COVID-19 (Coronavirus): Billing and coding for testing

June 29, 2020

This article was revised on June 29, 2020, to update the effective timeline. To learn about testing and treatment coverage and prescribing information, please read this article.

AmeriHealth is committed to providing our members with access to the care they need. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.

We encourage all AmeriHealth members to visit our dedicated COVID-19 webpages for AmeriHealth New Jersey or AmeriHealth Pennsylvania regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Billing and coding for COVID-19 tests

AmeriHealth will cover and waive member cost-sharing (i.e., copayment, deductible, and coinsurance) for the COVID-19 tests when ordered or authorized by a health care professional licensed and/or qualified to do so under state law. Testing coverage for AmeriHealth New Jersey members is effective March 6, 2020, through the public health emergency or December 31, 2020, whichever is later. Testing coverage for AmeriHealth Pennsylvania members is effective March 6, 2020, through December 31, 2020.

Diagnostic testing codes

HCPCS codes U0001 and U0002 for Centers for Disease Control and Prevention (CDC) and non-CDC testing for SARS-CoV-2 (COVID-19) are effective and must be used for dates of service as of February 4, 2020, and after:  

  • U0001: CDC 2019 novel coronavirus (2019-nCoV) Real-Time RT-PCR diagnostic panel
  • U0002: 2019-nCoV coronavirus, SARS-CoV-2 /2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

Note: HCPCS code U0002 applies to all types of COVID-19 laboratory testing (e.g., RT-PCR).

HCPCS codes U0003 and U0004 for COVID-19 laboratory testing using high throughput technologies, are effective and must be used for dates of service as of April 14, 2020 and after.

  • U0003: 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 as described by CMS-2020-01-R
  • U0004: 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 as described by CMS-2020-01-R

CPT® code 87635 for COVID-19 nucleic acid testing is effective and must be used for dates of service as of March 13, 2020, and after.

Antibody testing codes

CPT codes 86328 and 86769 for COVID-19 antibody testing are effective and must be used for dates of service as of April 10, 2020, and after.

Specimen collection codes

HCPCS codes C9803, G2023, and G2024 for the collection of SARS-CoV-2 (COVID-19) specimens including nasopharyngeal swab (NP), oropharyngeal swabs (OP), serum, plasma, or venipuncture whole blood are effective and must be used for dates of service as of March 1, 2020, and after:

  • C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024: 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

Laboratory testing for differential diagnosis

  • 86603
  • 86710
  • 86756
  • 87260
  • 87275
  • 87276
  • 87279
  • 87280
  • 87301
  • 87420
  • 87501
  • 87502
  • 87503
  • 87631
  • ​87632
  • 87633
  • 87634
  • 87804
  • 87807
  • 87809

 

Specimen collection for differential diagnosis lab testing

  • S9529
  • 36400
  • 36405
  • 36406
  • 36410
  • 36415
  • 36425
  • 36420

ICD-10 diagnosis codes

Please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) – Updated May 13, 2020, for examples of applicable ICD-10 codes. You can view this article on our Medical Policy Portal in the News & Announcements section.

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources:

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