CPT code 87635: COVID 19 coding guidelines

Basics of Covid 19 CPT code 87635 & HCPCS code U0001/U0002

The COVID 19 cases or Coronavirus diagnosed cases should be reported separately with unique specific CPT and HCPCS codes. Three codes have been added newly for Covid 19 or coronavirus related cases. CPT code 87635 should be reported by the payers other than medicare for testing services related to SARS-CoV-2/2019-nCoV (COVID-19). While for medicare payers two new HCPCS code U0001 and U0002 should be used for CDC testing laboratories and non-CDC testing laboratories for for SARS-CoV-2/2019-nCoV (COVID-19) respectively.

The AMA added the Category I Pathology and Laboratory CPT code 87635 in reference to COVID-19 testing, effective March 13, 2020.

               
Attentive physicians and coders will note that the pathology and laboratory section of the CPT code set already contains codes for coronavirus testing. But those are for nucleic acid assays that detect multiple respiratory viruses in a multiplex reaction, while CPT code 87635 is for the detection of SARS-CoV-2 (COVID-19) and any pan-coronavirus types or subtypes.
CPT code 87635: COVID 19 coding guidelines

Description of CPT code 87635 

87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
Use of code 87635 will help to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the United States.
For Medicare claims, the Centers for Medicare & Medicaid Services (CMS) has established two new Healthcare Common Procedure Coding System (HCPCS) codes for coronavirus testing. HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2 and to track new cases of the virus. HCPCS code U0002 is intended for laboratories to report non- CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). Therefore, to meet the needs of the CDC safety-monitoring programs and to track the specific testing performed, it is important that the appropriate code is listed on claim forms.
CPT Code 87635 does not require reporting of an additional CPT code for this service. There are no known restrictions on the reporting of code 87635, if performed as a separate assay, with CPT code 87631, 87632, 87633, 0098U, 0099U, or 0100U. Codes selected should accurately describe the service provided.

Description of HCPCS code U0001 & U0002

The Centers for Medicare & Medicaid Services (CMS) developed two new lab testing codes:
U0001 CDC 2019 novel coronavirus (2019-nCoV) real-time RT-PCR diagnostic panel
U0001 will be reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
U0002 will be reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID- 19).
Code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2 and to track new cases of the virus. HCPCS code U0002 is intended for laboratories to report non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
If your office is not running the test for COVID-19 or incurring the cost, you will not report these codes.
CPT code 87635  and HCPCS code U0001 & U0002 should not both be reported on the same claim. Ypu can contact your local third-party payer directly to determine their specific reporting guidelines.
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9 Thoughts to “CPT code 87635: COVID 19 coding guidelines”

  1. […] we learnt previously the ICD 10 codes list for COVID 19 or coronavirus cases and also the use of CPT code 87635 for COVID 10 […]

  2. […] already seen the complete list of ICD 10 codes for Covid 19 and the coding guidelines for them. The CPT code 87635 and the two new HCPCS codes U0001 and U0002 have also been added recently for Covid 19 lab […]

  3. […] modifier is applicable for COVID-19 Lab test CPT code 87635 and below E&M category […]

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  5. […] used for COVID 19 or coronavirus cases I have already shared. It is also important to check the CPT codes used for COVID 19 reports before using the COVID-19 ICD […]

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