CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

TEMPORARY COVID-19 Diagnostic Testing

Defines BCBSRI coverage, billing codes, and a temporary waiver of member cost-share for FDA-authorized or EUA COVID-19 diagnostic tests and specimen collection for BCBSRI participating and non-participating providers while the policy is in effect.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTEMPORARY COVID-19 Diagnostic Testing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 6, 2020

Next Review DateN/A

Key ActionNo prior authorization required; physician or advanced practice provider order is required for laboratory testing described in the policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

waives member cost-sharecost-share waived

QW requiredQW modifier

~30 codesnamed codes

no prior authprior authorization

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Diagnostic laboratory tests and specimen collection related to COVID-19 that are FDA-approved or authorized under Emergency Use Authorization (EUA) and listed on the FDA website are covered.

BCBSRI will temporarily waive all member cost-share (co-pays and deductibles) for covered COVID-19 diagnostic testing and specimen collection while the policy is in effect; this applies to Commercial and Medicare products and, as noted, should also apply to BlueCard host members as required by federal law.

A physician or advanced practice provider order is required for laboratory testing described in this policy, except where Medicare/CMS guidance permits testing without an order as described in CMS interim guidance for Medicare beneficiaries.

Testing performed for return-to-work, employment, education, court order, other third-party requirements, or for general health surveillance is excluded under Commercial subscriber agreements unless otherwise specified by contract.

Specified diagnostic and specimen collection CPT/HCPCS codes should be billed by the laboratory processing the test; Modifier QW is required for CLIA-waived tests as noted in coding guidance.

Benefits may vary by group/contract; refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific laboratory benefits and exclusions.

BCBSRI reserves the right to audit medical and administrative records for adherence to policy requirements.

Coding and Code-level Rules

Covered COVID-19 diagnostic and specimen collection codesmixedCovered

86328	Immunoassay for infectious agent antibodies, qualitative Or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19)
86409	Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19); titer
86408	Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19); screen
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, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay Or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS CoV-2 [COVID-19)
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 RTPCR, nasopharyngeal swab, each pathogen reported as detected or not detected
87635	Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19), amplified technique probe
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 RTPCR, nasopharyngeal swab, each pathogen reported as detected or not detected
0225U	Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets; including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected probe

1–10 of 19

1/2

FDA / EUA requirement

ApplicabilityApplies to COVID-19 diagnostic tests that are FDA-approved or authorized under an FDA Emergency Use Authorization (EUA) and listed on the FDA website.

ScopeIncludes tests billed to Medicare, commercial payers, and laboratories following CMS/AMA coding guidance for COVID-19 diagnostics.

Related codesPolicy references HCPCS/CPT codes used for FDA/EUA-authorized testing (e.g., U0001, U0002, 87635) and specimen collection codes (G2023, G2024, C9803).

High-throughput identification

IdentificationHCPCS U0003 and U0004 represent high-throughput SARS‑CoV‑2 diagnostic tests mapped to tests otherwise reported with CPT 87635 when performed on high‑throughput platforms.

RestrictionNeither U0003 nor U0004 should be used for tests that detect COVID‑19 antibodies (e.g., CPT 86328, 86769).

Billing practiceUse U0003/U0004 only for molecular nucleic acid detection tests performed on high‑throughput technologies, not for serology/antibody testing.

Provider Actions and Billing Requirements

Prior Authorization

Prior authorization not required; provider order required for laboratory testing

No prior authorization is required for COVID-19 diagnostic laboratory testing described in this policy; however, BCBSRI requires a physician or advanced practice provider order for all laboratory testing to diagnose or treat conditions, so an order is required for the tests described in this policy. Note: Medicare guidance may allow certain tests without an order as described by CMS.

Prior authorization: Not applicable.
Provider order: Physician or advanced practice provider order required for all laboratory testing described in this policy.
Medicare exception: Coverage for BlueCHiP for Medicare follows Medicare guidelines; CMS may allow certain tests without an order.

Definitions

High-throughput technologies

DefinitionHigh‑throughput technologies are automated platforms that employ automated processing to allow increased test capacity (e.g., more than 200 specimens per day).

CharacteristicsThese technologies require sophisticated equipment, specialized technician training, and more time‑intensive processes to ensure quality.

Coding mappingHigh‑throughput molecular SARS‑CoV‑2 tests are mapped to HCPCS codes U0003 and U0004 (and identify tests that otherwise would be reported with CPT 87635 when performed on these platforms).

Modifier QW requirement

Modifier QW requirementUse of Modifier QW is required for any test that is CLIA‑waived.

ApplicabilityApplies to CLIA‑waived COVID‑19 tests billed to payers as noted in policy.

DocumentationLaboratories must append Modifier QW to claims for tests meeting CLIA‑waived status to reflect waiver status as required by the policy.