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: |
Shortness of Breath
(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.