OMFS: DWC Orders Further Pathology/Clinical Lab Adjustments

OMFS: DWC Orders Further Pathology/Clinical Lab Adjustments

California’s Division of Workers Compensation (DWC) ordered further adjustments to the Pathology and Clinical Laboratory Section of the state’s Official Medical Fee Schedule (OMFS) for workers’ compensation. The changes increase reimbursement for “high throughput” COVID-19 testing and apply retroactively.

The latest order by the Administrative Director adds two new billing codes, as well as adjusting fees and clarifying effective dates of service for other, existing codes.

COVID-19 Necessitates New Billing Codes

The DWC order adds the following Health Care Common Procedure Coding System (HCPCS)  codes to the Pathology and Clinical Laboratory fee schedule for COVID-19 testing:

Billing Code

Procedure

Effective Dates of Service

Reimbursement

U0003

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, making use of high throughput technologies as described by CMS-2020-01-R

On or after March 18, 2020

$120.00

U0004

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R

On or after March 18, 2020

$120.00

According to an April 23 DWC Newsline, the “more intensive training and resources required for high throughput devices,” which process over 200 specimens per day, warrants higher reimbursement rates to providers.

Accordingly, the same order adopts the changes and clarifications listed in the table below to the Pathology and Clinical Laboratory fee schedule.

Billing Code

Procedure

Effective Dates of Service

Reimbursement

U0001

CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel

On or after February 4, 2020

$43.09

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

On or after February 4, 2020

$61.57

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source

On or after March 1, 2020

$28.15

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source

On or after March 1, 2020

$30.55

CPT 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

On or after March 13, 2020

Medicare rate not set

See CMS-Ruling 2020-1-R : “It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.”

With these adjustments, the Pathology and Clinical Laboratory fee schedule conforms to the Medicare payment system as required by Labor Code section 5307.1. The adjustments came as a result of the Centers for Medicare and Medicaid Services (CMS)’s additional changes to the 2nd Quarter 2020 Medicare update, as well as the April 14 CMS ruling which created the new HCPCS codes for “high throughput” testing.

As always, DaisyBill welcomes questions or concerns from providers regarding the billing and payment landscape as altered by COVID-19. Email info@daisybill.com, and we will address the most frequently asked questions in this space.

Check out our COVID-19 resources page, which includes free videos on how to bill for telehealth, fee schedule updates, and other news and guidelines relevant to the current situation.

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