Billing and Coding Guidelines During 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.
Services Related to COVID-19
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.
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
COVID-19 Related service:
- Append modifier 32, CR, or CS to COVID-19 related service(s)
- Include one of these modifiers on all services related to active COVID-19 cases to identify services related to care on CMS-1500 and/or Outpatient UB-04 Claim Forms.
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
*The below grids are not all-inclusive lists of every service a member may receive for COVID-19 treatment. The grids provide guidelines to assist with billing and cost share waivers for active COVID-19 cases.
COVID-19 Vaccines
The American Medical Association (AMA) released the following codes for the COVID-19 vaccine and vaccine administration. Providers should refer to the Modifier SL – State Supplied Vaccinations Reimbursement Policy for guidelines for billing COVID-19 State Issued vaccines.
Services Related to COVID-19 Vaccines and Vaccine Administration
Providers rendering a significantly separate and identifiable office visit related to a COVID-19 vaccination received on the same date as the office visit must append modifier 32, CR, or CS to the office visit on professional and outpatient facility claims in conjunction to modifier 25. Providers should not report an office visit code if the only service provided is the COVID-19 vaccine and administration.
Monoclonal Antibody COVID-19 Infusion and Administration
The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab, on November 9, 2020. On November 21, 2020, an EUA was issued for casirivimab and imdevimab (also known as REGN-COV2 or REGEN-COV2). casirivimab and imdevimab are to be administered together. On February 9, 2021, Eli Lilly has received FDA EUA for bamlanivimab and etesevimab administered together. 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.
Non COVID-19-Related Services
To allow for social distancing, BCBSND has 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
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 | |
21 | Inpatient Hospital | |
22 | On Campus – Outpatient Hospital | |
23 | Emergency Room – Hospital | |
31 | Skilled Nursing Facility | |
32 | Nursing Facility | |
33 | Custodial Care Facility | |
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 | 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]) |
86408 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen (CPT Code Effective August 10, 2020) | |
86409 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer (CPT Code Effective August 10, 2020) | |
86413 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative (CPT Code Effective September 8, 2020) | |
86769 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (CPT Code Effective April 10, 2020) | |
87426 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) (CPT Code Effective June 25, 2020) | |
87428 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B (CPT Code Effective November 10, 2020) | |
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) | |
87636 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique (CPT Code Effective October 6, 2020) | |
87637 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique (CPT Code Effective October 6, 2020) | |
87811 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (CPT Code Effective October 6, 2020) | |
91300 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use (Code Effective December 11, 2020) | |
91301 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use (Code Effective December 18, 2020) | |
91302 | Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use (Code Effective upon Receiving Emergency Use Authorization or approval from the Food and Drug Administration) | |
91303 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010viral particles/0.5mL dosage, for intramuscular use (Code Effective February 26, 2021) | |
0001A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose (Code Effective December 11, 2020) | |
0002A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose (Code Effective December 11, 2020) | |
0011A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose (Code Effective December 18, 2020) | |
0012A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose (Code Effective December 18, 2020 | |
0021A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; first dose (Code Effective upon Receiving Emergency Use Authorization or approval from the Food and Drug Administration) | |
0022A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose (Code Effective upon Receiving Emergency Use Authorization or approval from the Food and Drug Administration) | |
0031A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010viral particles/0.5mL dosage, single dos (Code Effective February 26, 2021) | |
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 May20, 2020) | |
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 RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected (CPT Code Effective June 25, 2020) | |
0224U | Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed (CPT Code Effective June 25, 2020) | |
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 probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected (CPT Code Effective August 10, 2020) | |
0226U | Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum (CPT Code Effective August 10, 2020) | |
0240U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected (CPT Code Effective October 6, 2020) | |
0241U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected (CPT Code Effective October 6, 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) | |
G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment (Code Effective January 1, 2021) | |
G2251 | Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion (Code Effective January 1, 2021) | |
G2252 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion (Code Effective January 1, 2021) | |
M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring (Code Effective November 9, 2020) | |
M0243 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring (Code Effective November 21, 2020) | |
M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring (Code Effective February 9, 2021) | |
Q0239 | Injection, bamlanivimab-xxxx, 700 mg (Code Effective November 9, 2020) | |
Q0243 | Injection, casirivimab and imdevimab, 2400 mg (Code Effective November 21, 2020) | |
Q0245 | Injection, bamlanivimab and etesevimab, 2100 mg (Code Effective February 9, 2021) | |
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) | |
U0005 | 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 (Code Effective January 1, 2021) | |
COVID-19 | B97.29 | Other coronavirus as the cause of diseases classified elsewhere (Confirmed COVID-19 DX Prior to April 1, 2020) |
J12.82 | Pneumonia due to coronavirus disease 2019 (Code Effective January 1, 2021) | |
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 | |