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Elizabeth M. Whitehorn, Director

Provider Notice Issued 01/08/2021

Date:   January 8, 2021

 

To:       FederallyQualified Health Centers, Rural Health Centers, and Encounter Rate Clinics

 

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

 

 

 

 

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

 

A COVID-19 specimen collected during an encounteris considered inclusive of the visit detail code. Therefore, CPT 99000 should notbe reported separately as a detail code in addition to the T1015 encounterprocedure code and visit detail code as originally instructed in the

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

 

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

 

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

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​