New! COVID-19 Test Billing Guidance

The Families First Coronavirus Response Act (the FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) require health plans to cover diagnostic testing of COVID-19. Coverage must be provided without any cost-share, prior authorization, or medical management requirements. The table below is provided to help understand which billing codes are appropriate for these services. Please note that antibody testing is appropriate as a diagnostic test in limited circumstances and will not be a benefitable service when conducted for return to work or surveillance purposes.

Asymptomatic and pre-surgical COVID-19 diagnostic testing is covered when medically appropriate and supported by the accepted standards of current medical practice.

See updates below in red.

Test Type HCPCS/CPT Code Providers Eligible to Bill Is cost share waived? Is it a benefit?
COVID-19 Diagnostic Test
CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel U0001 CDC, State Lab YES YES
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC U0002 Physician Offices, Urgent Care, Labs, Hospitals YES YES
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
U0003 Laboratories only YES YES
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
U0004 Laboratories only YES YES
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 87635 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) (Coronavirus disease [COVID-19])

and influenza virus types A and B, multiplex

amplified probe technique

87636 Physician Offices, Urgent Care, Labs, Hospitals YES YES
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

87637 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious agent antigen detection by immunoassay

technique, qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg,

SARS-CoV, SARS-CoV-2 [COVID-19])

87426 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 87811 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Rapid COVID-19 Diagnostic Test
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC U0002-QW Physician Offices, Urgent Care, Labs, Hospitals YES YES
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 87635-QW Physician Offices, Urgent Care, Labs, Hospitals YES YES
Proprietary Lab Codes
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

 

BioFire® Respiratory Panel 2.1 (RP2.1), BioFire® Diagnostics, BioFire® Diagnostics, LLC

0202U Physician Offices, Urgent Care, Labs, Hospitals YES YES
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

 

QIAstat-Dx Respiratory SARS CoV-2 Panel, QIAGEN Sciences, QIAGEN GmbH

0223U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed

 

COVID-19 Antibody Test, Mt Sinai, Mount Sinai Laboratory

0224U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected

 

ePlex® Respiratory Pathogen Panel 2, GenMark Dx, GenMark Diagnostics, Inc

0225U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum

 

Tru-Immune™, Ethos Laboratories, GenScript® USA Inc

0226U Physician Offices, Urgent Care, Labs, Hospitals YES YES
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

 

Xpert® Xpress SARSCoV-2/Flu/RSV (SARS-CoV-2 & Flu targets only), Cepheid

0240U Physician Offices, Urgent Care, Labs, Hospitals YES YES
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

 

Xpert® Xpress SARSCoV-2/Flu/RSV (all targets), Cepheid

0241U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Specimen Collection
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source G2023 Laboratories only YES YES
– 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 G2024 Skilled Nursing
Lab on behalf of a Home Health Agency
YES YES
Hospital Outpatient clinic visit specimen collection for severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus disease[COVID-19]), any specimen source C9803 Hospital Outpatient YES YES
Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory 99000 Physician Offices YES YES
Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory 99001 Mobile Unit
Walk-in Retail Health Clinic
Urgent Care
Emergency Room Hospital
Drive through testing
YES YES
Antibody Tests
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]) 86328 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Neutralizing antibody, severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen

86408 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen titer

 

86409 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 86769 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment

 

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