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 from 1/27/2021 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, CDC Or Non-CDC, Making Use Of High Throughput Technologies, Completed Within 2 Calendar Days From Date Of Specimen Collection (List Separately In Addition To Either HCPCS Code U0003 Or U0004) | U0005 | 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
BioFire® Respiratory Panel 2.1- EZ (RP2.1-EZ), BioFire® Diagnostics, BioFire® Diagnostics, LLC |
0202U
0202U-QW
| 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 | 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 |
| 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 |