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This code should be used for clinical diagnostic laboratory tests that use high-throughput amplified probe technologies to detect and diagnose COVID-19.This code should be used for infectious agent antigen detection testing.*Effective dates of codes were determined by reference to CMS Ruling No. This code should be used when billing for add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory a) completes the test in 2 calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in 2 calendar days or less for all of their patients (not just their Medicare patients) in the previous month.We will also accept the following HCPCS codes for COVID-19 testing performed for dates of service listed below, as outlined by the Centers for Medicare & Medicaid Services (CMS): On or After Jan.
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More information is available at AMA Resource Center for Physicians, or you can download the CPT Assistant Guide. Use CPT code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2). *Does not apply to short-term limited duration health plans. UnitedHealthcare will pay administration fees at CMS published rates unless otherwise specified.įor more member-focused information, view our What to know about the COVID-19 vaccine page. Administration fees for out-of-network providers will be based on CMS published rates.įor Medicaid, Medicaid state-specific requirements may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable. Administration fees for in-network providers will be based on contracted rates.
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Medicare Advantage health plans: Charges for COVID-19 vaccine administration for all Medicare beneficiaries should be billed to the Center for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). The MAC will reimburse claims for Medicare beneficiaries with no cost share (copayment, coinsurance or deductible) for the remainder of 2020 and through 2021. For more information, visit the CMS COVID-19 Insurers Toolkit.Īny COVID-19 vaccine-related claims for Medicare beneficiaries that are submitted to UnitedHealthcare will be denied, and health care professionals will be directed to submit the claims to the MAC.Įmployer and Individual health plans, including Student Resources, short term limited liability (STLD) and Exchange plans: UnitedHealthcare and self-funded customers cover the administration of COVID-19 FDA-authorized vaccines with no cost share for in- and out-of-network providers, during the national public health emergency period. UnitedHealthcare will reimburse administration of FDA-authorized COVID-19 vaccines in accordance with applicable state laws and federal provisions, including the CARES Act and Emergency Use Authorization (EUA) guidance, as outlined below. Updates and additional information will be posted on this site as quickly as possible when new information is released.

The cost of COVID-19 FDA-authorized vaccine serums will initially be paid for by the government.
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If a health care professional bills visit codes on the same date of service as a COVID-19 testing code claim for the same patient, UnitedHealthcare will deny the testing code with the following remark code: I4. Service: COVID-19 testing at urgent care facilitiesįor in-network health care professionals, we will reimburse COVID-19 testing at urgent care facilities only when billed with a COVID-19 testing procedure code along with one of the appropriate Z codes (Z20.828, Z03.818 and Z20.822) through the end of the public health emergency.
