Medical Coding for COVID-19 Novel Coronavirus
- COVID-19 ICD-10-CM Coding
- COVID-19 CPT® Coding
- COVID-19 HCPCS Coding
- COVID-19 DRG Coding
- Optum360 COVID-19 Product Updates
- We Are Here to Help
- Other COVID-19 Resources
Optum360® is committed to ensuring that you have the information you need to effectively and efficiently address COVID-19 from a medical coding, billing and reimbursement perspective. We have compiled information from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), American Medical Association (AMA), and the Centers for Medicare and Medicaid Services (CMS), so you can easily access the most up-to-date medical code detail and effective dates in one convenient place.
COVID-19 ICD-10-CM Coding
There is one new ICD-10-CM code for COVID-19, effective April 1, 2020:
The CDC posted the official ICD-10-CM Coding and Reporting Guidelines for COVID-19 for April 1, 2020-September 30, 2020.COVID-19 Related Condition: Multisystem Inflammatory Syndrome in Children (MIS-C) (113 KB)
COVID-19 CPT® Coding
One new CPT® code was created for reporting new coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective March 13, 2020.
|87635||Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (New Coronavirus disease [COVID-19]), amplified probe technique)|
Two new CPT® codes were created, one revised, for reporting COVID-19 antibody testing, effective April 10, 2020.
|86318||Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip);|
|#86328|| Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
Code #86328 is a resequenced code that follows code 86318.
|86769||Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])|
|0202U||Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected|
COVID-19 HCPCS Coding
Two new HCPCS Level II codes were created for new coronavirus testing, effective April 1, 2020, for dates of service starting February 4, 2020.
|U0001||CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel For tests developed only by the CDC (reporting allows CDC testing laboratories to test new patients and track new cases).|
|U0002||2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
For laboratories performing non-CDC testing.
Two new HCPCS Level II codes were created for coronavirus testing using high throughput technologies, effective April 14, 2020 (reportable for services provided on March 18, 2020 and forward).
|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
|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 SNF or by a laboratory on behalf of a HHA, any specimen source|
|C9803||Hospital outpatient clinic visit specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source|
Modifier CS was revised and may be appended to COVID-19 related testing services provided on or after March 18, 2020 to identify the cost-sharing waiver is applied and the Medicare patient should not be charged co-insurance or deductible.
|CS||Cost-sharing for specified COVID-19 testing-related services that result in an order for or administration of a COVID-19 test|
COVID-19 DRG Coding
The CMS has released an update to the ICD-10 MS-DRG grouper software package to accommodate the new diagnosis code, U07.1 for COVID-19, effective with discharges on and after April 1, 2020.
The ICD-10 MS-DRG Grouper assigns each case into an MS-DRG based on the reported diagnosis and procedure codes and demographic information (age, sex, and discharge status).
The assignment of new ICD-10-CM diagnosis code U07.1 COVID-19 is as follows:
Optum360 COVID-19 Product Updates
We recognize our coders rely on various resources and tools to access the most up-to-date medical codes. We are committed to ensuring you have all the information you need regarding COVID-19 codes, guidelines and effective dates.
Content updates pertaining to COVID-19 for your 2020 edition print books are now posted online:
Optum360 online coding tools (e.g. EncoderPro.com, RevenueCyclePro.com, etc.) published the necessary code and reference content updates on April 1, 2020. More information will be posted to the various online coding tool homepages – please sign in for details.
Optum360 data file/web service content is updated to include new COVID-19 codes. Please refer to the above-mentioned effective dates to comply with CDC, NCHS, AMA, and CMS guidelines. Log in to the data vault to access the newest content updates.
We Are Here to Help
Complimentary 30-day Trial | Online Coding Tools
As some of you are transiting to work-from-home status, we want to ensure you have the coding content you need at your fingertips. Request a 30-day trial for our online coding tools where all codes are up to date, in one solution.
COVID-19 | Optum360 Specialty Articles
Optum360 articles are created and reviewed by our clinical and product experts. Optum360 Specialty Articles Add-on provides exclusive access to the most recent and relevant specialty newsletter content available today. Due to the current COVID-19 situation, we are offering complimentary access to these articles:
- OSA Article 2019 Novel Coronavirus New ICD-10-CM Code (101 KB)
- OSA Article COVID-19 Public Health Emergency Waivers (141 KB)
- OSA Article Changes to Telehealth related to COVID-19 (364 KB)
- OSA Article WHO Adopting another ICD-10 Code (76 KB)
For customer service and tech support, contact us with any questions you might have in regards to our coding products.
Other COVID-19 Resources
American Medical Association
- AMA CPT® COVID-19 Coding and Guidance
- AMA CPT® COVID-19 Physician Resource Center
- AMA CPT® COVID-19 Testing Code Update
- AMA CPT® Assistant COVID-19 Article
Centers for Medicare and Medicaid Services
- Medicare Administrative Contractor (MAC) COVID-19 Test Pricing
- CMS Link COVID-19 Lab Tests
- CMS Link FAQ for Providers
- CMS Link Medicare Telemedicine Provider Fact Sheet
Centers for Disease Control and Prevention
- New ICD-10-CM code for 2019 Novel Coronavirus (COVID-19)
- ICD-10-CM Official Coding Guidelines – Supplement Coding encounters related to COVID-19 Coronavirus Outbreak
American Hospital Association
CPT © Copyright 2020 American Medical Association. All rights reserved.
AMA and CPT are registered trademarks of the American Medical Association.