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New HCPCS Codes for COVID-19 Testing

Date: 03/27/20

Coronavirus disease 2019 (COVID-19) is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, the total impact of the illness, and many other factors. Superior HealthPlan encourages members who have been exposed to COVID-19 or begin showing symptoms of the virus or flu, to contact their health-care provider immediately. As a reminder, members can schedule a telehealth visit with an in-network provider and avoid having to leave their home.

Telehealth visits with a Superior in-network provider are available for ­most members at no cost and no cost sharing. Additionally, COVID-19 testing per CDC guidelines is available at no cost or cost sharing for members.

Any provider in the Superior network can offer telehealth services to Superior members for certain health-care needs. Telehealth services are virtual health-care visits with a provider through a mobile app, online video or phone.

Superior treats telehealth services with in-network providers in the same way as face-to-face visits.

  • A telehealth visit with an in-network Superior provider does not require prior authorization.
  • Telehealth visits with an in-network Superior provider are available to members at no cost.

New Healthcare Common Procedure Coding System (HCPCS) Codes

The American Medical Association (AMA) has created a Current Procedural Terminology (CPT) code to report laboratory testing services that diagnose the presence of COVID-19, according to the Texas Medical Association (TMA). This CPT code, 87635, is effective immediately, and is defined as follows:

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.

Labs will need to upload the code descriptor into their electronic health record (EHR) system manually in order to report this early-release code. This code will become part of the complete 2021 CPT code set, which will be released later this year.

The release of this CPT code follows the Centers for Medicare & Medicaid Services (CMS)’ creation of two new Healthcare Common Procedure Coding System (HCPCS) codes for labs for testing patients for coronavirus.

  • HCPCS code U0001 - Used specifically for Centers for Disease Control and Prevention (CDC) testing laboratories to test patients for the coronavirus.
  • HCPCS code U0002 - Allows laboratories to bill for non-CDC laboratory tests for the virus.

Please hold claims until April 1, 2020, for COVID 19 testing to allow for the new procedure codes to be implemented.

For questions about telehealth services*, please contact Provider Services:

  • STAR, CHIP, STAR Health, STAR Kids, STAR+PLUS: 1-877-391-5921
  • Allwell from Superior HealthPlan: 1-877-391-5921
  • STAR+PLUS Medicare-Medicaid Plan (MMP): 1-877-391-5921
  • Ambetter from Superior HealthPlan (HMO, HMO SNP): 1-877-687-1196

*We are actively working with Texas Health and Human Services (HHS) and Texas Association of Health Plans (TAHP) to evaluate the expansion of telehealth and telemedicine to other services in Medicaid and CHIP. 

Telehealth and telemedicine can only be provided by those services currently specified in the Texas Medicaid Provider Procedures Manual.