MedicaidBilling CodesMedium impact
MAB2020050101
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Infectious Disease +1 more·Provider Bulletin
Effective date
Feb 4, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) added multiple new COVID-19 laboratory test codes (HCPCS U0001-U0004, CPT 87635, 86328, 86769) to their fee schedule with varying effective dates from February 2020 to April 2020. These codes cover different types of COVID-19 testing including PCR diagnostic tests and antibody tests, with specific reimbursement rates and frequency limits.
Action Required
Immediately: Update billing system to include new COVID-19 test codes U0001, U0002, U0003, U0004, 87635, 86328, and 86769 for Pennsylvania Medicaid patients. Configure frequency limits (1-3 per day depending on code) and reimbursement rates. Ensure providers have appropriate CLIA certification for testing. Add QW modifier capability for codes U0002 and 87635 when applicable.