Does any one know how United and Aetna are paying for PCR tests? Looks like we are losing money on these codes. Any helpful answers would be appreciated.
Most carriers are paying at least the CMS Medicare amount of $51.31–United has been a notable exception. (Why? Because they can.) HOWEVER, as noted on SOAPM on June 4, they will increase their payment to the CMS level IF you jump through some hoops. See:
COVID-19 testing for pediatric/family
medicine health care professionals
We heard the concerns from health care professionals like you and we’re working to
address them. With that, for dates of service Jan. 1, 2021 through Dec. 31, 2021,
UnitedHealthcare is willing to reimburse you at 100% of the Centers for Medicare &
Medicaid Services (CMS) rate for the following COVID-19 test codes, in spite of our
previous contractual arrangement:
• 87635
• U0001
• 87636
• U0002
• 87811
• U0003
• 0240U
• U0004
• 0241U
• U0005
Reminder: You should not bill UnitedHealthcare members for any costs associated with the
COVID-19 testing.
What you need to do
To receive the full 100% CMS rate amount, you will need to:
1. Contact UnitedHealthcare at covidpediatrictest@uhc.com or by calling 866-229-
2921.
2. Provide UnitedHealthcare with proof of services including, but not limited to, invoices
and applicable documentation of COVID-19 diagnostic testing services that cost the
practice more than the UnitedHealthcare reimbursed amount.
3. Review, sign and return a one-page amendment of your existing contract, which will
outline the CMS rate in full details.
a. Claims prior to amendment signing: Once you’ve signed your
amendment, we will retroactively reprocess claims with dates of service
starting from Jan. 1, 2021.This process may take up to 90 days from the
date of signing your amendment.
b. Claims after amendment signing: For claim submissions after you’ve
signed your amendment, you should see a new rate on those claims.
UnitedHealthcare will be batching this process monthly. It may take 6-8
weeks, depending on cycle time, for new rates to be reflected. This new rate
will be based on your amendment agreement and will be effective
throughout 2021.
4. We’ll notify you once your claims have been reprocessed.
Questions?
If you have any questions, please email covidpediatrictest@uhc.com.
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We use PCR test, code 87636 - Covid and Flu A/B (LIAT), charge $220 and UHC and Anthem range from a reimbursement of $58.31 up to as high as $183.30! The average UHC payment is $58.31 or $65.34 and Anthem most common payment amount is $65.35. Depends on the plan. We feel the other carriers reimburse well enough to cover the low margin from ANT and UHC. Caresource is paying $149.76 per test!
Bah - you asked for Aetna - not Anthem. Aetna is reimbursing $206.96 per 87636!
Thank You for the info
Hi, which PCR test (machine) do you do for billing 87636?
Cobas LIAT is the name of the machine.
Thank you for this information! Has anyone had success completing this process?
I was told FDA recalled the machine. Henry Schein has stopped selling the machine.
https://www.360dx.com/regulatory-news-fda-approvals/fda-warns-potential-false-positive-results-roche-cobas-liat-rapid-sars#.YSzssY5KiUk
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRes/res.cfm?ID=186423
So, everything is fine?
Works well for us and we are doing our best to order another asap.
I had one 4 years ago and I returned it. My major problem I recall was the refrigeration required for the test kits. We run hundreds of tests so the refrigeration needs was a big issue. Do the test still require refrigeration? I got the machine for free in the past and no commitments. What is the deal now?
Refrigeration is required - and yes, there are contractual obligations for so many test kids purchased in a year.
We work through our McKesson rep for testing machines and supplies.
Not to put him on blast - but here is the rep and his info that we work with regarding contracting:
Seth Gutwein
Inside Sales Representative - Point of Care
Roche Diagnostics
9115 Hague Road
Indianapolis, Indiana 46256
Cell: 317-263-4248 (EST)
Email: seth.gutwein@roche.com