Attention lab providers: COVID-19 update regarding reimbursement

Material Adverse Change (MAC)

 

Reimbursement changes to COVID-19 laboratory services codes for Commercial and Medicare Advantage programs from Empire BlueCross and BlueShield (Empire) in New York.

 

Beginning with dates of service on or after January 12, 2023, or the end of the public health emergency (PHE), whichever is the latter, reimbursement for COVID-19 laboratory services codes will be reduced for providers contracted as independent laboratory (ancillary) providers and participating in an Empire independent laboratory provider network.

 

New COVID-19 laboratory service codes were implemented and reimbursed at rates to meet the needs of providers during the PHE. Reimbursement will be revised to Empire’s standard reimbursement methodology for independent laboratory providers for the following codes:

 

U0001	86328	87426	87811	0226U
U0002	86408	87428	0202U	0240U
U0003	86409	87635	0223U	0241U
U0004	86413	87636	0224U
U0005	86769	87637	0225U

 

The revised standard fee schedule for the COVID-19 laboratory services codes outlined above can be viewed on www.availity.com* beginning January 12, 2023.

 

If you have any questions regarding this notice, please contact your designated Ancillary Provider Network manager. Please incorporate this notice into your Empire provider agreement folder.

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross and BlueShield.
NYBCBS-CRCM-013045-22-CPN12350