COVID-19 treatment and testing

COVID-19 treatment

COVID-19-recognized treatment and inpatient medications received at in-network facilities are covered at no cost for our fully insured members through March 31, 2021. COVID-19-recognized treatment and inpatient medications are covered at no cost for Medicare Advantage members through the period that the COVID-19 public health emergency is in effect as declared by the Secretary of the Department of Health and Human Services. Note: Our administrative services only (ASO) group partners have the option to opt in to the cost-share waiver for treatment through the end of the group’s plan year.

We will continue to monitor the health of our community and will communicate changes in coverage at least 30 days in advance.

We recognize COVID-19 treatment for ambulance, telehealth, outpatient and inpatient services when the below diagnoses are billed in the primary position.

  • For dates of service from March 1 through March 31, 2020: B97.29 in the primary position
  • For dates of service beginning on April 1, 2020: U07.1 in the primary position
    COVID infection complicating pregnancy is also considered treatment when: U07.1 is billed in the secondary position with one of the following diagnoses in the primary position: O98.511, O98.512, O98.513, O98.519, O98.52, O98.53

If you previously submitted claims with incorrect COVID-19 diagnosis codes and the member’s benefits were not applied correctly, please rebill these claims using the:

  • Type of bill that indicates a corrected claim
  • Correct COVID-19 diagnosis codes (as shown above)

For dates of service before April 1, 2020, view the CDC's ICD-10-CM Official Coding Guidelines - Supplement Coding encounters related to COVID-19 Coronavirus Outbreak (PDF). For dates of service beginning on April 1, 2020, view the CDC's ICD-10-CM Official Coding and Reporting Guidelines.

The Centers for Medicare and Medicaid Services’ (CMS’) implemented 12 new International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) procedure codes to describe infusion of therapeutics, including remdesivir and convalescent plasma, effective August 1, 2020.

Note: We will not cover the cost of personal protective equipment (PPE) for medical or dental services as a separate reimbursable expense.

In addition, we do not reimburse for CPT 99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.

COVID-19 testing

COVID-19 testing coverage

Antigen or molecular diagnostic or antibody tests used to evaluate community health (surveillance testing) or for tracking purposes are not covered. We believe surveillance testing is the responsibility of the public health system. COVID-19 testing is not covered for administrative or qualification purposes, including testing related to employment, school or sports teams.

View our COVID-19 testing FAQ

To help you answer questions from your patients about coverage for testing, view these answers to frequently asked questions about COVID-19 testing.

To ensure our members have access and coverage for antigen or molecular diagnostic or antibody testing through the end of the federal emergency declaration:

  • We are not requiring pre-authorization for COVID-19 testing.
  • We will cover the cost of the COVID-19 test and an associated office visit with no cost share, if it is part of appropriate medical care and ordered by:
    • Commercial members: The member’s attending provider or a pharmacist
    • Medicare Advantage members: A licensed health care professional
  • For Medicare Supplement members: Only the test is covered at no cost share.
  • We will cover the cost of the COVID-19 test if it is provided prior to a procedure.
  • We will cover COVID-19 testing conducted at drive-up testing sites with no cost share, if a provider determines a test is necessary. Claims for tests conducted at drive-up sites should be submitted using POS 15.

For more information about coverage for COVID-19 testing, view the policies included below.

COVID-19 testing claim submission guidelines

We recognize COVID-19 testing and the testing-related visit (when the visit resulted in an order for a COVID-19 test) when billed with the following:

  • Modifier CS must be added to each line item for COVID-19-testing related service per CMS Guidelines. (For telehealth claims, both modifier 95 and modifier CS must be included.)
    • On August 27, 2020, CMS published guidelines to deny Medicare Advantage outpatient facility claims with services that CMS has indicated are not appropriate to bill with the CS modifier for dates of service beginning on March 18, 2020 through the end of the Public Health Emergency. The MLN Matters Number: SE20011 includes links to the list of the 208 procedure codes CMS has identified as appropriate to bill with CS modifier. We are applying these guidelines, effective October 16, 2020, to Medicare Advantage claims received on or after this date and to claims we are currently adjusting with dates of service beginning on March 18, 2020.
  • For dates of service beginning on March 1, 2020, through December 31, 2020, bill:
    • Z03.818 or Z20.828 in the primary position or
    • Z03.818 or Z20.828 in a position other than the primary position with modifier CS on the appropriate line item. (For telehealth claims, both modifier 95 and modifier CS must be included.)
  • For dates of service beginning on January 1, 2021, bill:

    • Z20.822 in any position or
    • Z20.822 with modifier CS on the appropriate line item. (For telehealth claims, both modifier 95 and modifier CS must be included.)

The following must be included when submitting the claim:

  • The provider’s NPI or TIN:
    • Commercial members: The member’s attending provider or pharmacist
    • Medicare Advantage members: A licensed health care professional
  • For tests submitted by labs: The test must be performed at a Clinical Laboratory Improvement Amendments (CLIA-) certified laboratory.
  • For tests submitted by the provider or facility: The manufacturer of the test must be approved or authorized by the FDA or have been approved for FDA-Emergency Use Authorization- (EUA-) for the COVID-19 pandemic.

    • The manufacturer’s name must be included on the electronic claim (837P or 837i) in the 2300 loop, NTE01 or NTE02 segment, either at claim level or line level. If the manufacturer’s name is not included on the claim, the provider will receive a letter requesting this information. The provider will receive two additional letters requesting the information. If no response is received in 90-days, the claim will be denied, following our normal process.

View our COVID-19 testing policies

  • Reimbursement policies:
    • Commercial: COVID-19 Testing
    • Medicare Advantage: COVID-19 Testing
      • Policy includes information about coverage for repeat or subsequent COVID-19 testing ordered by a health care professional licensed and enrolled in the state that the services are rendered in and practicing within the scope of their license and part of appropriate medical care as determined by the attending health care professional. (One initial COVID-19 test is covered without an order by a health care professional)
  • COVID-19 Testing (Laboratory #74) medical policy

View the CDC’s Interim Guidelines for COVID-19 Antibody Testing in Clinical and Public Health Settings.

COVID-19 testing codes

The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have established codes for COVID-19 testing to allow for better tracking of the public health response for this virus to help protect people from the spread of this infectious disease.

We will reimburse COVID-19 testing in accordance with applicable law, including the Coronavirus Aid, Relief and Economic Security (CARES) Act and the Family First Coronavirus Response Act (FFCRA).

Please ensure your bill the appropriate code based on which test was used.

Molecular testing

HCPCS/CPT code

Description

Claims can be submitted to us now with dates of service beginning

CPT 0202U

The code is used for use as the industry standard for reporting BioFire® Respiratory Panel 2.1

June 25, 2020

CPT 0223U

The code is used for use as the industry standard for reporting QIAstat-Dx Respiratory SARS CoV-2 Panel

June 25, 2020

CPT 0225U

The code is used for use as the industry standard for reporting ePlex® Respiratory Pathogen Panel 2, GenMark Diagnostics

August 10, 2020

CPT 0240U

The code is used for use as the industry standard for reporting Xpert® Xpress SARS-CoV-2 & Flu Targets Only, Cepheid

October 10, 2020

CPT 0241U

The code is used for use as the industry standard for reporting Xpert Xpress SARS-CoV-2/Flu/RSV (all targets), Cepheid

October 10, 2020

CPT 87635

The code is for use as the industry standard for reporting SARS-CoV-2, amplified probe technique.

March 13, 2020

CPT 87636

The code is for use as the industry standard for reporting SARS-CoV-2 and influenza virus types A and B, multiplex probe technique.

October 10, 2020

CPT 87637

The code is for use as the industry standard for reporting SARS-CoV-2 and influenza virus types A and B, and respiratory syncytial virus, multiplex probe technique.

October 10, 2020

HCPCS U0001

This code is to be used for billing the CDC or state 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.

February 4, 2020

HCPCS U0002

This code is to be used for billing all other viral identification, non-CDC laboratory testing.

February 4, 2020

HCPCS U0003

This code is to be used to identify tests that would otherwise be identified by CPT 87635 but are being performed with high-throughput technologies. This code should not be used for tests that detect COVID-19 antibodies.

April 14, 2020

HCPCS U0004

This code is to be used to identify tests that would otherwise be identified by HCPCS U0002 but are being performed with high-throughput technologies. This code should not be used for tests that detect COVID-19 antibodies.

April 14, 2020

HCPCS U0005

This code is to be used to identify tests being performed with high throughput technologies, completed within two calendar days from date of specimen collection (list separately in addition to either HCPCS U0003 or U0004).

January 1, 2021

Antigen testing

HCPCS/CPT code

Description

Claims can be submitted to us now with dates of service beginning

CPT 87426

The code is for use as the industry standard for reporting the multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 COVID-19)

June 25, 2020

CPT 87428

The code is for use as the industry standard for reporting severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 COVID-19) and influenza virus types A and B

November 10, 2020

CPT 87499

The code is for use as the industry standard for reporting the multiple-step method, not otherwise specified, each organism

May 8, 2020

CPT 87811

The code is for use as the industry standard for reporting immunoassay with direct optical (i.e., visual) observation

October 6, 2020

Antibody testing

HCPCS/CPT code

Description

Claims can be submitted to us now with dates of service beginning

CPT 0224U

This code is for use as the industry standard for reporting Mt Sinai Laboratory tests

June 25, 2020

CPT 86328

This code is for use as the industry standard for reporting an antibody test using a single-step method.

April 10, 2020

CPT 86413

This code is for use as the industry standard to assist in studies of the epidemiology, pathogenesis, prevention and treatment of COVID-19.

September 8, 2020

CPT 86769

This code is for use as the industry standard for reporting an antibody test using a multiple-step method.

April 10, 2020

COVID-19 specimen collection

The CDC has information caring for patients with a possible COVID-19 infection. View the CDC’s recommendations for reporting, testing and specimen collection.

CMS created two new HCPCS codes representing COVID-19 specimen collection. These codes are billable by clinical diagnostic laboratories.

The codes are effective for claims with dates of service on or after March 1, 2020:

  • HCPCS G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2, any specimen source
  • HCPCS G2024: Specimen collection for severe acute respiratory syndrome coronavirus 2 from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency (HHA), any specimen source

In addition, HCPCS C9803 is applicable to specimen collection in only the outpatient hospital setting. This code is billable by professionals, independent labs or ambulatory surgical centers (ASCs) for claims with dates of service on or after March 1, 2020.

CPT 99211 should be used for lab specimen collection from a patient billed by a physician office for claims with dates of service on or after March 1, 2020. To indicate the specimen collection is specific to COVID-19 testing, providers should include modifier CS and/or the diagnosis code, following the COVID-19 testing claim submission guidelines above.

Order tests from participating labs

LabCorp and Quest Diagnostics can test for COVID-19. Our provider networks include one or both of these labs. You can verify your patient's coverage using our provider search tool, Find a Doctor.

Note: Individuals seeking testing for COVID-19 should not visit a LabCorp or Quest Diagnostics location to request a test. Tests must be ordered by a physician or other authorized health care provider.

LabCorp, our preferred lab

Providers can order the COVID-19 test the same way that other tests are ordered from LabCorp. If you are not already registered, create an account on LabCorp’s website.

More information about COVID-19, including answers to frequently asked questions, is available on LabCorp’s website.

Quest Diagnostics

Providers can order the test the same way that other tests are ordered from Quest Diagnostics. If you are not already registered, create an account on Quest Diagnostic’s website.

For more information, including a link to a Healthcare Provider Fact Sheet, visit Quest Diagnostic’s website.