The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have created the following new Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes to use when billing for infusion, testing, and lab tests related to COVID-19.
NOTE - for questions regarding coverage and reimbursement, please call the South Country Health Alliance Provider Contact Center at 1-888-633-4055. You may also access additional detail on COVID-19 coverage at Minnesota Department of Human Resources Minnesota Health Care Programs MHCP Provider Manual (external link) and CMS https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page (external link).
After May 11, 2023 (End of the Public Health Emergency (PHE)) – Appropriate laboratory tests for COVID-19 that are ordered by a qualifying provider will still be covered through September 30, 2024.
The table COVID-19 Related Lab Codes was last modified at 2022-05-02 10:27:01
| COVID-19 Lab Codes | Effective Date | Detailed Description |
|---|---|---|
| U0001 | 2/4/2020 | CDC-2019 Novel Coronavirus Real Time RT-PCR Diag Test Panel This code to be used if the CDC and Prevention lab test is performed |
| U0002 | 2/4/2020 | 2019 nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) This code to be used if the test performed is not the CDC test |
| U0003 | 3/18/2020 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified prove technique, making use of high throughput technologies as described by CMS-2020-01-R U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with high throughput technologies |
| U0004 | 3/18/2020 | 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 U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies |
| U0005 | 1/1/2021 | 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) as described by CMS-2020-01-r2 |
| G2023 | 3/1/2020 | Specimen collection for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], any specimen source |
| G2024 | 3/1/2020 | 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 |
| C9803 | 3/1/2020 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source |
| 86318 | 3/1/2020 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)(Coronavirus disease [COVID-19]) |
| 86328 | 4/10/2020 | Immunoassay for Infectious Agent Antibody(ies), Qualitative or semi-quantitative Single Step Method (e.g., Reagent Strip); Severe Acute Respiratory Syndrome Coronavirus2 (SARS-CoV2) (Coronavirus Disease [COVID-19]) |
| 86408 | 8/10/2020 | Coronavirus 2 (SARS-CoV-2) neutralizing antibody screen |
| 86409 | 8/10/2020 | Coronavirus 2 (SARS-CoV-2) neutralizing antibody titer |
| 86413 | 9/08/2020 | Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative |
| 86769 | 4/10/2020 | Antibody; Severe Acute Respiratory Syndrome Coronavirus2 (SARS-CoV2) (Coronavirus Disease [COVID-19]) |
| 87635 | 3/13/2020 | Microbiological laboratory testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) |
| 87426 | 6/25/2020 | Infectious agent antigen detection by immunoassay technique (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) |
| 87428 | 11/10/2020 | Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Severe Acute Respiratory Syndrome Coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B |
| 87635 | 3/13/2020 | Microbiological laboratory testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) |
| 87636 | 10/06/2020 | Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
| 87637 | 10/06/2020 | Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
| 87811 | 10/06/2020 | Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) |
| 0223U | 6/25/2020 | NFCT DS 22 TRGT SARS-COV-2 |
| 0224U | 6/25/2020 | Antibody SARS-CoV-2 titer(s) |
| 0225U | 8/10/2020 | 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 |
| 0226U | 8/10/2020 | Surrogate Viral Neutralization Test (sVNT), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum |
| 0240U | 10/6/2020 | 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 |
| 0241U | 10/6/2020 | 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 |
*Please note the EUA effective date may vary from the date it is covered by South Country Health Alliance.
The table COVID-19 Infusion Codes was last modified at 2022-09-09 12:06:43
| Antibody infusion | Antibody Code Detailed Description | *EUA Effective Date | Administration Code | Administration Code Description |
|---|---|---|---|---|
| Q0220 | Injection, Tixagev and cilgav, 300 mg | 12/18/2021 | M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring |
| Q0221 | Injection, Tixagev and cilgav, 600 mg | 02/24/2022 | M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring |
| Q0222 | Injection, bebtelovimab, 175 mg Effective 8/15/2022 and after, only bill Q0222 with a charge amount if use commercially purchased products; do not bill for United States Government-purchased products. Check the Batch# on the vial. Watch for Eli Lilly to release more information about future Commercially purchased batch numbers. | 02/11/2022 | M0222
| Intravenous injection, bebtelovimab, includes injection and post administration monitoring
|
| Q0239 | Injection, bamlanivimab-xxxx, 700 mg These codes are for a new Medicare Monoclonal Antibody COVID-19 Infusion Program effective November 10, 2020. The antibody product received an Emergency Use Authorization (EUA) from the FDA on November 9, 2020. | 11/9/2020-4/16/2021 Note: On April 16, 2021, the FDA revoked the EUA for bamlanivimab when administered alone. | M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post-administration monitoring |
| Q0240 | Injection, casirivimab and imdevimab, 600 mg | 07/30/2021 | M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
| Q0243 | Injection, casirivimab and imdevimab, 2400 mg This code is for a new Medicare Monoclonal Antibody COVID-19 Infusion Program effective November 21, 2020. The antibody product received an Emergency Use Authorization (EUA) from the FDA on November 21, 2020. | 11/21/2020 | M0243 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring |
| Q0245 | Injection, bamlanivimab and etesevimab, 2100 mg Medicare identified specific code(s) for the monoclonal antibody product and specific administration code(s) for Medicare payment: Eli Lilly and Company’s Antibody Bamlanivimab and Etesevimab, (ZIP) | 02/09/2021 | M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
| Q0247 | Injection, sotrovimab, 500 mg | 05/26/2021 | M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
| Q0249 | Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg | 06/24/2021 | M0249 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose |
* Please note, the EUA effective date may vary from the date it is covered by South Country Health Alliance. Please visit the CMS Covid-19 Monocional Antibodies webpage (external link) for more information on Monocional Antibody EUA.
For more information, review the AMA billing guidelines (pdf) regarding COVID-19 lab codes.
COVID-19 developments are changing rapidly and we will be updating our website as new developments occur. Please check back frequently for updates.
Last Updated on 06/02/2023 by Chris Gartner