Claim Coding, Submissions and Reimbursement

Last update: September 28, 2020, 11:00 a.m. CDT

Care providers are responsible for submitting accurate claims in accordance with state and federal laws and UnitedHealthcare’s reimbursement policies. When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below and review the CDC guideline for ICD-10-CM diagnosis codes.

Network physicians are required to use a network laboratory. UnitedHealthcare Preferred Lab Network providers meet higher standards for access, cost, quality and service standards.

Resources

Use CPT code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2). More information is available at AMA Resource Center for Physicians, or you can download the CPT Assistant Guide. We will also accept the following HCPCS codes for COVID-19 testing performed for dates of service listed below, as outlined by the Centers for Medicare & Medicaid Services (CMS):

On or After Feb. 4, 2020

HCPCS U0001:

  • This code is used for the laboratory test developed by the Centers for Disease Control and Prevention (CDC).  
  • Description: 2019 – nCoV diagnostic P

HCPCS U0002:

  • This code is used for the laboratory test developed by entities other than the CDC.
  • Description: COVID-19 lab test non-CDC

On or After March 18, 2020*

HCPCS U0003:

  • This code should be used for clinical diagnostic laboratory tests that use high-throughput amplified probe technologies to detect and diagnose COVID-19.
  • Description: 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.

HCPCS U0004:

  • This code should be used when billing under Medicare Part B for clinical diagnostic laboratory tests that use high-throughput technologies to detect and diagnose COVID-19.
  • Description: 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.

*Effective dates of codes were determined by reference to CMS Ruling No. (CMS-2020-01-R).

On or After June 25, 2020 (Antigen testing)

 CPT 87426

  • This code should be used for infectious agent antigen detection testing.

For dates of service on or after March 1, 2020*, UnitedHealthcare will accept the following codes:

G2023:

  • This code is used when billing for lab specimen collection for COVID-19. 
  • Description: Specimen collection for COVID-19 (SARS-CoV-2), any specimen source.

G2024:

  • This code is used when billing for independent laboratories when specimens are collected from patients in skilled nursing facilities (SNF) and specimens collected on behalf of home health agencies (HHA).
  • Description: Specimen collection for SARS-CoV-2 COVID-19 from an individual in an SNF or by a laboratory on behalf of an HHA, any specimen source.

*Effective dates of codes were determined by reference to CMS Interim Final Rule (CMS-1744-IFC).

Use the following codes for antibody detection for COVID-19 for dates of service on or after April 10, 2020:

  • 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])
  • 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Provider Billing Guide

To help you understand how UnitedHealthcare will reimburse services during the national public health emergency period, we created a COVID-19 testing and testing-relates services billing guide. UnitedHealthcare’s temporary changes to its reimbursement policies do not alter state and federal laws applicable to your practice.

Laboratory Billing Scenarios

The following procedure and/or diagnosis codes are provided for reference purposes only and may not be all inclusive.

If you are both collecting the specimen for the laboratory testing, and your laboratory is performing the test itself, use the guidance in both laboratory and patient scenarios below. Please note: You cannot bill for the laboratory test if your laboratory is not performing it. 

If you have a laboratory that is performing the actual COVID-19 test, please use the following preferred codes for the applicable scenarios: 

Laboratory Scenario:

  • Laboratory receives physician order and patient specimen for testing
  • Laboratory performs testing and reports test results

Billing:

Step 1. Use CPT code 87635

Step 2. Use ICD Dx provided on physician order.  ICD DX: Z03.818 – Suspected exposure to COVID-19 or ICD Dx: Z20.828 – Exposure to confirmed case of COVID-19

If a laboratory is performing the actual COVID-19 test, we will also accept the following HCPCS codes for the applicable scenarios:

  • HCPCS U0001: This code is used for the laboratory test developed by the CDC.
  • HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC, in accordance with CDC guidelines.

Tim Kaja, Chief Operating Officer, UnitedHealthcare Networks, offers guidance on billing for COVID-19 laboratory tests.  

We have sought guidance and input from AMA CPT® committee in the development of all billing scenarios. Information provided by the American Medical Association (AMA) does not dictate payer reimbursement policy, and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.

Tim Kaja Detailed Video Transcript

[UnitedHealthcare logo]

[Covid-19 Provider Update: Lab Billing for Coronavirus Test]

[How should labs bill for the Coronavirus (COVID-19) test?]

[Tim Kaja, Chief Operating Officer, UnitedHealthcare Networks]

During these times of uncertainty, I’d like to focus on how UnitedHealthcare is creating clarity around coding practices for health care professionals billing for the coronavirus test.

Specifically, laboratories as they bill for the coronavirus test.

We had an opportunity to confer with the American Medical Association, their CPT experts, and the Federation of Medicine a short while ago.

When billing from a laboratory for the coronavirus test, you’ll need to remember one CPT code and two ICD-10 codes.

You may have heard previously that there was a distinction as to whether or not the test kit was provided by the CDC or not.

We are no longer recognizing that distinction.

So, the correct CPT code to bill is the new CPT code 87635 for all laboratory tests being submitted for the coronavirus test.

On the ICD-10 code, follow the diagnoses that were submitted by the participating physician who submitted the test.

And that will be consistent with whether or not the patient had previous confirmed exposure to someone with coronavirus or only suspected exposure to someone with coronavirus.

If it’s the former, bill with ICD-10 code Z20.828.

[Actual exposure to COVID-19]

If the patient has only been suspected of having contact with someone with coronavirus, go with ICD-10 code Z03.818.

[Possible exposure to COVID-19]

We know that these are difficult times and at UnitedHealthcare, we are attempting to create clarity in claims submission processes. 

In this case, for billing of a coronavirus test from a laboratory.

This information can also be found on UHCprovider.com

[UnitedHealthcare logo]

uhcprovider.com

We have sought guidance and input from AMA CPT® committee in the development of all billing scenarios. Information provided by the American Medical Association does not dictate payer reimbursement policy, and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.

Office Billing Scenarios

If you are a care provider collecting the specimen for the COVID-19 test, please use the following codes for the applicable scenarios:

Patient Scenario:

Practice Collects Specimen

  • Patient presents for an office visit, urgent care visit or emergency room visit.
  • Physician/practice staff collect nasal specimen for COVID-19 testing OR physician/practice staff oversees FDA-approved self-administered collection.
  • Practice sends specimen to approved locations in accordance with CDC guidelines.

Billing:

Step 1. Use appropriate Office Visit E/M code

Step 2:

  • Use ICD Dx: Z03.818 – For suspected exposure to COVID-19
  • Use ICD Dx: Z20.828 – For exposure to confirmed case of COVID-19 

If specimen is collected somewhere other than a physician office, bill CPT code 99001 or one of the new COVID-19 specimen collection codes.*

This billing requirement and associated reimbursement applies to claims submitted on CMS 1500 claims forms, UB04 or electronic equivalent only.

*Drive-up testing is permissible if ordered by a physician or health care provider. Telehealth and virtual visit providers can order a COVID-19 antibody test. UnitedHealthcare will follow CDC guidelines and state requirements regarding testing limits.  

Tim Kaja, Chief Operating Officer, UnitedHealthcare Networks, offers guidance on how practices should bill for COVID-19 initial office visits.

We have sought guidance and input from AMA CPT® committee in the development of all billing scenarios. Information provided by the American Medical Association (AMA) does not dictate payer reimbursement policy, and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.

Tim Kaja – How Practices Bill Detailed Video Transcript

[UnitedHealthcare logo]

[Covid-19 Provider Update: Office Billing for Initial Coronavirus Test]

[How should practices bill for the Coronavirus (COVID-19) office visits?]

[Tim Kaja, Chief Operating Officer, UnitedHealthcare Networks]

We want to thank everyone for their continued patience around coding protocols as they continue to evolve for the coronavirus and coronavirus testing.

In this edition, we're going to talk specifically about how the primary care physician bills for the coronavirus test when the patient presents in an in-office setting.

Our guidance continues to be informed by the American Medical Association and their CPT code experts.

When the patient presents to the physician’s office with symptoms of the coronavirus, the physician should bill the appropriate evaluation and management code consistent with the level of history, exam and medical decision-making made.

The swab and the submission of the coronavirus test is included in the evaluation and management code.

The ICD-10 codes submitted are consistent with the reason why the patient visited the physician and the diagnosis but also includes whether or not the patient had previous confirmed exposure to coronavirus, or only suspected exposure to someone with coronavirus.

If it's the former, bill ICD-10 code Z20.828

[Actual exposure to COVID-19]

If it's only suspected exposure to coronavirus, bill ICD-10 code Z03.818.

[Possible exposure to COVID-19]

We know these are difficult times and at UnitedHealthcare, we're attempting to create clarity in claim submission processes. In this case, for how to bill for the coronavirus when the patient presents in an in-office setting.

This information can also be found on UHCprovider.com

[UnitedHealthcare logo]

uhcprovider.com

We have sought guidance and input from AMA CPT® committee in the development of all billing scenarios. Information provided by the American Medical Association does not dictate payer reimbursement policy, and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.

We will reimburse COVID-19 testing in accordance with applicable law, including the CARES Act. Updates and additional information will be posted on this site as quickly as possible when new information is released.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 


CPT® is a registered trademark of the American Medical Association

Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.