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Provider Notice Issued 01/08/2021

Date:   January 8, 2021

 

To:       Federally Qualified Health Centers, Rural Health Centers, and Encounter Rate Clinics

 

Re:      Correction to Previous Billing Guidance for COVID-19 Specimen Collection Code 99000

 

 

This notice provides corrected information to that communicated in the July 17, 2020 provider notice regarding billing of specimen collection procedure code 99000 when there is a billable encounter (face-to-face visit with a physician, physician assistant, or advance practice nurse).  This information is effective with dates of service beginning March 18, 2020 and applies to claims for participants covered under both traditional Medicaid fee-for-service and Medicaid managed care plans.

 

A COVID-19 specimen collected during an encounter is considered inclusive of the visit detail code. Therefore, CPT 99000 should not be reported separately as a detail code in addition to the T1015 encounter procedure code and visit detail code as originally instructed in the

July 17, 2020 provider notice. When a patient presents for COVID-19 specimen collection only and there is no billable encounter, clinics may bill 99000 only and be reimbursed $23.46.

 

Clinics that have received G70 rejections due to their encounter claims containing detail code 99000 should exclude that detail code and rebill. The timely filing edit has been suspended for these specific claims. 

 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565. 

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​ 


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JB Pritzker, Governor • Theresa Eagleson, Director