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Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)

Our new reimbursement policy, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), will be effective January 1, 2021. This policy aligns with the Centers for Medicare & Medicaid Services’ approach.

Effective January 1, 2021, and throughout the period of the COVID-19 public health emergency as declared by the Governor of New Jersey, we will:

  • Consider an additional add-on payment (U0005) of $25 for COVID-19 diagnostic testing run on high throughput technology, when billed with procedure code U0003 or U0004, and when the following conditions are met:
    1. Procedure codes U0003 or U0004 COVID-19 testing is completed in two calendar days or less for the specific test billed, and
    2. The laboratory can certify that 51% of the previous months' U0003 and U0004 COVID-19 diagnostic testing was completed within two calendar days or less.
  • Reduce our reimbursement for U0003 and U0004 from $100 to $75.

The clinical laboratory must maintain self-certification of the above conditions.

Failure to adhere to the above requirements while continuing to bill U0005 shall be considered inappropriate billing with this policy and may result in add-on payments not being reimbursed.

We reserve the right to perform post-service audits to ensure the above requirements are met and to recover reimbursement made if these requirements are not met.

We encourage clinical laboratories to review the content of our Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005) reimbursement policy.

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