Purpose
The purpose of this communication is to provide advance notice regarding information and procedure codes related to testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage members. Additionally, this Company document identifies when coverage is provided for clinical purposes, and the not covered instances such as public health surveillance and screening.
Note: Information related to SARS-CoV-2 is continuously evolving. The Company is closely monitoring the outbreak caused by the novel coronavirus, and will update our communications accordingly.
- This document replaces the version published on December 15, 2022.
- Further guidance on procedure and diagnosis codes related to diagnostic testing have been added.
- Examples of noncovered screening diagnosis codes are listed.
- Nonprescription over-the-counter (OTC)/direct-to-consumer (DTC) diagnostic COVID-19 tests and molecular diagnostic test reader for nonprescription, self-administered, and self-collected use for pathogens (including, but not limited to, COVID-19, influenza, and/or RSV viruses), and associated procedure codes for these services are not covered, and therefore, are benefit exceptions.
- Procedure codes U0003, U0004, U0005, G2023 and G2024 have been terminated effective May 11, 2023 with the end of the Public Health Emergency (PHE). Therefore, these codes have been removed from this policy communication because they are no longer active.
Background
There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has been detected both nationally and internationally. The virus has been named “SARS-CoV-2" and the disease it causes has been named “Coronavirus Disease 2019" (COVID-19). To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.
Centers for Disease Control and Prevention COVID-19 Testing
The Centers for Disease Control and Prevention (CDC) has developed a new laboratory test kit for use in testing patient specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. The test kit is called the Centers for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel. The test kit is intended for use by laboratories designated by CDC as qualified, and, in the United States, certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity tests. This test is approved through the Emergency Use Authorization (EUA) processes of the US Food and Drug Administration (FDA).
Emergency Use Authorizations (EUA) by the FDA for COVID-19 Diagnostic Testing (RT-PCR and Antigen Testing) and Antibody Testing
Diagnostic Tests
Diagnostic testing for SARS-CoV-2 is intended to identify occurrence at the individual level and is performed when there is a reason to suspect that an individual may be infected, such as having symptoms or suspected recent exposure to SARS-CoV-2, or to determine resolution of infection.
RT-PCR
Recognizing the emergent circumstances related to this virus, the FDA has issued guidance to provide a policy for COVID-19 molecular diagnostics tests (e.g., RT-PCR) developed by laboratories certified to perform high-complexity testing under CLIA prior to issuance of EUA for such tests. For a reasonable period of time after validation, and while they are preparing their EUA requests, the FDA does not intend to object to the use of these tests for specimen testing. This FDA EUA process for COVID-19 testing includes certain diagnostic lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases. Among several other technical, analytic, and clinical COVID-19 diagnostic RT-PCR test performance requirements, the FDA requires high levels of positive percent agreement (PPA)/sensitivity and negative percent agreement (NPA)/specificity. These parameters, generally, do not have a lower range below percentages in the nineties.
Antigen Tests
There is FDA EUA issuance for COVID-19 antigen testing, which is a category of diagnostic tests to detect fragments of proteins found on or within the virus. Among several other technical, analytic, and clinical COVID-19 diagnostic antigen test performance requirements, the FDA requires that antigen tests should demonstrate a minimum sensitivity of ≥80% for all sample types submitted.
Other Diagnostic Tests for SARS-CoV-2
The FDA also communicates about authorized SARS-CoV-2 diagnostic tests that analyze breath samples and have been authorized individually.
Serology Tests (Antibody Tests)
These EUAs by the FDA also include serology testing to determine COVID-19 status from antibodies in blood samples (e.g., immunoglobulin G/immunoglobulin M (IgG/IgM), and includes rapid testing to detect antibodies against SARS-CoV-2 in serum, plasma, or venipuncture whole blood). The FDA details several requirements for the clinical agreement studies, for COVID-19 serological tests, which are intended to establish the performance characteristics for this antibody testing. Among several other technical, analytic, and clinical COVID-19 antibody test performance requirements, the FDA requires a minimum overall 90.0% PPA/sensitivity and overall 95.0% NPA/specificity. The FDA specifies other required values for each antibody type and combined parameters as well.
Revised FDA Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency
During Fall 2022, the FDA announced updates to its COVID-19 test policy to address public health testing needs during this phase of the COVID-19 public health emergency. During the past 2 years, more than 400 COVID-19 tests have been granted EUA and there are generally enough at-home tests, tests that can be used at the point-of-care such as health clinics, and laboratory-based tests to meet testing needs. The FDA is revising its COVID-19 test policy to encourage most COVID-19 test developers to pursue a traditional premarket review pathway for their tests, rather than EUA. The FDA intends to prioritize its review of EUA requests on COVID-19 diagnostic tests that are likely to have a significant public health benefit or are likely to fulfill an unmet need. This could include novel technologies like the use of breath samples, or unique features like the ability of a test to detect a new SARS-CoV-2 virus variant.
CDC Recommendations for Specimen Collection for Diagnostic COVID-19 Testing
For initial diagnostic testing for COVID-19, the CDC recommends collecting and testing an upper respiratory nasopharyngeal swab (NP). Collection of oropharyngeal swabs (OP) is a lower priority and, if collected, should be combined in the same tube as the NP. Collection of only OP swab is acceptable if other swabs are not available. Collection of sputum should only be done for those patients with productive coughs. Induction of sputum is not recommended. The CDC also recommends testing lower respiratory tract specimens, if available. For individuals who develop a productive cough, sputum should be collected and tested for SARS-CoV-2. For individuals for whom it is clinically indicated (e.g., those receiving invasive mechanical ventilation), a lower respiratory tract aspirate or bronchoalveolar lavage sample should be collected and tested as a lower respiratory tract specimen. Specimens should be collected as soon as possible once an individual under investigation is identified, regardless of the time of symptom onset. Note that individual commercial lab tests may require collection of only one specimen type for initial diagnostic testing (nasopharyngeal OR oropharyngeal). For updated information go to: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html.
At-Home Self-Sample Collection for COVID-19 Diagnostic Test
The FDA has begun authorizing diagnostic testing with a home specimen self-sample collection option for COVID-19. These self-collected samples must be tested and processed at approved laboratories for COVID-19 testing that is being performed within the FDA EUA guidance. As an example, the FDA re-issued the EUA for the Laboratory Corporation of America (LabCorp) COVID-19 RT-PCR Test to permit testing of nasal swab samples self-collected by patients at home using LabCorp's Pixel by LabCorp COVID-19 Test home collection kit.
There is FDA EUA issuance that permits testing of saliva samples self-collected by patients at home using the FDA-authorized COVID-19 diagnostic testing, which uses saliva samples to test for this virus in a healthcare setting.
The FDA's position is at-home processing tests cannot be utilized without an EUA for regulatory reasons outside of the scope of the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Home Test Kits (Rapid or Instant Tests)
A number of at-home COVID-19 tests are available. These tests may or may not be authorized for usage without a prescription. Any COVID-19 test intended for complete at-home testing requires an FDA-authorized EUA.
Differential Diagnosis
Because the signs and symptoms of the early stages of the COVID-19 disease are nonspecific, the differential diagnosis of COVID-19 infection may include the possibility of a range of common respiratory disorders, including:
- Adenovirus
- Influenza
- Human metapneumovirus (HmPV)
- Parainfluenza
- Respiratory syncytial virus (RSV)
- Rhinovirus (common cold)
For suspected cases, ruling out other common respiratory pathogens may be necessary.
PUBLIC HEALTH SURVIELLANCE AND SCREENING FOR COVID-19
Public Health Surveillance
Surveillance for SARS-CoV-2 includes ongoing systematic activities, including collection, analysis, and interpretation of health-related data that are essential to planning, implementing, and evaluating public health practice. Surveillance testing is generally used to monitor for a community- or population-level occurrence, such as an infectious disease outbreak, or to characterize the occurrence once detected, such as looking at the incidence and prevalence of the occurrence. Surveillance testing is used to gain information at a population level, rather than an individual level, and results of surveillance testing can be returned in aggregate to the requesting institution. Surveillance testing may sample a certain percentage of a specific population to monitor for increasing or decreasing prevalence and to determine the population effect from community interventions, such as social distancing. An example of surveillance testing is a plan developed by a state public health department to randomly select and sample a percentage of all individuals in a city on a rolling basis to assess local infection rates and trends.
Screening
Screening tests for SARS-CoV-2 are intended to identify occurrence at the individual level even if there is no reason to suspect infection (e.g., there is no known exposure). This includes, but is not limited to, screening of nonsymptomatic individuals without known exposure with the intent of making decisions based on the test results. Screening tests are intended to identify infected individuals without, or prior to development of, symptoms who may be contagious so that measures can be taken to prevent further transmission. Screening helps to identify unknown cases so that measures can be taken to prevent further transmission. Examples of screening per the CDC include:
- Testing employees in a workplace setting
- Testing students, faculty, and staff in a school or university setting
- Testing a person before or after travel
- Testing at home for someone who does not have symptoms associated with COVID-19 and no known exposures to someone with COVID-19
Coverage Statement
The Company follows federal, state, and local regulatory guidance related to COVID-19 testing. COVID-19 tests will only be covered when ordered by a healthcare professional licensed and/or authorized to do so under state law.
SPECIMENS COLLECTED BY A HEALTHCARE PROFESSIONAL
Diagnostic COVID-19 Testing (RT-PCR, Antigen Tests, or Other Diagnostic Tests for SARS-CoV-2 (e.g., tests that analyze breath samples))
The Company will cover (1) certain diagnostic COVID-19 tests (diagnostic RT-PCR and antigen tests), including COVID-19 tests that have been approved, cleared, or authorized by the FDA or for which the developer has requested, or intends to request, Emergency Use Authorization (EUA) for the COVID-19 pandemic; and (2) the administration of such tests, when ordered by a licensed healthcare provider and performed at an approved healthcare setting (this includes drive-through testing). Such testing will only be covered if medically appropriate as determined by the member's healthcare provider in accordance with accepted standards of current medical practice. We recommend that healthcare providers confirm with the Company if such lab is an authorized and/or contracted lab and if they have the ability to perform such testing. Diagnostic COVID-19 testing will be covered for:
- Individuals with signs or symptoms consistent with COVID-19
- Asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 to control transmission
When ordered by a healthcare provider, the Company will cover medically necessary diagnostic pooled testing only for testing that is associated with Company members' samples.
To be eligible for reimbursement, clinically valid procedure code
and diagnosis code for the COVID-19 test must be submitted. Please
refer to the Coding section of this document for further guidance on
diagnosis and procedure codes.
Antibody COVID-19 Testing
The Company will cover (1) certain antibody COVID-19 tests including COVID-19 tests that have been approved, cleared, or authorized by the FDA or for which the developer has requested, or intends to request, EUA for the COVID-19 pandemic; and (2) the administration of such tests, when ordered by a licensed healthcare provider and performed at an approved healthcare setting (this includes drive-through testing). Such testing will only be covered if medically appropriate as determined by the member's healthcare provider in accordance with accepted standards of current medical practice. We recommend that healthcare providers confirm with the Company if such lab is an authorized and/or contracted lab and if they have the ability to perform such testing. Currently, antibody testing for COVID-19 has clinical support in these scenarios, and will be covered when:
- Antibody tests are used to support the clinical assessment of COVID-19 illness for individuals who are being tested 9 to 14 days after illness onset, in addition to recommended virus detection methods such as PCR. This may maximize sensitivity as the sensitivity of nucleic acid detection is decreasing and serologic testing is increasing during this time period.
- Antibody testing is being used to help establish a clinical picture when individuals have late complications of COVID-19 illness, such as multisystem inflammatory syndrome in children.
- Neutralizing antibody screening and titer testing, and surrogate viral neutralization testing are used exclusively for the purpose of convalescent plasma administration during a hospital admission at the decision of the individual's medical providers.
Antibody test results should not be used to diagnose someone with an active infection.
REQUIREMENTS REGARDING FDA AUTHORIZATIONS FOR COVID-19 TESTING
A developer's COVID-19 diagnostic or antibody test kit will be considered not covered unless (1) the FDA approves the test for use; (2) the developer has submitted an EUA to the FDA for approval during the time of the public health emergency (or intends to do so within a reasonable period of time, which is currently 15 days for RT-PCR and antigen tests and 10 days for serology (antibody tests)*; or (3) the test was developed in and authorized by a State that has notified the Secretary of Health and Human Services of its intention to review tests intended to diagnose COVID-19.
*The FDA expects commercial manufacturers to submit EUA requests, including their validation data, within 10 days of publication of the updated policy or the date they notify the FDA of their test validation, whichever is later.
If the FDA denies an EUA application for a COVID-19 diagnostic or antibody test or the test's developer fails to timely submit the EUA to the FDA for approval, the test will no longer be covered.
A diagnostic or antibody COVID-19 test will not be covered if it does not meet the requirements, including technical, analytic, and clinical performance measures, detailed by the FDA in the most recent version of Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency -- Immediately in Effect Guidance for Clinical Laboratories, Commercial Manufacturers, and Food and Drug Administration Staff.
Authorized labs must notify local public health authorities before initiating testing with a COVID-19 diagnostic or antibody test kit, follow the terms and conditions described in the applicable EUA for an approved at-home diagnostic or antibody test kit, and administer the test in accordance with the applicable test procedures referenced therein.
Lab specimens for members enrolled in HMO and HMO-POS products may need to be sent to a different in-network approved laboratory, which is not the member's designated capitated laboratory site, when the designated capitated laboratory site does not have the ability to perform the COVID-19 test.
Referral and out-of-capitation authorization requirements have been waived for COVID-19 Laboratory Testing HCPCS codes U0001, U0002, and CPT codes 0202U, 0223U, 0224U, 0225U, 0226U, 0240U, 0241U, 86328, 86408, 86409, 86413, 87428, 86769, 87246, 87635, 87636, 87637, and 87811.
Laboratory Corporation of America® Holdings (LabCorp), the national outpatient laboratory provider for the Company, is equipped to process diagnostic (RT-PCR) and antibody (IgG) COVID-19 specimen testing for members. Details are available on the LabCorp website available at:
Laboratory Testing for COVID-19 Differential Diagnosis
The Company will cover testing of other clinically relevant respiratory pathogens, for the differential diagnosis of COVID-19. These tests include testing of the following pathogens through any clinically established method:
- Adenovirus
- Influenza
- Human metapneumovirus (HmPV)
- Parainfluenza
- Respiratory syncytial virus (RSV)
- Rhinovirus (common cold)
Referral and out-of-capitation authorization requirements have also been waived for COVID-19 Differential Diagnosis Laboratory Testing procedure codes when performed in conjunction with COVID-19 Laboratory Testing.
SPECIMEN COLLECTED BY AN AUTHORIZED WORKER FROM HOME HEALTH AGENCIES
To help reduce potential exposure of COVID-19, the Company is waiving the requirement that a member be homebound for the purpose of laboratory specimen collection for diagnostic COVID-19 testing in their home.
In response to the COVID-19 outbreak, home specimen collection for diagnostic COVID-19 and related diagnostic respiratory pathogens' testing is considered medically necessary and, therefore, covered when all of the following criteria are met:
- The specimen is collected by a nurse from a home health agency or by a trained laboratory technician.
- The requirement that a member must be homebound (as defined in the medical policy) is waived, in order to receive a nurse visit from a home health agency for the purpose of laboratory specimen collection for COVID-19 testing in their home.
- The specimen collection is medically necessary for the individual's condition and has been ordered by an eligible professional provider.
- The specimen will be delivered to the appropriate Company participating laboratory to perform the test and send the results to the prescribing professional provider.
SPECIMENS COLLECTED BY A MEMBER
Testing of Samples Self-Collected by Members
The Company will cover testing of samples self-collected by members when the testing is conducted at FDA-approved locations as detailed in the EUA (including home), and all FDA EUA requirements are followed for the specific test being administered. This includes self-collection materials (including kits) and other related equipment having received specific FDA EUA approval.
For example, the FDA re-issued the EUA for the LabCorp COVID-19 RT-PCR Test to permit testing of samples self-collected by members at home using LabCorp's Pixel by LabCorp COVID-19 Test home collection kit.
ROUTINE COVID-19 TESTING
In Advance of Procedures
Reimbursement for routine COVID-19 laboratory testing, for asymptomatic and/or nonexposed individuals (e.g., preadmission testing; screening prior to procedures as part of an institutional protocol) is reimbursed as part of the procedural or surgical payment and is not eligible for separate reimbursement.
Testing of Nursing Home Residents and Patients
Based on the evolving recommendations from the CDC for Testing Guidelines for Nursing Homes (https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-home-long-term-care.html), the Centers for Medicare & Medicaid Services (CMS) has issued communications for COVID-19 testing for nursing home residents and patients.
Reimbursement of routine COVID-19 testing in these contexts is reimbursed as part of the per diem payment to the facility and is not eligible for separate reimbursement for members admitted to skilled nursing facilities for short-term medical or rehabilitation purposes.
PUBLIC HEALTH SURVEILLANCE AND SCREENING
The Company does not cover COVID-19 testing when the primary purpose of this testing is for public health surveillance and/or screening. This includes tests using pooling methodologies or any others with a current FDA EUA. Please refer to the Background section of this document for further guidance on public health surveillance and screening.
NONPRESCRIPTION OVER-THE-COUNTER (OTC)/DIRECT-TO-CONSUMER (DTC) DIAGNOSTIC COVID-19 TESTING
Nonprescription over-the-counter (OTC)/direct-to-consumer (DTC) diagnostic COVID-19 tests are not covered.
MOLECULAR DIAGNOSTIC TEST READER FOR NONPRESCRIPTION SELF-ADMINISTERED AND SELF-COLLECTED USE
Molecular diagnostic test reader for nonprescription, self-administered, and self-collected use for pathogens (including, but not limited to, COVID-19, influenza, and/or RSV viruses) are not covered.
REQUIRED DOCUMENTATION
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members regardless of the participation status of the provider. Medical record documentation must be maintained on file to reflect the medical necessity of the care and services provided. This includes verification that laboratory or home test kits have been approved, cleared, or authorized by the FDA and/or that the developer has adequately abided by the FDA guidance before and after formally requesting EUA for the COVID-19 testing, including—but not limited to—test validation standards, reporting requirements, clinical testing to establish acceptable performance characteristics, and timeline adherence. This also includes review of any tests whose EUA has been revoked by the FDA.
All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
BILLING REQUIREMENTS
Eligible professional providers performing SARS-CoV-2 (COVID-19) laboratory testing must report the most appropriate procedure code to represent the method of testing used. Additionally, the clinically appropriate diagnosis code(s) must be reported to support the testing being performed (e.g., diagnosis code(s) representing CDC listed signs and symptoms and/or required exposure to COVID-19 must be reported for any diagnostic testing). Please refer to the Coding section of this document for further guidance on diagnosis and procedure codes.
Eligible professional providers performing diagnostic pooled SARS-CoV-2 (COVID-19) laboratory testing must report the most appropriate procedure code to represent the method of testing used and only one unit of service for each of the Company's members tested.
Coding
DIAGNOSTIC TESTING FOR COVID-19 (e.g., through RT-PCR)
HCPCS codes U0001 and U0002, representing CDC and non-CDC testing, respectively, for SARS-CoV-2 (COVID-19) are effective and must be used for dates of service as of February 4, 2020 and after.
- U0001: CDC 2019 novel coronavirus (2019-nCoV) Real-Time RT-PCR diagnostic panel
- U0002: 2019-nCoV coronavirus, SARS-CoV-2 /2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
Note: HCPCS code U0002 can apply to all types of COVID-19 laboratory testing (e.g., RT-PCR, diagnostic breath test, or antibody testing).
CPT code 87635 for SARS-CoV-2 (COVID-19) nucleic acid testing is effective and must be used for dates of service as of March 13, 2020 and after.
CPT code 87913 for mutation identification in targeted region(s) for SARS-CoV-2 (COVID-19) through nucleic acid testing is effective and must be used for dates of service as of February 21, 2022 and after.
CPT code 0202U for BioFire® Respiratory Panel 2.1 (RP2.1) testing manufactured by BioFire® Diagnostics, LLC is effective and must be used for dates of service as of May 20, 2020 and after.
CPT codes 0223U for QIAstat-Dx Respiratory SARS CoV-2 Panel testing manufactured by QIAGEN Sciences is effective and must be used for dates of service as of June 25, 2020 and after.
CPT code 0225U for ePlex® Respiratory Pathogen Panel 2 developed by GenMark Diagnostics, Inc. is effective and must be used for dates of service as of August 10, 2020 and after.
CPT codes 0240U, 0241U, 87636, and 87637 for SARS-CoV-2 (COVID-19) and other respiratory pathogens' nucleic acid testing are effective and must be used for dates of service as of October 06, 2020 and after.
DIAGNOSTIC ANTIGEN TESTING FOR COVID-19
CPT code 87426 for infectious agent antigen detection by immunoassay technique of SARS-CoV and/or SARS-CoV-2 is effective and must be used for dates of service as of June 25, 2020 and after.
CPT code 87811 for SARS-CoV-2 (COVID-19) antigen testing by immunoassay with direct optical observation is effective and must be used for dates of service as of October 06, 2020 and after.
CPT code 87428 for SARS-CoV-2 (COVID-19) and other respiratory pathogens' antigen testing through an immunoassay technique is effective and must be used for dates of service as of November 09, 2020 and after.
ANTIBODY TESTING FOR COVID-19
CPT codes 86328 and 86769 for SARS-CoV-2 (COVID-19) qualitative or semiquantitative antibody testing are effective and must be used for dates of service as of April 10, 2020 and after.
CPT code 0224U for SARS-CoV-2 (COVID-19) antibody testing developed by Mt. Sinai Laboratory is effective and must be used for dates of service as of June 25, 2020 and after.
CPT codes 86408 and 86409 for SARS-CoV-2 (COVID-19) neutralizing antibody screening and titer testing respectively are effective and must be used for dates of service as of August 10, 2020 and after.
CPT code 0226U for Tru-Immune, a serological test that measures and also quantifies the neutralizing capacity of antibodies against the SARS-CoV-2, by Ethos Laboratories and GenScript® USA Inc. is effective and must be used for dates of service as of August 10, 2020 and after.
CPT code 86413 for SARS-CoV-2 (COVID-19) quantitative antibody testing is effective and must be used for dates of service as of September 08, 2020 and after.
SPECIMEN COLLECTION BY A HEALTHCARE PROFESSIONAL FOR COVID-19
HCPCS codes C9803 or CPT code 99211 (as appropriate) for collection of SARS-CoV-2 (COVID-19) specimens, including nasopharyngeal swab (NP), oropharyngeal swabs (OP), serum, plasma, or venipuncture whole blood, are effective and must be used for dates of service as of March 1, 2020 and after.
- C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source
Revenue code 0551 may be used by Home Health Agencies performing specimen collection for SARS-CoV-2 (COVID-19) and related respiratory pathogens' laboratory testing:
- 0551: Skilled Nursing – Visit Charge
LABORATORY TESTING FOR COVID-19 DIFFERENTIAL DIAGNOSIS
- 86603
- 86710
- 86756
- 87260
- 87275
- 87276
- 87279
- 87280
- 87301
- 87400
- 87420
- 87501
- 87502
- 87503
- 87631
- 87632
- 87633
- 87634
- 87804
- 87807
- 87809
SPECIMEN COLLECTION FOR COVID-19 DIFFERENTIAL DIAGNOSIS LABORATORY TESTING
- S9529
- 36400
- 36405
- 36406
- 36410
- 36415
- 36420
- 36425
NOT COVERED
HCPCS code K1034 for provision of COVID-19 test, nonprescription self-administered and self-collected use, FDA approved, authorized or cleared, one test count is not covered effective and must be used for dates of service as of May 12, 2023 and after.
HCPCS code K1035 Molecular diagnostic test reader, nonprescription self-administered and self-collected use, FDA approved, authorized or cleared is not covered for dates of service as of April 1, 2023 and after.
MODIFIER
CS: Cost-sharing waived for specified COVID-19 testing-related services that result in an order for, or administration of, a COVID-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in Rural Health Clinics and Federally Qualified Health Centers during the COVID-19 public health emergency
INTERNATIONAL CLASSIFICATION OF DISEASES, TENTH REVISION, CLINICAL MODIFICATION (ICD-10-CM)
DIAGNOSIS CODES THAT MAY BE COVERED FOR COVID-19 DIAGNOSTIC TESTS
THE FOLLOWING CODE(S) ARE USED TO REPRESENT COVID-19 SIGNS AND SYMPTOMS, AND TYPES OF EXPOSURE TO COVID19 (NOT AN ALL-INCLUSIVE LIST):
R09.81 Nasal congestion
R05.1 Acute cough
R05.2 Subacute cough
R05.3 Chronic cough
R05.4 Cough syncope
R05.8 Other specified cough
R05.9 Cough, unspecified
R19.7 Diarrhea, unspecified
R53.83 Other fatigue
R50.9 Fever, unspecified
R68.83 Chills (without fever)
R51.9 Headache, unspecified
G47.10 Hypersomnia, unspecified
G47.11 Idiopathic hypersomnia with long sleep time
G47.12 Idiopathic hypersomnia without long sleep time
G47.19 Other hypersomnia
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.15 Cyclical vomiting syndrome unrelated to migraine
R11.2 Nausea with vomiting, unspecified
R41.0 Disorientation, unspecified
R43.0 Anosmia
R43.1 Parosmia
R43.2 Parageusia
R43.8 Other disturbances of smell and taste
R43.9 Unspecified disturbances of smell and taste
R23.0 Cyanosis
R23.8 Other skin changes
R23.9 Unspecified skin changes
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R06.00 Dyspnea, unspecified
R06.02 Shortness of breath
R06.03 Acute respiratory distress
R06.09 Other forms of dyspnea
J02.9 Acute pharyngitis, unspecified
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R07.82 Intercostal pain
Z20.822 Contact with and (suspected) exposure to COVID-19
NOT COVERED
THE FOLLOWING CODE(S) ARE USED TO REPRESENT SCREENING (NOT AN ALL-INCLUSIVE LIST):
Z11.59 Encounter for screening for other viral diseases
Z11.52 Encounter for screening for COVID-19
Z11.8 Encounter for screening for other infectious and parasitic diseases
Z11.9 Encounter for screening for infectious and parasitic diseases, unspecified
Z13.9 Encounter for screening, unspecified
