Coding for COVID-19 Testing
Updated April 22, 2020
The Centers for Disease Control & Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel worked quickly to create diagnosis and billing codes for the COVID-19 pandemic, with specific instructions for maternity care.
CMS requires group and individual health plans to cover visits that result in the administration of COVID-19 testing provided on or after March 18, 2020 without prior authorization or cost-sharing, including telehealth and non-traditional care settings, such as drive-through COVID-19 screening sites.
Effective April 1, 2020, a new ICD-10-CM diagnosis code chapter, Chapter 22 Codes for Special Purposes (U00-U85) and new code U07.1 COVID-19 was made available for reporting the coronavirus diagnosis.
Coding Rules for U07.1:
- U07.1 should only be used for confirmed cases of COVID-19 with positive or presumptive-positive test results.
- U07.1 should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients
- Obstetric patients with confirmed COVID-19 during pregnancy, childbirth or the puerperium should have O98.5-, Other viral diseases, as the primary diagnosis, followed by code U07.1 and any codes for associated manifestation(s).
- If COVID-19 is not confirmed or if testing is negative, the following Encounter Codes should be used:
Z11.59: Encounter for screening for other viral diseases
Asymptomatic, no known exposure, results unknown or negative
Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out
Possible exposure to COVID-19, infection ruled out
Z20.828: Contact with and (suspected) exposure to other viral communicable diseases
Contact with COVID-19, Suspected exposure
The following diagnosis codes may be appropriate as associated manifestations, regardless of confirmed COVID-19:
- R05: Cough
- R06.02: Shortness of breath
- R50.9: Fever, unspecified
- J12.89: Other viral pneumonia
- J20.8: Acute bronchitis due to other specified organisms
- J22: Unspecified acute lower respiratory infection
- J40: Bronchitis, nor specified as acute or chronic
- J80: Acute respiratory distress syndrome
- J96.01: Acute respiratory failure with hypoxia
- J98.8: Other specified respiratory disorders
There is no specific code for swabbing the enduring for COVID-19. Swab collection is included in E/M service. However, if collected in the office and transported to the laboratory, CPT code 99000 can be billed:
- 99000: Handling and/or conveyance of specimen for transfer from office to a laboratory
There are three codes for COVID-19 testing: 87635 is designed to detect the COVID-19 virus and effective March 13, 2020, and 86328 and 86769 will be used to identify the presence of antibodies to the COVID-19 virus and are effective April 10, 2020.
Please note that all aforementioned changes are not included in CPT 2020 code set. They will be included in CPT 2021 in the Pathology and Laboratory section, The Immunology subsection.
- 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Coronavirus disease [COVID-19])
- 86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 87635: 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
- Submit a ticket to get your Coding questions answered
- ICD-10-CM Official Coding and Reporting Guidelines (PDF)
- AMA Quick reference flow chart for CPT reporting for COVID-19 testing (PDF)
- AMA Telehealth/COVID-19 coding scenarios (PDF)
- AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing
- SARS-CoV-2 Serologic Laboratory Testing
- Managing Patients Remotely: Billing for Digital and Telehealth Services
Private payers continue to update their policies as the COVID-19 public health crisis. To check each payer’s most updated policy changes in relation to the billing and coding for telehealth and COVID-19, please visit the payer’s website.