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.

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.

UB-04

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.

monoclonal antibody treatment

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
CPT &
HCPCS
Codes

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
Diagnosis Codes

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

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