When to use new HCPCS code C9803

Again their is one more important update from Medicare for coding coronavirus or COVID 19 cases. Their is a new HCPCS code C9803 has been added for Hospital OPPS for specimen collection. The New HCPCS code, C9803, is created to describe hospital outpatient clinic visit specimen collection for SARS-CoV-2 (COVID-19), any specimen source. The code will be reimbursed at $22.98 and it will be retired after the public health emergency ends.

This new Level II HCPCS code C9803 has been added by CMS for specimen collection for COVID-19 testing. This code will be used only for billing Medicare under the Outpatient Prospective Payment System (OPPS).

Read also : When to use COVID 19 CPT code 87635

When to use Antibody testing CPT code for COVID 19

While hospital outpatient departments should use a new Healthcare Common Procedure Coding System code, C9803, Providers should bill Medicare under the existing level 1 evaluation and management code CPT code 99211

The new code, C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source, is effective for services provided on or after March 1, 2020. 

OPPS claims received on or after May 1, 2020, with Coronavirus Specimen Collection HCPCS Codes G2023 and G2024 will be returned to you with edit W7062. Resubmit returned claims as a packaged service to include Code C9803, when appropriate.

Since their has been lot of confusion in coding COVID 19 cases due to addition of so many new CPT and HCPCS codes. Below table will help to differentiate between these new COVID 19 codes and when these codes should be used.

• CDC RNA Based Lab Test ; HCPCS code U0001
• Non- CDC Lab Test that uses any technique, multiple types or subtypes (includes all targets) ; HCPCS code U0002
• Non CDC Lab Test using RNA based technique ; CPT code 87635
• Serology (antibody) test ; CPT code 86328, CPT code 86769
• Lab Test Using High Through-Put Technology ; HCPCS code U0003, HCPCS code U0004
• Lab Specimen Collection from a Patient ;

1. HCPCS code C9803 billed by hospital outpatient department
2. HCPCS code 99211 billed by a physician office
3. HCPCS code G2023/G2024 for home/nursing home collection by a lab or on behalf of a home health agency