COVID 19 Coding and Billing
Payment and coding guidance for COVID-19 testing, immunizations, and related laboratory services affecting providers submitting claims to Blue KC across multiple commercial and Medicare Advantage lines of business.
Vaccine status codes added.
Novavax vaccine and vaccine administration codes added.
Diagnosis code guidance updated for asymptomatic patient with no confirmed exposure from Z20.822 to Z11.52 per FY2024 ICD-10-CM guidelines.
HCPCS codes G2023 and G2024 removed from policy.
HCPCS codes U0003, U0004, and U0005 removed from policy.
Proprietary lab codes 0240U and 0241U deleted and removed.
Coverage and Documentation Requirements
Coverage criteria
Covered when ALL of the following are met:
ALL of the following
- There is a written or electronic order/request for testing from an authorized healthcare professional (HCP).
Order must include authorized HCP name, address, and NPI; patient name/unique identifier; sex and age or date of birth. Exception: first test rendered for a Medicare beneficiary may be exempt from individualized assessment requirement.
- An individualized patient assessment has been performed and documented (except as noted above).
- Laboratory documentation includes date of collection, date of receipt, and date of test results or 'release'.
- Diagnosis coding supports testing: use U07.1 for confirmed COVID-19 (positive or presumptive-positive), Z20.822 for symptomatic patients with confirmed or suspected exposure and negative or unknown test results, Z11.52 for asymptomatic screening encounters with negative or unknown results, Z09 or Z86.16 for follow-up or personal history as appropriate; obstetric patients with confirmed COVID-19 should list O98.5X as primary diagnosis followed by U07.1.