Skilled Nursing Facility payment for outpatient COVID-19 testing

Last modified: July 16,  2021

In an effort to further support our valued Skilled Nursing Facility (SNF) partners, we’re implementing payment for COVID-19 testing performed outside of a skilled inpatient stay at an SNF for Medicare Advantage members.

The effective dates of the COVID-19 testing reimbursement will be for the duration of the national public health emergency period, from Jan. 27, 2020, and renewed on April 21, 2021, subject to further extension.

We’re reprocessing claims – no action required from you

COVID-19 testing performed outside of a skilled inpatient stay at a SNF were reimbursed at a zero-dollar amount. We will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.

Plans included: 

  • Medicare Advantage Plans
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • UnitedHealthcare Assisted Living Plans (IE-SNP)
  • FIDE/MMP Plans

Plans not included:

  • UnitedHealthcare Nursing Home Plans (ISNP)
  • UnitedHealthcare commercial plans
  • UnitedHealthcare Community Plans (Medicaid Only Plans)

Impacted codes to use

COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.

These COVID-19 testing codes will be reimbursed at 100% of the CMS fee schedule allowance:

Testing procedure codes

Description

87635

Diagnostic test

87426

Antigen detection of SARS-CoV and SARS-CoV-2/rapid test

87636-87637

Combined testing

87811

Antigen detection of SARS-CoV-2

87428

Multiplex viral/rapid test

U0001-U0005

Diagnostic tests – HCPCS codes

0226U

PLA codes for detection of SARS-CoV-2

0240U-0241U

PLA codes combo detection

0224U

Antibody test

86328

Antibody test

86769

Antibody test

86408

Antibody test

86409

Antibody test

86413

Antibody test

Qualifying related services

Codes

Description

99001

Specimen handling

G2023, G2024, C9803

Specimen collection