Previously, UHC would not reimburse for COVID-19 testing when done outside of a skilled inpatient stay at a SNF.
However, during the PHE, starting Jan 27,2020 and then renewed on April 21,2021, subject to further extension, UHC is going to pay for the COVID-19 testing that is done outside of the skilled inpatient stay at a SNF.
This change applies to the following Medicare Advantage Plans:
Medicare Advantage Plans
Dual Eligible Special Needs Plans (DSNP)
Chronic Special Needs Plans (CSNP)
UnitedHealthcare Assisted Living Plans (IE-SNP)
Plans that this change DOES NOT APPLY TO:
UnitedHealthcare Nursing Home Plans (ISNP)
UnitedHealthcare commercial plans
UnitedHealthcare Community Plans (Medicaid Only Plans)
UHC will re-process theclaims, there is no further action needed.
UHC will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.
The following codes are going be reimbursed at 100% of Medicare Fee Schedule:
COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.
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These codes should only be used when the provider or facility is NOT running the test.
+Providers should bill 99211-CS for collecting specimen in the office setting.
+Independent clinical diagnostic laboratories should bill G2023 or G2024 (for patients that are homebound, in skilled nursing facility)
+Outpatient Hospitals should use C9803 to code for symptoms assessment and specimen collection.
Effective for DOS 05/01/2020 and thereafter (consistent with NY Medicaid billing guidance)
+Practicioners and Clinics should bill G2023 or G2024 -this code should be bill ONLY when NO OTHER service was given to the patient on that particular DOS AND the provider is NOT billing for Laboratory COVID-19.
+ Independent Laboratories (POS 81) are NOT reimbursed separately for specimen collection
G2023 – Specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) by a laboratory on behalf of a home health agency, any specimen source
G2024 – Specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) from an individual in a skilled nursing facility by a laboratory, any specimen source
C9803 – Hospital outpatent clinic visit specimen collecton for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source
99211-CS – Use for specimen collecton in the physician ofce for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source