Blue Cross is continuing to update information related to COVID-19 testing based on guidance and instruction provided by the CDC, World Health Organization (WHO) and CMS. Codes related to testing and specimen collection are included below. For COVID-19 diagnosis codes see our COVID-19 Treatment page.
When making referrals to laboratories for COVID-19 testing, always use a Blue Cross and Blue Shield of Alabama in-network lab. A list of in-network labs is available at AlabamaBlue.com/providers/FindALab.
|Note: Blue Cross and Blue Shield of Alabama is working with providers to ensure patient access to affordable care during this crisis. We encourage out-of-network providers to accept our payment for COVID-19 testing as payment in full and to work together with us to protect our members from financial harm.|
COVID-19 Testing for Surveillance Purposes Not Covered
As COVID-19 vaccines increasingly become available in Alabama, we want to remind providers that testing for surveillance purposes is not covered, whether conducted separately or in conjunction with the vaccine administration. We do not cover COVID testing to determine vaccine effectiveness.
To clarify, our coverage for COVID-19 testing is outlined below:
Medically Appropriate COVID-19 Testing – Testing to detect or diagnose COVID-19 in an individual when there is presence of a potential COVID-19 symptom or actual or suspected exposure to a person with COVID-19.
Surveillance COVID-19 Testing – Testing for patients to return to work or school to rule out the possibility of COVID-19 in the absence of symptoms or exposure. Federal government guidance on this legislation issued June 23, 2020, states that group health plans and insurers are not required to pay for COVID-19 tests that are ordered for surveillance purposes.
Testing and Specimen Collection Codes
COVID-19 testing and specimen collection codes are listed in the tables below.
Testing Procedure Codes
|U0001||CDC 2019 novel coronavirus (2019-nCoV) real-time rt-pcr diagnostic panel|
|U0002||Non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)|
|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|
|0224U||Antibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed|
|86328||Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])|
|86413||Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative|
|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])|
|86769||Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])|
|87635||COVID-19 Infectious agent detection by nucleic acid (DNA or RNA); 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])|
Specimen Collection Codes
Specimen collection billed by hospital outpatient department
C9803 should be billed with an appropriate laboratory revenue code for payment consideration.
Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
Note: G2023 applies to independent labs.
|G2024||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|
Evaluation and Management Code Level 1 can be used for COVID-19 physician office specimen collection except when the provider is reporting another Evaluation and Management code for a concurrent service. Blue Cross and Blue Shield of Alabama is allowing incident-to flexibility for COVID-19 specimen collection by network physician offices as long as the credentialed network practitioner is on the premises at the time of collection.
COVID-19 Panel Testing Guidance
As the demand continues for COVID-19 testing, we are advising providers that panel testing should be ordered only if it is medically necessary for the patient. Routinely performing respiratory panels is not appropriate in the absence of supportive clinical symptoms. In most cases, only a specific test to determine the presence of COVID-19 is needed.
At some point in the near future, medical necessity reviews may be used to determine if panel tests given to patients were needed. Providers who order panel tests should note in the medical record the reason for such a test.
Use of Serologic Antibody Tests for COVID-19
Guidance on the use of serologic antibody tests for COVID-19 advises that it is not appropriate to diagnose an acute infection. Serologic antibody testing should not be used as the sole basis for diagnosis and can only aid in the diagnosis of patients in conjunction with a medical review of symptoms and results of other laboratory tests.
Serologic antibody testing specific for COVID-19 can reveal if a patient has been exposed to the virus and had an immune response to the virus; however, it will not reveal if the patient is currently infected.
- CDC: Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)
- Alabama Department of Public Health: Information for Healthcare Providers
- Food and Drug Administration: FAQs on Diagnostic Testing for SARS-CoV-2