Billing and Coding Guidelines For COVID-19

The following billing guidelines reflect the Centers for Medicare & Medicaid Services (CMS), Blue Cross Blue Shield Association (BCBSA) and North Dakota Department of Insurance State guidance. Please follow these directions to ensure proper claims processing. 

The following code modifications determine how Blue Cross Blue Shield of North Dakota (BCBSND) appropriately waives cost sharing amounts as outlined in our expanded COVID-19 coverage. Not all COVID-19 related services are paid with a cost share waiver of 100%, this is based on member benefits.

COVID-19 Testing/Collection

• Append modifier 32, CR, or CS to the COVID-19 testing/collection and related Evaluation and Management (E/M) codes on professional and outpatient facility claims

Note: 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.  Telehealth E/M visits may result in the determination of the need for a COVID-19 specimen collection. Providers must submit modifier 25 and 95 on the Telehealth E/M to support the separately identifiable Telehealth visit from the onsite clinical staff collection fee.

COVID-19 Vaccines and Monoclonal Antibodies

Refer to CMS COVID-19 Vaccines and Monoclonal Antibodies webpage for a full listing of the COVID-19 vaccine, administration and monoclonal antibodies codes, descriptions and effective dates.

Vaccine & Administration

Providers should refer to the Modifier SL – State Supplied Vaccinations Reimbursement Policy for guidelines for billing COVID-19 State Issued vaccines.

Vaccine Administration At Home

Effective June 8, 2021, CMS established a new Healthcare Common Procedure Coding System (HCPCS) code, M0201, to report for an additional payment when COVID-19 vaccines are administered to patients that have difficulties leaving their homes or are hard-to-reach. HCPCS M0201 is reported in addition to the existing product-specific COVID-19 vaccine administration codes (e.g., 0001A, 0002A, 0011A, 0012A, 0031A) when administered in the home.

• This code can only be used if the sole purpose of the visit is for vaccine administration.
• M0201 can only be used once per home per date of service.
• If the vaccine is given to more than one person in the home on the same day, only one claim for M0201 may be filed.

Monoclonal Antibody Infusion and Administration

The U.S. Food and Drug Admin­istration (FDA) issued an Emergency Use Authorization (EUA) for the investigational monoclonal anti­body therapy. These monoclonal anti­body therapies are for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospital­ization. 

References