Reminder: Use correct codes when evaluating for COVID-19

The CDC released new COVID-19-specific diagnosis codes effective January 1, 2021.

When evaluating a patient for COVID-19, member cost sharing for the Evaluation and Management services related to this condition will be waived when one of the following codes are submitted:

  • Z11.52 – Encounter for screening for COVID-19
  • Z20.822 – Contact with and (suspected) exposure to COVID-19
  • J12.82 – Pneumonia due to coronavirus disease 2019
  • U07.1 – 2019-nCoV acute respiratory disease

Based on CDC recommendations, these codes should be considered as most appropriate when a patient was evaluated and COVID-19 was considered. Other diagnoses, in addition to these codes, should also be reported, as appropriate. Reimbursement for claims that do not report one of the above diagnoses will be reduced by any applicable member cost sharing based on the benefit plan.

Since there are now more specific codes available to report a visit where testing for COVID-19 is likely to be ordered or performed, claims reporting the below diagnosis codes will not have cost sharing waived.

  • Z20.828 – Contact with and suspected exposure to other viral communicable diseases
  • Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out
  • B97.29 – Other Coronavirus as the cause of diseases classified elsewhere
  • B97.21 – SARS-associated coronavirus as the cause of diseases classified elsewhere
  • B34.2 – Coronavirus infection, unspecified