE), the interim final rule states.
The MLN Connects post specifies that the codes are “effective with line item date of service on or after March 1, 2020.” Watch for CMS to issue additional guidance once the PHE is over and when the codes are no longer valid for reporting.
Just the Latest COVID-19 Codes
HCPCS Level II specimen collection codes G2023 and G2024 aren’t the only recent additions related to COVID-19. They join new HCPCS Level II COVID-19 testing codes and a new CPT® COVID-19 testing code. ICD-10-CM has also added a new code, U07.1 COVID-19, with official coding guidelines.
More information on testing codes is available here.
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Can you bill the 87635 for lab test that will be sent out, and will be billed to our facility and then bill for specimen collection G2023 and also bill for Specimen handling charge 99001? This would all be coming from the ED.
Mary
Can the medical office use G2023 for the collection of the specimen being sent to LabCorp? They brought us testing kits today for the U0002, but there should be a code reimbursable to the Provider, I would think?
Hi Mary – You should be able to follow your usual process for reporting handling and the outside lab test billed to the facility, but checking with your compliance team is a good idea. Regarding specimen collection, please note Medicare’s response to the question of who can bill: “Independent laboratories can bill Medicare through their MAC for the specimen collection fee. The specimen collection fee applies if the specimen is collected by trained laboratory personnel from a homebound or non-hospital inpatient and the specimen is a type that would not require only the services of a messenger pick up service. However, the specimen collection fee is not available for tests where a patient collects his or her own specimen.” https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Hi Barbara Ann – According to the interim final rule, the codes are intended for use by independent laboratories, particularly when lab technicians are traveling to patients: “We will provide for Medicare payment of a nominal specimen collection fee and associated travel allowance to independent laboratories for collection of specimens related to COVID-19 clinical diagnostic laboratory testing for homebound and non-hospital inpatients.” This CMS FAQs document also refers only to independent labs when answering “Who can bill for the Medicare specimen collection fee?” https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Depending on the nature of the encounter and payer, you may be able to consider an E/M code and/or handling code 99000. These AMA resources may be helpful: https://www.ama-assn.org/system/files/2020-04/cpt-reporting-covid-19-testing.pdf and https://www.ama-assn.org/system/files/2020-04/covid-19-coding-advice.pdf.
Hi Mary – You should be able to follow your usual process for reporting handling and the outside lab test billed to the facility, but checking with your compliance team is a good idea. Regarding specimen collection, please note Medicare’s response to the question of who can bill: “Independent laboratories can bill Medicare through their MAC for the specimen collection fee. The specimen collection fee applies if the specimen is collected by trained laboratory personnel from a homebound or non-hospital inpatient and the specimen is a type that would not require only the services of a messenger pick up service. However, the specimen collection fee is not available for tests where a patient collects his or her own specimen.” https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Can we bill 36415 and G2023 on the same Date of Service?
yes
Can outpatient hospital lab bill for this collection service for G2023 and G2024. We have lab personnel collect the specimens on outpatients that come to the hospital as well as lab personnel go to skilled facilities and collect the COVID specimens. Some of the tests we result at our hospital outpatient lab and some are sent off to the state, but we do bill for the test (87635 or U0001) as well. We bill these on a UB claim not a 1500.
Thanks for any guidance.
According to a CMS Fact Sheet, CMS changed the Medicare payment rules during the PHE for the COVID-19 pandemic to provide payment to independent labs for specimen collection from beneficiaries who are homebound or inpatients not in a hospital for COVID-19 testing “under certain circumstances.”
Hospital outpatient departments can be paid for symptom assessment and specimen collection for COVID-19 using a new HCPCS code C9803 (Hospital outpatient clinic visit
specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19])), any specimen source retroactive to March 1, 2020. The
service would be paid as conditionally packaged when furnished with another payable service under the OPPS. (https://www.cms.gov/files/document/covid-19-laboratories.pdf)
For FQHC facility G2023 should have place of service 11 or 02?
A FQHC is not a physician’s office (11) and G2023 isn’t performed via telehealth (02). The place of service code for FQHCs is 50.
thank you for your response Renee , It was very helpful. Dee
what is the correct code to use for the COLLECTION of the COVID 19 test. We do the collection in our office and send to the lab.
CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection. However, if the specimen is collected during a routine office visit, it would not be separately payable.
The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection are for use by independent laboratories, not medical practices
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
The PCP can bill an E/M code if the visit is for the specimen collection only, and not if it is done during a scheduled visit. The reimbursement depends on the E/M code.
Can a SNF bill Medicare for G2024 if the nurses are the ones doing the swabs?
HCPCS codes G2023 and G2024 should not be billed by certified home health care agencies or skilled nursing facilities.” … https://provider.excellusbcbs.com/en/resources/news/article?articleId=280991931&classPK=280991927
These codes are for labs to bill when performed by certified techs.
If a patient is seen via a curbside/virtual visit at our urgent care clinic for possible Covid and the provider orders a covid collection to be obtained for send out. Can we bill for example a 99213 for the virtual visit plus the 99211 for the collection? If so, would modifiers be needed?
Thanks
For Medicare Part B, “Services should only be reported as telehealth services when the individual physician or practitioner furnishing the services is not at the same location as the beneficiary.” (COVID-19 FAQs on Medicare FFS Billing) Also for Medicare Part B, “Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection incident to the billing professional’s services for both new and established patients. When the specimen collection is performed as part of another service or procedure, such as a higher level visit furnished by the billing practitioner, that higher level visit code should be billed and the specimen collection would not be separately payable.” (COVID-19 FAQs on Medicare FFS Billing) Modifier CS may be applicable to waive the patient’s cost-sharing for the COVID-19-related service. Other payers may have different policies on this.
Can a PCP bill for COVID 19 specimen collection during a pre-op visit? For this scenario would it be appropriate to bill 99214-25 with 99000 (since the sample will be sent to an outside lab)? Thank you.
Louella
not if it is routine
What is the fee schedule of G2023 and G9818?
Renee, FQHCs bill split claims to Medicare/Medicaid payers with non-FQHC services (such as labs, x-rays, etc) billing on the FFS claim with POS 11. The MAC adjudicates the FFS claim at physician fee schedule reimbursement.
The G2023 code is only for homebound? Or can I use this code in place of service 81?
Can a PCP office bill for a Rapid Detection SARS CoV-2? we received the testing kits and BD veritor system to verify results. If so, what codes would I use?
Our clinic is performing ABBOTT now testing, for our Medicare patient’s would we use 87635 mod QW and G2023?
CPT Assistant SE says:
“Question: Should CPT code 87635, a HCPCS Level II
code, or both be reported if the test for COVID-19 is
performed?
Answer: The appropriate code to be reported is
dependent upon the payer to which the claim is
being submitted. If the claim is submitted to a payer
that requires CPT codes, then code 87635 should be
reported. Conversely, if the payer requires use of the
HCPCS Level II code, the HCPCS Level II code
should be reported. CPT and HCPCS codes should
not both be reported on the same claim.
Contact your local third-party payer directly to
determine their specific reporting guidelines.
Further guidance from CMS on the reporting of
HCPCS Level II codes can be found at https://
http://www.cms.gov/files/document/03092020-covid-19-
faqs-508.pdf.”
CMS sates here https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
“6. Question: What are the new level II HCPCS codes for specimen collection for COVID-19
testing?
Answer: To identify specimen collection for COVID-19 testing, we established two new level
II HCPCS codes effective March 1, 2020. Independent laboratories must use one of these
HCPCS codes when billing Medicare for the nominal specimen collection fee for COVID-19
testing for the duration of the PHE for the COVID-19 pandemic. These HCPCS codes are:
• G2023, specimen collection for severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
• G2024, specimen collection for severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by
a laboratory on behalf of a HHA, any specimen source
We note that G2024 is applicable to patients in a non-covered stay in a SNF and not to
those residents in Medicare-covered stays (whose bundled lab tests would be covered
instead under Part A’s SNF benefit at §1861(h) of the Act).
Updated: 4/17/20”
You will probably find the answers to your questions here: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Can G2023 is billable under POS 15? If not what code needs to bill for mobile unit.
Can Indepndant lab bill for this specimen collection service for G2023 and G2024. We have lab personnel collect the specimens on outpatients that come to the Lab as well as lab personnel go to skilled facilities and collect the COVID specimens.
Can this specimen collection code G2023 and 87635 be billed on each individual patient samples that we collected in our Lab and also from nursing home..
Thanks for any guidance.
Yes, labs can bill specimen collections, as well as a travel allowance (P9603/P9604) for homebound and non-hospital Part B inpatients, but not for Part A hospital or SNF inpatients. The specimens must be collected by trained lab personnel. If I understand your second question, the answer is yes. You may bill for both the collection and test if you meet the requirements.
If this mobile unit is run by a certified lab and the specimens are being collected by trained personnel, then yes.
Urgent care doing curbside covid testing/ eval.
we are getting a lot of denials for 99202/99212 and g2023 for our collection or the specimens.
Any advise to prevent this.