UnitedHealthcare is waiving cost-sharing for COVID-19 treatment; continuing to expand access to telehealth. Learn more.

UnitedHealthcare is waiving...
Skip left navigation

Claim Coding, Submissions and Reimbursement

Last update: March 30, 2020, 7:20 p.m. CDT

When submitting COVID-19-related claims, follow the coding guidelines and guidance outlined below.

We’ll have codes loaded in our claims system by April 1, 2020, for commercial, Medicare Advantage and Medicaid plans, and will process and pay for COVID-19 testing. Additionally, we will update this guidance when the U.S. Department of Health and Human Services releases a modifier (or other identifier) to include on claims to identify COVID-19 testing-related services.

The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report until a new code becomes effective Oct. 1, 2020:

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 on or after Feb. 4, 2020, as outlined by the Centers for Medicaid & Medicare Services (CMS):

  • 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.

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 are billing for yourself from a different location, bill using your own tax ID number (TIN) and billing address. If you are providing services as part of another group, claims should be billed by the group using the group’s TIN and billing address.

Laboratory Billing Scenarios

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 oversee 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 – Suspected exposure to COVID-19 or ICD Dx: Z20.828 – Exposure to confirmed case of COVID-19

If specimen is collected somewhere other than a physician office, bill CPT code 99001.

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

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

Submit Feedback

CPT® is a registered trademark of the American Medical Association

Disclaimer:

The benefits described on this website describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.