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COVID-19 Diagnostic Testing CPT and HCPCS Codes Updated

May 6, 2020

In response to coronavirus disease 2019 (COVID-19), the Centers for Medicare & Medicaid Services (CMS) established HCPCS codes U0003 and U0004 and CPT® codes 86328, and 86769 for COVID-19 diagnostic testing services, among other codes.

The Department of Health Care Services (DHCS) is establishing reimbursement rates for the new codes. These rates are based on the most recent corresponding Medicare rates, and are reimbursed at 100 percent of the Medicare rate. Upon expiration of the public health emergency or national emergency, these rates will be amended to amounts that correspond with the clinical laboratory services methodology in Welfare and Institutions Code (W&I Code) Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.

The effective date of this policy update for HCPCS codes U0003 and U0004 is for dates of service on or after March 18, 2020, and for CPT codes 86328 and 86769 is dates of service on or after April 10, 2020.

An EPC letter will be issued for affected claims for codes U0003, U0004, 86328 and 86769 retroactive to dates of service on or after March 18, 2020, or April 10, 2020. The updated manual pages reflecting this change will be released in a future Medi-Cal Update.