Medical Coding for COVID-19 Novel Coronavirus
- COVID-19 ICD-10-CM Coding
- COVID-19 ICD-10-PCS 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:
U07.1 COVID-19
The CDC posted the official ICD-10-CM Coding and Reporting Guidelines for COVID-19 for April 1, 2020-September 30, 2020.
The Centers for Disease Control and Prevention (CDC) issued a health alert on Thursday, May 14, 2020, outlining the case definition for multisystem inflammatory syndrome in children (MIS-C), which has been recently associated with COVID-19: COVID-19 Related Condition: Multisystem Inflammatory Syndrome in Children (MIS-C) (111 KB).Six new ICD-10-CM codes were created for the capture of COVID-19 related encounters, effective January 1, 2021 through September 30, 2021.
J12.82 | Pneumonia due to coronavirus disease 2019 |
M35.81 | Multisystem inflammatory syndrome |
M35.89 | Other specified systemic involvement of connective tissue |
Z11.52 | Encounter for screening for COVID-19 |
Z20.822 | Contact with and (suspected) exposure to COVID-19 |
Z86.16 | Personal history of COVID-19 |
COVID-19 ICD-10-PCS Coding
The Centers for Medicare and Medicaid Services (CMS) has added twelve new procedure codes to the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective August 1, 2020. These codes describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, current treatments used to manage COVID-19 patients. These codes do not affect MS-DRG assignment.
XW013F5 | Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5 |
XW033E5 | Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
XW033F5 | Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
XW033G5 | Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
XW033H5 | Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
XW043E5 | Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5 |
XW043F5 | Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5 |
XW043G5 | Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5 |
XW043H5 | Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5 |
XW0DXF5 | Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5 |
XW13325 | Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
XW14325 | Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5 |
The Centers for Medicare and Medicaid Services (CMS) added 21 new ICD-10-PCS procedure codes, effective January 1, 2021. These codes describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines, for COVID-19 treatment. These codes do not affect MS-DRG assignment.
XW013F5 | Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6 |
XW013K6 | Introduction of leronlimab monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6 |
XW013S6 | Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6 |
XW013T6 | Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6 |
XW013U6 | Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6 |
XW023S6 | Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6 |
XW023T6 | Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6 |
XW023U6 | Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6 |
XW033E6 | Introduction of etesevimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
XW033F6 | Introduction of bamlanivimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
XW033G6 | Introduction of REGN-COV2 monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
XW033H6 | Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
XW033L6 | Introduction of CD24Fc immunomodulator into peripheral vein, percutaneous approach, new technology group 6 |
XW043E6 | Introduction of etesevimab monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
XW043F6 | Introduction of bamlanivimab monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
XW043G6 | Introduction of REGN-COV2 monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
XW043H6 | Introduction of other new technology monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
XW043L6 | Introduction of CD24Fc immunomodulator into central vein, percutaneous approach, new technology group 6 |
XW0DXM6 | Introduction of baricitinib into mouth and pharynx, external approach, new technology group 6 |
XW0G7M6 | Introduction of baricitinib into upper GI, via natural or artificial opening, new technology group 6 |
XW0H7M6 | Introduction of baricitinib into lower GI, via natural or artificial opening, new technology group 6 |
Summary of COVID-19 code changes as of 12.10.20 (194 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 |
87426 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) |
0223U | 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 |
0224U | Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed |
Two new CPT codes and one PLA CPT code were created for reporting COVID-19 neutralizing antibody testing, and one additional PLA CPT code was created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective August 10, 2020.
#86408 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen |
#86409 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer Codes #86408 and #86409 are resequenced codes that follow code 86352. |
0225U | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected |
0226U | Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum |
Two new CPT codes were created, one for reporting COVID-19 antibody testing, and one for reporting additional supplies and clinical staff time required during a Public Health Emergency (PHE), effective September 8, 2020.
#86413 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative Code #86413 is a resequenced code that follows code 86409. |
99072 | Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease |
Three new CPT codes were created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, two additional PLA CPT codes were created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, and one CPT code was revised, effective October 6, 2020.
87636 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
87637 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
#87811 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) |
0240U | 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 | 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 |
87426 | Infectious agent antigen detection by immunoassay technique, (eg, 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]) |
One new CPT code was created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, and six new codes for reporting COVID-19 vaccines, effective November 10, 2020.
87428 | Infectious agent antigen detection by immunoassay technique, (eg, 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 |
0001A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose |
0002A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose |
00011A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose |
00012A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose |
91300 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use |
91301 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use |
NOTE: A HCPCS code and CPT® code should not be reported together. Providers should contact third-party payer(s) for reporting either a CPT® or a HCPCS code, as well as for retroactive billing and reimbursement guidelines.
Summary of COVID-19 code changes as of 12.10.20 (194 KB).
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 |
Modifier CS was revised and may be appended to COVID-19 related testing services provided on or after July 1, 2020, to identify the cost-sharing waiver is applied and the Medicare patient should not be charged co-insurance or deductible, for services furnished via telehealth in Rural Health Clinics and Federally Qualified Health Centers.
CS | Cost-sharing waived for specified COVID-19 testing-related services that result in an order for, or administration of, a COVID-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in Rural Health Clinics and Federally Qualified Health Centers during the COVID-19 public health emergency |
Two new HCPCS Level II codes were created for investigational monoclonal antibody therapy for specific patients who test positive for COVID-19.
M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
Q0239 | Injection, bamlanivimab-xxxx, 700 mg |
Two new HCPCS Level II codes were created for investigational monoclonal antibody therapy for specific patients who test positive for COVID-19, effective November 21, 2020.
M0243 | Intravenous infusion, casirivimab and imdevimab, includes infusion and post administration monitoring |
Q0243 | Injection, casirivimab and imdevimab, 2400 mg |
Summary of COVID-19 code changes as of 12.10.20 (194 KB).
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:
Diagnosis Code | Description | CC | MDC | MS-DRG | ||||||
---|---|---|---|---|---|---|---|---|---|---|
U07.1 | COVID-19 | MCC |
|
|
Summary of COVID-19 code changes as of 12.10.20 (194 KB).
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:
ICD-10-CM (90 KB)| ICD-10-PCS | CPT® | HCPCS (63 KB) | DRG (140 KB)
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.
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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)
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Other COVID-19 Resources
Optum
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
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