Screening for COVID-19 Diagnosis Guidance
Asymptomatic and pre-surgical COVID-19 diagnostic testing is covered when medically appropriate and supported by the accepted standards of current medical practice. Diagnostic tests will not be a benefitable service when conducted for return to work or surveillance purposes. All COVID-19 diagnostic test claims should be submitted with an ICD-10 code(s) that appropriately describes the patient’s diagnosis. To ensure proper reimbursement for COVID-19 diagnostic tests, please follow the guidelines set out below.
See updates below in red.
| In these cases: | Code | Description |
| Concern about a possible exposure to COVID-19, but this is ruled out after evaluation. | Z03.818 | Encounter for observation for suspected exposure to other biological agents ruled out.
|
| Actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown. | Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases. |
| Actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown. | Z20.822 | Contact with and (suspected) exposure to COVID19 |
| Asymptomatic individuals who are being screened for COVID-19 prior to a surgical procedure. | Z01.818 | Encounter for other preprocedural examination. |
| Asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative. Do not code when the individual is presenting with signs & symptoms. | Z11.59
|
Encounter for screening for other viral diseases.
Asymptomatic screening for COVID-19 is not a benefit. Do not code when the individual is presenting with signs and symptoms. |
| Individuals who are being screened for COVID-19 | Z11.52 | Encounter for screening for COVID-19.
Please include signs and symptoms of COVID-19 if present.
|
| Presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established.
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code. |
For example:
R05 R06.02 R50.9
|
Cough Shortness of Breath Fever (unspecified) (codes listed are not the only Dx codes that can be used)
|
| Asymptomatic individuals who test positive for COVID-19. | U07.1 | Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection. |
COVID-19 Related Diagnosis Codes
New COVID-19 related diagnosis codes such as J12.82, M35.81, and M35.89 will not waive cost share unless U07.1 is included on the claim.
