Reminder to use specific codes when evaluating for COVID-19
As you continue to treat your patients and evaluate for COVID-19, please use the appropriate codes.
In order for cost-sharing obligations to be waived, claims must include one of the following diagnosis codes in addition to any other diagnosis appropriate to report on the claim:
- Z20.828 – Contact with and suspected exposure to other viral communicable diseases
- Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out
- B97.29 – Other Coronavirus as the cause of diseases classified elsewhere
- U07.1 – 2019-nCoV acute respiratory disease
Based on CDC recommendations, we believe that one of these codes would be most appropriate to report when a patient is evaluated and COVID-19 was considered in the differential diagnosis. Other diagnoses, in addition to these codes, should also be reported as appropriate.
Claims that do not include one of the above diagnoses will be processed normally and the reimbursement will be reduced by any applicable member cost sharing based on the benefit plan.