COVID-19 Laboratory Test Place of Service Limitation

Published 03/17/2021

CMS has directed Medicare Administrative Contractors (MACs) to make any necessary Part B claim editing changes to ensure the following COVID-19 laboratory tests when billed with place of service 19 (off-campus outpatient hospital), 21 (inpatient hospital), 22 (on-campus outpatient hospital), or 23 (emergency room-hospital) are denied.

Clinical laboratory tests performed in these places of service represent Part A facility charges that must be billed by the facility. Denials will include claim adjustment reason code 109: Claim/service not covered by this payer/contractor. 

You must send the claim/service to the correct payer/contractor. These editing changes bring the processing of the listed COVID-19 clinical tests in line with longstanding processing guidelines for all other clinical tests performed in these places of service. 

CPT/HCPCS Code

CPT/HCPCS Code

CPT/HCPCS Code

CPT/HCPCS Code

CPT/HCPCS Code

CPT/HCPCS Code

U0001

86318

86769

87637

87637

0226U

U0002

86328

87426

87811

87811

0240U

U0003

86408

87428

0202U

0202U

0241U

U0004

86409

87635

0224U

0224U

G2023

U0005

86413

87636

0225U

0225U

G2024


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