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

October 30, 2020

This article was revised on October 30, 2020, to update COVID-19 testing, collection, diagnosis codes, and duration of testing coverage. 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 during the COVID-19 pandemic. We encourage all AmeriHealth members and providers 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 New Jersey will cover COVID-19 testing as follows:

  • Diagnostic tests: Covered without member cost-sharing* (i.e., copayment, deductible, and coinsurance) and without an order or prescription by a licensed or qualified health care professional, when performed at any site, including a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit.
  • Antibody tests: Covered without member cost-sharing* when performed at a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit, when ordered or authorized by a licensed or qualified health care professional. 
​Testing coverage for AmeriHealth New Jersey members is effective March 6, 2020, until 90 days after the end of both the state of emergency and the public health emergency.

AmeriHealth Pennsylvania will cover COVID-19 diagnostic tests and antibody tests with no member cost-sharing when directed by the member's health care provider. Testing coverage for AmeriHealth Pennsylvania members is effective March 6, 2020, and for the duration of the public health emergency.

*Member cost-sharing is waived both in an out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. The waiver of cost-sharing for out-of-network testing and diagnosis of COVID-19 will continue until 90 days after the end of both the state of emergency and public health emergency declared by the state of New Jersey. For High Deductible Health Plans, in-network cost-sharing waivers will remain in effect through December 31, 2020, unless prohibited by law.​

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.

CPT code 0202U for BioFire® Respiratory Panel 2.1 (RP2.1) testing manufactured by BioFire® Diagnostics, LLC is effective and must be used for dates of service as of May 20, 2020, and after.

CPT code 0223U for QIAstat-Dx Respiratory SARS CoV-2 Panel testing manufactured by QIAGEN Sciences is effective and must be used for dates of service as of June 25, 2020, and after.

CPT code 0225U for ePlex® Respiratory Pathogen Panel 2 developed by GenMark Diagnostics, Inc. is effective and must be used for dates of service as of August 10, 2020, and after.

Diagnostic antigen testing codes

CPT code 87426 for infectious agent antigen detection by immunoassay technique of SARS-CoV and/or SARS-CoV-2 is effective and must be used for dates of service as of June 25, 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.

CPT code 0224U for SARS-CoV-2 (COVID-19) antibody testing developed by Mt. Sinai Laboratory is effective and must be used for dates of service as of June 25, 2020, and after.

CPT codes 86408 and 86409 for SARS-CoV-2 (COVID-19) neutralizing antibody screening and titer testing respectively are effective and must be used for dates of service as of August 10, 2020, and after.

CPT code 0226U for Tru-Immune, a serological test that measures and also quantifies the neutralizing capacity of antibodies against the SARS-CoV-2, by Ethos Laboratories and GenScript® USA Inc. is effective and must be used for dates of service as of August 10, 2020, and after.

CPT code 86413 for SARS-CoV-2 (COVID-19) quantitative antibody testing is effective and must be used for dates of service as of September 8, 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

Revenue code 0551 may be used by Home Health Agencies performing specimen collection for SARS-CoV-2 (COVID-19) and related respiratory pathogens' laboratory testing:

  • 0551 Skilled Nursing – Visit Charge

Laboratory testing for differential diagnosis codes​

  • 86603​
  • 86710
  • 86756
  • 87260
  • 87275
  • 87276
  • 87279
  • 87280
  • 87301
  • 87400
  • 87420
  • 87501
  • 87502
  • 87503
  • ​87631
  • 87632
  • 87633
  • 87634
  • 87804
  • 87807​
  • 87809 

Specimen collection for differential diagnosis laboratory testing codes

  • 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)), for examples of applicable ICD-10 codes. You can view this article for AmeriHealth New Jersey or AmeriHealth Pennsylvania members on our Medical Policy and Claim Payment ​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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