Disclaimer Regarding Guidance on Coding and Billing for COVID-19 Related Services. The guidance set forth herein regarding coding and billing for COVID-19 related services is for educational purposes only and is based upon the limited information available to Experity at the time of publication. Nothing contained herein shall be deemed to constitute a representation, warranty or guaranty of proper coding or payment for any particular medical claim. The sole responsibility for proper coding and submission of any particular medical claim remains with you. You should consult with a certified professional coder and an attorney licensed in your state for guidelines specific to your state, contracts and applicable payors.
This is a living document that will be updated as this situation evolves. This version is current to what we know on November 4, 2021.
Only confirmed cases as documented by the provider or confirmed by test results should be coded with ICD U07.1. This code should be the primary diagnosis on the claim. Additional diagnoses should be used to report manifestations
Diagnosis | ICD-10-CM |
Pneumonia | U07.1 – COVID-19 J12.82 – Pneumonia due to coronavirus disease |
Acute Bronchitis | U07.1 – COVID-19 J20.8 – Acute bronchitis due to other specified organisms |
Bronchitis, Not Otherwise Specified (NOS) | U07.1 – COVID-19 J40 – Bronchitis, not specified as acute or chronic |
Lower Respiratory Infection, NOS, or
Acute Respiratory Infection, NOS |
U07.1 – COVID-19 J22 – Unspecified acute lower respiratory infection |
Respiratory Infection, NOS | U07.1 – COVID-19 J98.8 – Other specified respiratory disorders |
Acute Respiratory Distress Syndrome (ARDS) | U07.1 – COVID-19 J80 – Acute respiratory distress syndrome |
Multisystem Inflammatory Syndrome (MIS) | U07.1 – COVID-19 M35.81 – Multisystem inflammatory syndrome |
Other Involvement of Connective Tissue | U07.1 – COVID-19 M35.89 – Other specified systemic involvement of connective tissue |
Symptomatic Patients
Signs and symptoms without a definitive diagnosis should be reported with the code for each presenting problem. Some examples are:
Include ICD Z20.822 (Contact with and (suspected) exposure to COVID-19) in addition to the symptoms to identify the services as COVID-19 related.This is not a comprehensive list. If the identified signs and symptoms are not on the list above, use the most appropriate ICD-10 available.
Asymptomatic Patients
Asymptomatic patients with actual or suspected exposure should be coded with ICD Z20.822. Per the official guidelines, during the COVID-19 pandemic, a screening code is “generally not appropriate”. Even COVID-19 testing for preoperative testing should be coded as exposure, ICD Z20.822.
Use ICD U09.9 (Post COVID-19 condition, unspecified) for reporting sequela of COVID-19 or associated symptoms/conditions following a previous infection. This code should not be used for current infections. First code the current symptoms/conditions then add code U09.9 as a secondary diagnosis.
Other diagnoses include:
The American Medical Association (AMA) created a new code set for COVID-19 vaccine services. The structure is different from other vaccines. Each unique vaccine has its own administration codes(s), depending on the number of doses.
Vaccine Administration | Manufacturer | Vaccine Code |
0001A (1st dose)
0002A (2nd dose) 0003A (3rd dose) 0004A (Booster) |
Pfizer, Inc. | 91300
Original Formulation |
0051A (1st Dose)
0052A (2nd Dose) 0053A (3rd Dose) 0054A (Booster) |
Pfizer, Inc. | 91305
Tris-sucrose Formulation |
0071A (1st Dose)
0072A (2nd Dose) |
Pfizer, Inc. | 91307
Age 5-11 years |
0011A (1st dose)
0012A (2nd dose) 0013A (3rd dose) |
Moderna, Inc. | 91301
100 mcg/0.5 mL dosage |
0064A (Booster) | Moderna, Inc. | 91306
50 mcg/0.25 mL dosage |
0021A (1st dose)
0022A (2nd dose) |
AstraZeneca, Plc | 91302 |
0031A (Single dose)
0034A (Booster) |
Janssen (Johnson & Johnson) | 91303 |
0041A (1st dose)
0042A (2nd dose) |
Novavax, Inc. | 91304 |
Providers should not bill for the product since they receive it for free. Only the administration codes should be reported.
All vaccines are reported with diagnosis code Z23 (Encounter for immunization).
Report HCPCS M0201 in addition to the administration code for COVID-19 vaccine administration inside a patient’s home. Effective August 24, 2021, this code can be reported once for each patient vaccinated in a single home unit or communal space up to a maximum of 5 times if fewer than 10 patients are vaccinated on the same day in the same group living location.
When the sole purpose of the visit is to administer the vaccine, an evaluation and management (E/M) visit should not be reported separately. CPT 99211 (i.e., a minimal visit) captures the same services as the vaccine administration codes. Only the vaccine administration should be billed.
Until the Public Health Emergency (PHE) ends, include modifier CR on your claim if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.
Combination Codes
Manufacturers have created single tests that detect both influenza A and B plus COVID-19, and, in some cases, respiratory syncytial virus. There are two types: one includes the polymerase chain reaction (PCR) test, the other includes the antigen test.
Single Codes
Most major payers are covering both 87635 and U0002 at the same rate. Medicare requires modifier QW (CLIA waived test).
Point-of-care tests should be reported with CPT 86328 (Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])).
Medicare requires modifier QW (CLIA waived test).
CPT/Laboratory Test Crosswalk
All the tests listed have a waived status. Modifier QW should be appended when the insurance plan requires it.
Test | Manufacturer | CPT |
Accula SARS-Cov-2 Test | Mes Biotech Inc. | 87635 |
Assure CoVID-19 IgG/IgM Rapid Test Device | Assure Tech. (Hangzhou Co., Ltd) | 86328 |
BD Veritor System for Rapid Detection of SARS-CoV-2 | Becton, Dickinson and Company (BD) | 87426 |
BinaxNOW COVID-19 Ag Card | Abbott Diagnostics Scarborough, Inc. | 87811 |
BioFire Respiratory Panel 2.1-EZ (RP2.1-EZ) | BioFire Diagnostics, LLC | 0202U |
CareStart COVID-19 Antigen test | Access Bio, Inc. | 87811 |
cobas SARS-CoV-2 & Influenza A/B Nucleic Acid Test for use on the cobas Liat System | Roche Molecular Systems, Inc. | 87636 |
Cue COVID-19 Test | Cue Health Inc. | 87635 |
ID NOW COVID-19 | Abbott Diagnostics Scarborough, Inc. | 87635 |
LumiraDx SARS-CoV-2 Ag Test | LumiraDX UK Ltd. | 87426 |
QuickVue SARS Antigen Test | Quidel Corporation | 87811 |
Sofia 2 Flu + SARS Antigen FIA | Quidel Corporation | 87428 |
Sofia 2 SARS Antigen FIA | Quidel Corporation | 87426 |
Xpert Xpress SARS-CoV-2 test | Cepheid | 87635 |
Xpert Xpress SARS-CoV-2/Flu/RSV | Cepheid | 0241U |
Specimen collection should only be reported when there is no other evaluation and management (E/M) code on the claim.
CMS approved reporting 99211 for specimen collection for new and established patients.
Modifiers for COVID-19 Testing-Related Services
The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services.
E/M services that result in an order for or administration of a COVID-19 test, are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test should be billed with modifier CS for full payment. Patients should not be billed for these services.
This is effective until the end of the PHE.
The Food and Drug Administration (FDA) authorized the use of monoclonal antibody therapies to treat mild-to-moderate COVID-19 when the patient has a positive COVID-19 test result and is at high risk for progressing to severe COVID-19, hospitalization, or both.
The therapies that have received an emergency use authorization (EUA) are:
The first two products are distributed free-of-charge by the Department of Health and Human Services (HHS) so the provider should only bill for the administration. Sotrovimab will not be distributed by the federal government so both the product code and the administration code should be reported.
Services Provided in the Urgent Care
Administration Code | Treatment | Manufacturer | Product Code |
M0243
Initial Dose |
Casirivimab and imdevimab, administered together (1200 mg or 2400 mg) | Regeneron | Q0243 (2400 mg)
Q0244 (1200 mg) |
M0240
Subsequent Repeat Dose(s) |
Casirivimab and imdevimab, administered together (600 mg) | Regeneron | Q0240 |
M0245 | Bamlanivimab and etesevimab, administered together (2100 mg) | Eli Lilly and Company | Q0245 |
M0247 | Sotrovimab (500 mg) | GlaxoSmithKline | Q0247 |
Services Provided in the Home
Administration Code | Treatment | Manufacturer | Product Code |
M0244
Initial Dose |
Casirivimab and imdevimab, administered together (1200 mg or 2400 mg) | Regeneron | Q0243 (2400 mg)
Q0244 (1200 mg) |
M0241
Subsequent Repeat Dose(s) |
Casirivimab and imdevimab, administered together (600 mg) | Regeneron | Q0240 |
M0246 | Bamlanivimab and etesevimab, administered together (2100 mg) | Eli Lilly and Company | Q0245 |
M0248 | Sotrovimab (500 mg) | GlaxoSmithKline | Q0247 |
The place-of-service (POS) for the home is 12. Other possible POS include 04 (Homeless Shelter), and 16 (Temporary Lodging).
The patient must have a positive COVID-19 test result and be at high risk for progressing to severe COVID-19, hospitalization, or both. Report ICD-10 code U07.1 (COVID-19) as primary with additional codes for any manifestations or high-risk conditions(s).
Casirivimab and imdevimab, administered together, are also authorized as a post-exposure prophylaxis (PEP). Coverage is limited to patients who are:
For PEP, use ICD Z20.822 as the primary diagnosis with additional codes for any immunocompromised conditions. Documentation should include the requirements above.
Many prior restrictions have been relaxed for the duration of the PHE. Private payers have published effective periods.
Audio and Visual
CMS and many States have dictated that services be covered at the same rate as if the patient was in the clinic. Historically, CMS has covered these services at the lower facility rate due to decreased overhead.
CMS has instructed providers to bill with the same POS they would use if the patient had come to the office (i.e., 11 or 20). Modifier 95 (Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System) should be applied to indicate it was a telehealth service.
This coding ensures reimbursement at the appropriate non-facility rate. Claims submitted with POS 02 (Telehealth) will continue to be reimbursed at a lower rate.
These instructions are for payers that follow CMS guidelines. Instructions from private payers may vary.
Audio Only
Effective March 31, 2020, CMS began covering telephone calls. Many major private payers were already covering these services.
Documentation of time is used to support the level billed. Services can be reported for both new and established patients during the duration of the PHE.
The correct POS for these services is 11 (Office) or 20 (Urgent Care Facility) based on your contract.
Online Digital Evaluation and Management Services (E-Visits)
This is for when a patient communicates with a provider via an EHR secure portal, secure e-mail or other digital application. It is for established patients but can be for a new problem. Services should be performed by a billable provider, not clinical staff.
Virtual Check-In
This is a virtual check-in or brief communication technology-based service where the provider may respond to the patient’s concern by telephone, audio/video, secure text messaging, e-mail or use of a patient portal.
Virtual check-in services can only be reported when the billing practice has an established relationship with the patient.
These examples are typical coding for these services. It may vary by payer. Specimen collection is included if billing another E/M.
Specimen Collection Only
Specimen Collection Only
Onsite E/M Visit and Specimen Collection
Telehealth E/M Visits and Specimen Collection
Specimen Collection Only
Onsite E/M Visit and Specimen Collection
Telehealth E/M Visits and Specimen Collection
Specimen Collection Only
Onsite E/M Visit and Specimen Collection
Telehealth E/M Visits and Specimen Collection
Specimen Collection Only
Onsite E/M Visit and Specimen Collection
Telehealth E/M Visits and Specimen Collection
CMS COVID-19 Billing and Coding Toolkit: COVID-19
CDC Current Instructions for Coding COVID-19 Related Services: ICD-10 Official Coding and Reporting Guidelines October 1, 2021 through September 30, 2022
AMA List of Vaccine Codes: Find your COVID-19 Vaccine CPT® Codes
AMA Guidance for Coding Scenarios Unique to PHE: Special coding advice during COVID-19 public health emergency
CMS Billing Information for Monoclonal Antibody COVID-19 Infusion: Monoclonal Antibody COVID-19 Infusion
AMA Guidance for Reporting Code 87635: AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-Cov-2) Laboratory Testing
AMA Guidance for Reporting Code 86328: SARS-CoV-2 Serologic Laboratory Testing (Special Edition: April Update)
AMA Guidance for Reporting Code 0202U: TInfectious Disease Testing for Bacterial or Virus Respiratory Tract Infection (Special Edition: May Update)
AMA Guidance for Reporting Code 87246, 0223U, 0224U: Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV and SARS-CoV-2) Laboratory Testing (Special Edition: June Update)
AMA Guidance for Reporting Code 87636, 0241U: COVID-19 October Update
AMA Guidance for Reporting Code 87428: COVID-19 November Update
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