Billing and Coding Guidelines During COVID-19

The following billing guidelines reflect Centers for Medicare & Medicaid Services (CMS) guidance provided on March 17. Please use them to ensure proper claims processing. 

The following code modifications help us appropriately waive cost sharing amounts as outlined in our expanded COVID-19 coverage.

When ordering COVID-19 tests:
Append modifier 32, CR, or CS to the office visit and COVID-19 testing/collection codes on professional and outpatient facility claims

On outpatient facility claims:
Append condition code DR in addition to using the modifiers.

If testing through the state lab:

  • Append the office visit and collection fee with the modifier 32, CR, or CS
  • Include the DR condition code on the outpatient facility claim

For COVID-19-related inpatient hospitalization claims:

  • Append condition code DR and COVID-19 diagnosis

For durable medical equipment (DME) or home medical equipment (HME) services and supplies:

  • Append modifiers 32, CR, or CS to claims that meet the following conditions:
    • DME/HME supplies and items furnished to BCBSND members outside of the normal quantity and frequency limits
    • DME/HME services and supplies related to COVID-19

CMS-1500

COVID-19-Related Services

Service

Standard Office Visit

Telehealth E&M

Telehealth
Inpatient

Virtual Check-In

 

Digital Visit
(Patient Initiated)

Lab Test

Collection

CPT/HCPCS

New Patient
99201-99205

Established Patient
99211-99215

ER
99281-99285

New Patient
99201-99205

Established Patient
99211-99215

ER
99281-99285

Consult
G0425-G0427

Follow-up
G0406-G0408

Remote recorded video/image
G2010

Brief communication
G2012

Telephone E&M
99441-99443

Physician/QHP
99421-99423

Non-Physician/QHP
98970-98972
G2061-G2063

U0001
U0002
U0003
U0004
86318
86328
86769
87635
0202U

G2023
G2024

ICD-10-CM

B97.29
U07.1
Z03.818
Z11.59
Z20.828

B97.29
U07.1
Z03.818
Z11.59
Z20.828

B97.29
U07.1
Z03.818
Z11.59
Z20.828

B97.29
U07.1
Z03.818
Z11.59
Z20.828

B97.29
U07.1
Z03.818
Z11.59
Z20.828

B97.29
U07.1
Z03.818
Z11.59
Z20.828

Z03.818
Z11.59
Z20.828

Place of Service

11
19
22
23

02

02

02

02

11
19
22
81

11
15
17
20
23

COVID-19
Modifiers

32, CR or CS

32, CR or CS

32, CR or CS

32, CR or CS

32, CR or CS

32, CR or CS

32, CR or CS

Telehealth Modifier

N/A

95

95

95

95

N/A

N/A

Note

   

New or Established Patient

Established Patient Only

Established Patient Only

*During the COVID-19 emergency period only, use modifier 95 when reporting face-to-face or non-face-to-face digital visits to ensure correct claims processing.

 

The collection is an inherent component of the in-person E/M visit so it should not be billed unless it’s the only service provided.



UB-04

COVID-19-Related Services

ICD-10-CM

B97.29
U07.1
Z03.818
Z11.59
Z20.828

Condition Code

DR

COVID-19 Modifiers (Outpatient Claims)

32, CR or CS

To allow for social distancing, we’ve expanded telehealth coverage following state guidelines. Telehealth services may be billed if they meet all criteria of the CPT/HCPCS code rendered including, but are not limited to:

  • Office visits
  • Physical therapy (PT)
  • Occupational therapy (OT)
  • Speech therapy
  • Behavioral health and substance use disorder treatment/therapies (including group)
  • Applied Behavioral Analysis (ABA)
  • Diabetes education
  • Nutrition counseling

NOTE: Deferrable elective care is not included in the expanded coverage per to the Governor’s Executive Order 2020-05.1 and the NDIC’s bulletin 2020-3. Expanded coverage does not apply to elective care, chiropractic care, dental care and acupuncture.

Bill telehealth services on the CMS-1500 Claim Form unless specifically noted below in which case they can be billed on a UB-04 Claim Form.

CMS-1500 Claim Form telehealth service billing requirements are:  

  • Bill appropriate code for service rendered
  • Modifier 95 
  • POS 02

CMS-1500

Non COVID-19-Related Services

Service

Telehealth E&M

Telehealth Inpatient

Virtual Check-In

Digital Visit
(Patient Initiated)

CPT/HCPCS

New Patient
99201-99205

Established Patient
99211-99215

ER
99281-99285

Consult
G0425-G0427

Follow-up
G0406-G0408

Remote recorded video/image
G2010

Brief communication
G2012

Non-Physician/QHP
98966-98968

Telephone E&M
99441-99443

Physician/QHP
99421-99423

Non-Physician/QHP
98970-98972
G2061-G2063

Place of Service

02

02

02

02

Modifier

95

95

95

95

Note

   

Established Patient Only

Established Patient Only

* To ensure correct claims processing, during the COVID-19 emergency period only, use modifier 95 when reporting face-to-face or non-face-to-face digital visits.

UB-04

Non COVID-19-Related Services

Service

Telehealth Intensive Outpatient Program*

Telehealth Partial Hospitalization Program (20+ hours/week)*

Telehealth Hospital Based Therapy

Type of Bill

131

131

131

851

Revenue Code

0905
0906

0912
0913

042X
043X
044X

CPT/HCPCS

Psychiatric Services
S9480

Substance Use
H0015

Psychiatric Services
H0035 - Full day
S9485 - Eating Disorder Program

Substance Use
S9475

Use applicable code
Physical
Occupational
Speech

Condition Code

DR

DR

DR

Modifier

95

95

95

*Note: Telehealth IOP and PHP may be billed if it meets all the requirements of traditional IOP and PHP and will be reimbursed on a per diem basis. If services rendered do not meet all the requirements of traditional IOP or PHP, it will be reimbursed based on billable services (by payable and credentialed providers such as LPCC, LAC, LCSW, Ph.D. etc) and must be billed on a CMS-1500 with place of service 02 and modifier 95.

Additional Information

Description

Type of Service

Telehealth visit

Visit with a provider that uses a telecommunication system connecting the patient with the provider.

Virtual Check-In

A brief communication via telephone or other telecommunication device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

Digital Visit

Digital communication initiated by the member to a provider through the provider’s online patient portal.

Place of Service

02

Telehealth

11

Office

15

Mobile Unit

17

Walk-in Retail Health Clinic

19

Off Campus – Outpatient Hospital

20

Urgent Care Facility

22

On Campus – Outpatient Hospital

23

Emergency Room – Hospital

81

Independent Laboratory

Modifiers

32

Mandated Services

95

Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

CR

Catastrophe/disaster related

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

COVID-19 CPT & HCPCS Laboratory and Specimen Collection Codes

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 (Code Effective March 13, 2020)

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]) (CPT Code Effective April 10, 2020)

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (CPT Code Effective April 10, 2020)

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 RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected (CPT Code Effective 05/20/2020)

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source (Code Effective March 1, 2020)

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source (Code Effective March 1, 2020)

U0001

CDC 2019 novel coronavirus (2019-NCOV) real-time rt-pcr diagnostic panel (Code Effective February 4, 2020)

U0002

2019-NCOV coronavirus, SARS-CoV-2/2019-NCOV (COVID-19), any technique, multiple types or subtypes (includes all targets), NON-CDC (Code Effective February 4, 2020)

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. (Code Effective April 14, 2020)

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. (Code Effective April 14, 2020)

COVID-19 ICD-10-CM Diagnosis (DX) Codes

B97.29

Other coronavirus as the cause of diseases classified elsewhere (Confirmed COVID-19 DX Prior to April 1, 2020)

U07.1

COVID-19 (Effective COVID-19 DX on or after April 1, 2020)

Z03.818

Encounter for observation for suspected exposure to other biological agents ruled out

Z11.59

Encounter for screening for other viral diseases

Z20.828

Contact with and (suspected) exposure to other viral communicable diseases

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