Help Ensure Accurate Payment for COVID-19 Testing

Last modified: November 10, 2020

Follow Centers for Medicare & Medicaid Services (CMS) coding guidelines when billing, to help ensure you’re receiving accurate reimbursement for UnitedHealthcare Medicare Advantage plans. Per CMS article A56851- MoIDX- Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels, there are certain guidelines that CMS requires for payment.

What You Need to Do

You are responsible for submitting accurate claims in accordance with CMS national coverage determinations, local coverage determination, state and federal laws and UnitedHealthcare’s reimbursement policies.

When submitting COVID-19-related claims under CPT® code 87631 (Infectious agent detection by nucleic acid (DNA or RNA)), claims must have two diagnosis elements in the claim submission:

  1. Must be listed under the appropriate article per state jurisdiction
  2. Must provide reasons (signs or symptoms) for suspicion of respiratory illness

Please be sure to check all applicable COVID-19 testing CMS articles and bill according to CMS guidelines.

Learn More

For additional COVID-19 testing guidance visit > Testing, Treatment, Coding & Reimbursement.

*CPT® is a registered trademark of the American Medical Association.