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​
