by Wyn Staheli, Director of Research
April 21st, 2020
With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.
Specimen Collection Coding
During this PHE, for their own safety or the safety of others, patients are confined to their homes to minimize the risk of exposure. Therefore, in order to obtain testing, new codes and methodologies have been put into place.
To report the collection of a specimen for COVID-19 testing, report one of the following codes (as applicable):
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]);
G2023 - any specimen source
G2024 - from an individual in an SNF or by a laboratory on behalf of an HHA, any specimen source
Additionally, if a patient is homebound (see definition below), a healthcare provider will need to travel in order to obtain the specimen. To report travel incurred obtaining a specimen, report one of the following codes (as applicable):
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient;
P9603 - prorated miles actually travelled
P9604 - prorated trip charge
CMS Definition of Homebound
According to the “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” Final Rule, “the definition of ‘confined to the home’ (that is, ‘homebound’) allows patients to be considered 'homebound' if it is medically contraindicated for the patient to leave the home.” They gave the following examples during this PHE:
- A physician has determined that it is medically contraindicated for a beneficiary to leave the home because he or she has a confirmed or suspected diagnosis of COVID-19
- A physician has determined that it is medically contraindicated for a beneficiary to leave the home because the patient has a condition that may make the patient more susceptible to contracting COVID-19.
It should be noted that CDC guidelines specifically advise older individuals to stay at home, except for getting medical care. So older adults who are self-quarantining on their own — meaning that they have not been instructed by a healthcare provider to do so — would not be considered homebound for Medicare purposes unless “...there exists a normal inability for an individual to leave home and leaving home would require a considerable and taxing effort.”
Documentation of Laboratory Specimen Collection of Homebound Patient
It is necessary that the documentation clearly identifies how the patient meets the “homebound” requirement; however, CMS has noted “that paper documentation of miles traveled is not required and laboratories can maintain electronic logs with that information.”