COVID-19 Lab Tests are New Medi-Cal Benefits

Last Updated: March 19, 2020. Originally Published: March 13, 2020

Effective for dates of service on or after February 4, 2020, HCPCS code U0001 (2019-Novel Coronavirus [2019-nCoV diagnostic p]) and HCPCS code U0002 (COVID-19 lab test non-cdc) are new Medi-Cal benefits. HCPCS code U0001 is billable for the tests developed by the CDC for COVID-19, and providers will be reimbursed at the Medi-Cal rate up to $35.91, subject to Medi-Cal policy. HCPCS code U0002 is billable for non-CDC laboratory tests for COVID-19 and providers will be reimbursed at the Medi-Cal rate up to $51.31, subject to Medi-Cal policy.

Additionally, effective for dates of service on or after March 13, 2020, CPT code 87635 (SARS-COV-2 COVID-19 AMP PRB) is also a new Medi-Cal benefit. CPT code 87635 will be reimbursed at the Medi-Cal rate up to $35.91, subject to Medi-Cal policy.

All three codes are:

  • Limited to two tests per day, per patient.
  • Able to be billed with any ICD-10-CM diagnosis code.
  • Eligible as a Presumptive Eligibility benefit.
  • Billable with modifiers 33, 59, 90 and 99.
  • Exempt from the Assembly Bill 97 10 percent payment reduction.

However, these codes should not be reported concurrently.

When billing, providers will likely receive erroneous claim denials for these new benefits until changes in the system can be properly implemented. These system changes are anticipated to take place on April 1, 2020.

However, providers should not hold off on submitting claims, nor deny service to beneficiaries, for this reason alone. Erroneously denied claims will be reprocessed with an Erroneous Payment Correction (EPC) upon implementation. No action will be required of providers.

These changes will be reflected in the provider manual in an upcoming Medi-Cal Update.