Coronavirus (SARS-CoV-2 or COVID-19) Pricing

 

CLH offers Coronavirus testing, also known as SARS-CoV-2 or COVID-19 testing, through multiple methods:

  • Molecular Test – Also called polymerase chain reaction (PCR) or nucleic acid amplification tests (NAAT), this method detects low levels of viral genetic material or nucleic acid present inside a virus particle, and tend to be highly sensitive (especially laboratory PCR tests)
  • IgG test - Also known as serology or antibody testing, this method looks for an antibody called immunoglobulin G (IgG) that is typically produced as an immune response if you have been exposed to the virus that causes COVID-19

Molecular tests are usually ordered to detect active infections, whereas IgG tests are used to determine if you had the Coronavirus in the past.  Both methods must be ordered by a healthcare provider.  Both tests require payment, and only those tests are medically necessary are customarily covered by insurance.  Pre-travel, pre-employment, return to work, or self-requested testing is not covered by insurance and as a result, require payment at the time of service (specimen collection).  Prices for testing exclusive of fees that may be charged by healthcare organizations willing to order the test via drive through collection sites, are shown below.

 

Test NameBilling Code (CPT Code)Cash Price
SARS-CoV-2/COVID-19, molecularU0003, U0004, and 87635$125.00
SARS-CoV-2/COVID-19, IgG86769$40.00

 

Prices are subject to change.  All tests have received Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA).

 

 

Posted November 11, 2020

Effective October 6, 2020:  The AMA CPT updated the SARS-CoV-2 codes to include these new codes described below, at https://www.ama-assn.org/system/files/2020-10/coronavirus-long-descriptors.pdf.

 

Combined respiratory virus multiplex testing for the SARS-CoV-2, influenza virus A and influenza B targets

CPT Code 87636:  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
Net Price:  $143.00

 

Combined respiratory virus multiplex testing for the SARS-CoV-2, influenza virus A, influenza B targets and respiratory syncytial virus (RSV)

CPT Code 87637:  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
Net Price:  $143.00

 

 

Posted July 31, 2020

Update for Health Plans: New Pricing and CPT Code Information

Test NameCPT CodeNet Price (Expected Net Reimbursement)
SARS-CoV-2/COVID-19, High throughputU0003, U0004, and 87635$130.00
SARS-CoV-2/COVID-19, IgG86769$43.00*

 

*Effective April 30, 2020, Clinical Labs of Hawaii (CLH) began performing serology tests for COVID-19. In response to this national health crisis and to ensure optimal access for patients, we are offering a single price for all payors.

  • All previous pricing shown (e.g., March 23, 2020 Update for Health Plans) represent a Net Price (Expected Net Reimbursement)
  • As for all COVID-19 tests, CLH uses multiple platforms and methodologies for serology testing in order to:
    • maintain critical turnaround time commitment
    • prevent service interruptions due to platform-specific supply chain issues
    • resolve indeterminate results or inconsistencies between test results and clinical presentation
  • All tests have received Emergency Use Authorization (EUA) by the FDA.

 

 

Posted March 23, 2020

As part of our commitment to provide high quality services and optimal access to your members, Clinical Labs of Hawaii will continue to provide updates regarding testing for SARS-Cov-2/COVID-19.
 

Testing Access and Test Performing Locations:

  • Patients can access the test through requests generated by local healthcare providers currently serviced by Clinical Labs of Hawaii.
  • Testing is performed seven days a week and we are distributing test capacity amongst our laboratories to meet the demands of our clients.

 

Pricing and CPT Code Information:

  • Pricing: $130 per test, same for all CPT codes
  • CPT Codes: U0001, U0002, 87635

 

In response to this national health crisis and to ensure optimal access for patients, we are offering a single price for all payors, clients and patients. Any future adjustment due to changes in supply chain commitment and availability will apply to all payor agreements.

The goal of our pricing approach is to ensure affordable patient access and protect our testing capacity to avoid service interruptions. Our price is established to support the turnaround time, indeterminate result resolution and the four different platforms and methodologies, including the current gold standard CDC/IDT assay.