Coding Guidance for Pharmacies
New York Medicaid plans will reimburse Providers for COVID-19 specimen collection or CLIA waived COVID-19 testing for Medicaid Members, when such collection or testing is in compliance with the Governor’s Executive Order #202.24.
To see the full announcement please click here.
Effective 07/01/2020-
Medicare and Commercial:
Effective for DOS 03/01/2020 and thereafter
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.
Medicaid:
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
Code Definitions:
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
NOTE: This announcement was published in Empire NY Providers communication section on FEB 1,2020
According to Empire BCBS Health Plus (NY)- starting back in 12/1/2019- they began denying claims that were billed with non-covered codes (NY Medicaid).
HCPCS and CPT codes that are not on the NY Medicaid fee schedule are considered non-covered.
This policy affects only MMC and Child Health Plus programs.
Empire suggests that some of these non covered codes should be billed with a more appropriate code or a code that is considered (bundled).
For the list of COVERED codes please click on https://www.emedny.org.
For a complete list of NON covered CPT/HCPCS codes please visit: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf
Providers should bill the most current CPT or HCPCS code on the current NY Fee Schedule to avoid unnecessary denials.
If you have questions about this announcement please contact your Provider Relations Representative or the Provider Services: 1-800-450-8753
KR2 Medical Billing 