COVID-19 Billing Guidelines

COVID-19 Billing Guidelines

4/2/2020

BlueCross BlueShield of South Carolina and its subsidiary BlueChoice® HealthPlan will cover testing to diagnose COVID-19 at 100 percent of the allowed amount for its members when medically necessary and prescribed by health providers. Any subsequent needed care will be done in close coordination with federal, state and public health authorities. This currently applies to our Fully Insured groups, but our Administrative Services Only (ASO) groups are being encouraged to comply. We will be sure to keep you updated on the status of their decision. Below are the billing guidelines for COVID-19 testing services:

Codes Used for the Testing of COVID-19
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.

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

Modifier
CR - Catastrophe/Disaster Related.
Note: Use in conjunction with evaluation and management codes on HCFA1500 claim forms.

Condition Code
DR
- Disaster Related – Used to identify UB92 claims that are or may be impacted by specific payer/health plan policies related to a national or regional disaster.

Diagnosis Codes
U07.1 - 2019-nCoV acute respiratory disease. Note: Available 04/01/2020
Note: This is the preferred code to use when available. If not available, use the B97.29 in conjunction with other appropriate ICD-10 codes.

B97.29 - Other Coronavirus as the cause of diseases classified elsewhere
Note: Use in conjunction with other ICD-10 codes listed below.

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

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

For a pneumonia case confirmed due to the 2019 novel coronavirus (COVID-19), assign codes below if U07.1 is not available:

J12.89 - Other viral pneumonia 
and 
    B97.29 - Other coronavirus as the cause of diseases classified elsewhere

J20.8 - Acute bronchitis due to other specified organisms 
and 
    B97.29 - Other coronavirus as the cause of diseases classified elsewhere

J40 - Bronchitis, not specified as acute or chronic 
and 
    B97.29 - Other coronavirus as the cause of diseases classified

J22 - Unspecified acute lower respiratory infection 
and 
    B97.29 - Other coronavirus as the cause of diseases classified elsewhere

J98.8 - Other specified respiratory disorders 
and 
    B97.29 - Other coronavirus as the cause of diseases classified elsewhere

J80 - Acute Respiratory Distress Syndrome (ARDS) 
and 
    B97.29 - Other coronavirus as the cause of diseases classified

For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:

R05 - Cough
R06.02 - Shortness of breath
R50.9 - Fever, unspecified

If the physician documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828).