Published 3/23/2020, last updated 12/10/2020

Medical Coding for COVID-19 Novel Coronavirus

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

Summary of COVID-19 code changes as of  12.10.20 (194 KB).

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])

A new Proprietary Laboratory Analysis CPT® code was created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective May 20, 2020.

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

A new CPT code and two PLA CPT codes were created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective June 25, 2020.

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

Two new HCPCS Level II codes were created for specimen collection, effective March 1, 2020.

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

A new HCPCS Level II code was created for coronavirus specimen collection for hospital outpatient clinics effective March 1, 2020:

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
04
15
25
177,178,179
791,793
974,975,976


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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