New HCPCS codes for COVID-19 Diagnosis

April 22, 2020

Effective for dates of service on or after March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) has released specific HCPCS codes U0003 (SARS Cov-2 COVID-19 Amp prob high throughput) and U0004 (COVID-19 lab test non-CDC high throughput) for the detection of SARS-COV-2 or the diagnosis of the virus that causes the coronavirus disease 2019 (COVID-19).

These codes are:

  • Limited to two of each tests per day, per patient, on the same DOS
  • Eligible as a Presumptive Eligible benefit
  • Billable with modifiers 33, 59, 90 and 99
  • Not reimbursable when billed with each other, CPT® code 87635 or HCPCS codes U0001 or U0002

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