COVID-19: Billing Guidelines

February 10, 2021

Disclaimer: Due to continual development by the Centers for Disease Control and Prevention (CDC) and state laws, the contents of this bulletin will be updated regularly. Please refrain from saving or printing this information to ensure you always have the latest updates.

BlueCross® BlueShield® of South Carolina and BlueChoice® HealthPlan cover diagnostic tests, related services (such as office visits, urgent care and emergency room visits) and provider visits that are consistent with CDC guidelines related to COVID-19 at no cost share to the member.

Both plans have waived out-of-pocket costs for in-network COVID-19 medical treatment for members through April 30, 2021. Beginning May 1, 2021, COVID-19 medical treatment will be covered according to the member's plan benefits.

In addition, both plans have waived prior authorization for any other diagnostic tests and related services for members who have been diagnosed with COVID-19, until April 30, 2021. These tests and services must follow CDC guidelines.

Serology (antibody) testing will only be covered when medically appropriate for an individual, as determined and ordered by their physician, after an evaluation is completed and in accordance with accepted standards of current medical practice. Serology testing should not be used solely to diagnosis the COVID-19 infection.

Note: This applies to all full insured business and some self-insured plans. It does not include Healthy BlueSM.

In response to recent updates, slight modifications have been made to the billing guidelines.

 

Codes Used for the Testing of COVID-19

86328 — Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

86408 — Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen

86409 — Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer 

86413 — Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative 

86769 — Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

87426 — Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative, and multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19])

87428 — Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

87631 — Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, three to five targets

87632 — Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, six to 11 targets

87633 — Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12 to 25 targets

87635 — Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

87636 — Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637 — Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique  

87811 — Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19))

87428 — Infectious agent antigen detection by immunoassay technique (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

0098U — Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 14 targets (adenovirus, coronavirus, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, human rhinovirus/enterovirus, respiratory syncytial virus, bordetella pertussis, chlamydophila pneumoniae, mycoplasma pneumoniae)

0099U — Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 20 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus, coronavirus OC43, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, human rhinovirus/enterovirus, respiratory syncytial virus, bordetella pertussis, chlamydophila pneumoniae, mycoplasma pneumoniae)

0100U — Respiratory pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 210 targets (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, influenza A, influenza A subtype H1, influenza A subtype H3, influenza A subtype H1-2009, influenza B, parainfluenza virus, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, human rhinovirus/enterovirus, respiratory syncytial virus, bordetella parapertussis (IS1001), bordetella pertussis (PTXP), chlamydophila pneumoniae, mycoplasma pneumoniae)

0202U — Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

0223U — Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected 

0240U — Infectious disease (viral respiratory tract infection), pathogen-specific RNA, three targets (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected 

0241U — Infectious disease (viral respiratory tract infection), pathogen-specific RNA, four targets (severe acute respiratory syndrome coronavirus (SARS-CoV-2), influenza A, influenza B, respiratory syncytial virus (RSV)), upper respiratory specimen, each pathogen reported as detected or not detected  

0224U — Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], includes titer(s), when performed
Note: Do not report 0224U in conjunction with 86769.

U0001 — 2019-nCoV Real-Time RT-PCR Diagnostic Panel, CDC. 
Note: Use this code if your lab uses CDC test kits.

U0002 — 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC. 
Note: Use this code if your lab does not use CDC test kits and your test is not described by code 87635 listed below.

U0003 — Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. 

U0004 — 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R

 

Vaccine Codes

Pfizer

  • 0001A, first dose — 30mcg/0.3mL dosage: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose)
  • 0002A, second dose — 30mcg/0.3mL dosage: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose)

Moderna 

  • 0011A, first dose — 100 mcg/0.5mL dosage: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose)
  • 0012A, second dose — 100 mcg/0.5mL dosage: Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose)

Note: The vaccines are funded by the government and should not be billed for payment.

 

Monoclonal Antibody Infusion Therapy Codes

Bamlanivimab 

  • M0239 — Intravenous infusion, Bamlanivimab-xxx, includes infusion and post administration monitoring

Casirivimab and Imdevimab 

  • M0243 — Intravenous infusion, Casirivimab and Imdevimab, includes infusion and post administration monitoring

Note: At this time, prior authorization is not required.  Also, the drugs are funded by the government and should not be billed for payment.

 

Diagnosis Codes

B97.29 — Other Coronavirus as the cause of diseases classified elsewhere 

J12.82 — Pneumonia due to coronavirus disease 2019 

M35.81 — Multisystem inflammatory syndrome 

M35.89 — Other specified systemic involvement of connective tissue 

U07.1 — 2019-nCoV acute respiratory disease
Note: This code should be used when it has been confirmed that the member has COVID-19. For suspected exposure, use one of the other codes listed in conjunction with other appropriate diagnosis codes.    

Z03.818 — Encounter for observation for suspected exposure to other biological agents ruled out

Z20.822 — Contact with and (suspected) exposure to COVID19 

Z20.828 — Contact with and (suspected) exposure to other viral communicable diseases

Z11.52 — Encounter for screening for COVID-19 

Z11.59 — Encounter for screening for other viral diseases

Z86.16 — Personal history of COVID-19 

It is expected that coding for COVID-19 diagnosis now use the available COVID-19 specific codes, and not coding that was used as billing guidance at the start of the COVID-19 pandemic. The coding guidance at the start of the pandemic recommended using existing diagnosis codes not specific to COVID-19 until COVID-19 specific codes became available. 

For patients presenting with symptoms (e.g., cough, fever, etc.) and where a definitive diagnosis has not been established but COVID-19 exposure is suspected or possible, be sure to assign the appropriate diagnosis code(s) for each symptom in addition to a COVID-19 diagnosis code that identifies the suspected, possible or probable exposure.

For example, if a patient comes into the office and has a cough and fever, and you suspect they have been exposed to COVID-19, the claim should be filed with diagnosis codes R05, R50.9 and Z20.828.

Refer to CAM 244 on the Medical Policies page of www.BlueChoiceSC.com for further guidance.

For questions regarding the information presented in this bulletin, please contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.