MedicaidReimbursementMedium impact
Update to COVID-19 Diagnostic Testing Codes and Rates Effective March 1, 2021
Illinois Medicaid - HFS·IL · Pathology, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Mar 1, 2021
We identified it
Jun 20, 2026
Summary
Effective March 1, 2021, reimbursement rates for COVID-19 diagnostic testing codes U0003 and U0004 decreased from $100 to $75. A new add-on code U0005 is now available for $25 when labs meet specific turnaround time requirements for expedited results.
Action Required
By March 1, 2021: Billing team must update fee schedules to reflect reduced rates for U0003 and U0004 ($75 instead of $100). Add new HCPCS code U0005 ($25) for eligible high-throughput COVID-19 tests completed within 2 calendar days when lab meets 51% monthly turnaround requirement. Labs must maintain self-certification documentation to support U0005 billing or face recoupment during post-payment review.