COVID-19 Testing: Billing Updates

COVID-19 Testing: Billing Updates

BlueCross BlueShield of South Carolina and its subsidiary BlueChoice® HealthPlan cover testing to diagnose COVID-19 at 100% of the allowed amount for members when medically necessary and prescribed by health providers.  Both plans have been working diligently and actively to ensure the provider community is abreast of pertinent information that will allow for seamless services.  In response to recent updates, slight modifications have been made to the billing guidelines.

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.

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

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

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, 3-5 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, 6-11 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, 12-25 targets

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

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)

Modifiers
CR - Catastrophe/Disaster Related. 
Note: Use in conjunction with evaluation and management codes on HCFA 1500 claim forms.

CS - Cost-sharing for specified COVID-19 testing-related services that result in an order for or administration of a COVID-19 test.

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: 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.    

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

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 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.

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