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.