Revised editing for ordering/referring providers on lab claims

Because of the COVID-19 public health emergency (PHE), CMS previously amended regulations to remove the requirement that certain diagnostic tests are covered only when ordered by the treating physician.

With CMS' revised policy, Medicare beneficiaries may receive coverage for one COVID-19 and related test without the order of a physician or non-physician practitioner. This revised policy includes the following codes:

If you believe your claim denied in error due to missing an ordering provider, includes one of the codes listed above, and is for a date of service on or after March 1, 2020, you can complete a history correction reopening.

History corrections can be completed using:

Additional instructions are available on the Submit claim corrections and reopening's (JH) (JL) page of our website.

Note: Effective for claims processed on and after May 4, 2021, the ordering/referring provider NPI will be required for procedure codes 87632 and 87633.