Laboratory Testing

When possible, please refer your Humana-covered patients to an in-network laboratory if they need COVID-19 testing.

For COVID-19 testing, lab providers should use these HCPCS or CPT codes:

For dates of service Report one of these codes For this type of COVID-19 laboratory test

Feb. 4, 2020 – Mar. 12, 2020

HCPCS code U0001

The CDC-developed test kit

Feb. 4, 2020 – Mar. 12, 2020

HCPCS code U0002

A laboratory test that is not the CDC-developed test kit

Mar. 13, 2020 – Apr. 9, 2020

HCPCS code U0001

The CDC-developed test kit

Mar. 13, 2020 – Apr. 9, 2020

CPT code 87635

A laboratory test that is not the CDC-developed test kit that uses the method specified in the code description for CPT code 87635

Mar. 13, 2020 – Apr. 9, 2020

HCPCS code U0002

Any other COVID-19 laboratory test

Apr. 10, 2020 – Apr. 13, 2020

HCPCS code U0001

The CDC-developed test kit

Apr. 10, 2020 – Apr. 13, 2020

CPT code 86328, 86769 or 87635

A laboratory test that is not the CDC-developed test kit that uses one of the methods specified in the code descriptions for CPT code 86328, 86769 and 87635, as applicable according to AMA guidance (last updated April 10, 2020), opens new window

Apr. 10, 2020 – Apr. 13, 2020

HCPCS code U0002

Any other COVID-19 laboratory test

Apr. 14, 2020 – Current

HCPCS code U0001

The CDC-developed test kit

Apr. 14, 2020 – Current

CPT code 86328, 86769 or 87635

A laboratory test that is not the CDC-developed test kit that uses one of the methods specified in the code descriptions for CPT code 86328, 86769 and 87635, as applicable according to AMA guidance (last updated April 10, 2020), opens new window

Apr. 14, 2020 – Current

HCPCS code U0003

A laboratory test that is not the CDC-developed test kit that uses the method specified in the code description for CPT code 87635 but uses high throughput technologies

Apr. 14, 2020 – Current

HCPCS code U0004

Any other COVID-19 laboratory test that uses high-throughput technologies

Apr. 14, 2020 – Current

HCPCS code U0002

Any other COVID-19 laboratory test

For COVID-19 specimen collection services, Humana requires a provider to submit a charge as follows:

  • If the clinical staff at a physician or nonphysician practitioner’s office collected the specimen incident to their professional services, report CPT code 99211 for a new or established patient.
  • If the clinical staff at a hospital outpatient department collected the specimen:
    • For dates of service prior to March 1, 2020, report the most appropriate specimen collection code available for the date of service on CMS’s outpatient prospective payment system (OPPS).
    • For dates of service beginning March 1, 2020, report the new HCPCS code C9803 for collection of a COVID-19 laboratory test specimen.
  • If the staff from an independent laboratory collected the specimen from a homebound or non-hospital inpatient:
    • For dates of service prior to March 1, 2020, report the most appropriate specimen collection code available for the date of service on CMS’s Clinical Laboratory Fee Schedule (CLFS).
    • For dates of service beginning March 1, 2020:
      • Report the new HCPCS code G2024 if the patient is in a skilled nursing facility or the collection is being taken on behalf of a home health agency.
      • Report the new HCPCS code G2023 for a situation not described in the code description for HCPCS code G2024.

MODIFIER CS

For services provided during the COVID-19 public health emergency, append modifier CS to a claim line to identify the service as related to COVID-19 testing and therefore subject to the cost-sharing waiver.

Modifier CS may be appended to an evaluation and management service that:

  • Results in an order for or administration of a COVID-19 diagnostic laboratory test; and
  • Is related to either
    • the furnishing or administration of a COVID-19 diagnostic laboratory test, or
    • the evaluation of an individual for purposes of determining the need for such a test