COVID-19 Treatment

COVID-19 Treatment

Back to COVID-19 Provider Update Center

The coding information on this page applies to healthcare providers and labs.

Coverage and Cost-Sharing Information 

Blue Cross and Blue Shield Plans nationwide are implementing various types of cost-sharing waivers related to the COVID-19 Public Health Emergency. There could be variations in cost-sharing for telehealth and other services for some patients who have employer-based coverage or coverage under another Blue Cross and Blue Shield Plan outside of Alabama.

  • Always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details for each patient.
  • Refer to our Telehealth page for detailed information about eligible telehealth services.
  • For guidance on procedure codes related to testing and specimen collection, see our COVID-19 Testing page.
  • View our FEP Coverage and Billing Information page for information about COVID-19 and telehealth coverage, billing and cost-sharing (deductibles, copayments, etc.) for Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP) members.

LTACH and SNF Admissions Process for COVID Patients Extended Through October 31

As hospitals across the state are caring for patients admitted with COVID-19, Blue Cross and Blue Shield of Alabama is continuing to assess patient access to healthcare.

We are extending the process to streamline admissions for the following facilities:

  • Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses.
  • Skilled nursing facilities (SNF) specifically for Blue Advantage® members with one or more specified diagnoses who require an acute inpatient admission.

This streamlined process for SNF and LTACH admissions is effective through October 31, 2021. We will evaluate additional extensions for the admission process to LTACH and SNF facilities on a monthly basis.

Admission to an LTACH or SNF

Important note: The SNF admission process outlined below applies to Blue Advantage members only.

Blue Cross members who require an acute inpatient admission with specified COVID-19 diagnoses will be considered medically appropriate for admission to an LTACH or a SNF (the SNF process is available only to Blue Advantage members).

Patients with one or more specified non-COVID-19 diagnoses, who also meet inpatient criteria on the day prior to transfer, will be considered medically appropriate for admission to an LTACH or a SNF (the SNF process is available only to Blue Advantage members).

The Concurrent Utilization Review Program (CURP) precertification and InterQual review processes continue to apply for acute inpatient facilities.

Here’s how this process works:

  • If the receiving facility accepts a Blue Cross member for admission, the patient can be transitioned from acute inpatient care to the LTACH or SNF with notification to Blue Cross from the receiving LTACH or SNF within 72 hours of admission.
  • The initial 7 days at the LTACH or SNF are approved for medical necessity when this process is followed.
  • For additional days, the LTACH or SNF must submit clinical information to Blue Cross no later than day 7 for continued stay medical necessity review.
  • Blue Advantage process for SNF continued stay requests: Seven days will be approved for medical necessity; however, for additional days, the SNF must submit clinical information to Blue Cross on day 5 for continued stay medical necessity review. Notice of Medicare Noncoverage rules apply.
  • Regular member plan benefits apply.

Diagnoses appropriate for LTACH or SNF admission under this process are limited to the following:

  • COVID-19
  • SARS-associated coronavirus as the cause of diseases classified elsewhere
  • Other coronavirus as the cause of diseases classified elsewhere
  • Coronavirus infection, unspecified
  • 2019-nCoV acute respiratory disease
  • Multisystem inflammatory syndrome
  • Acute respiratory failure
  • Acute on chronic respiratory failure
  • Sepsis
  • Severe sepsis
  • Pneumonia
  • Pneumonia due to coronavirus disease 2019
  • Acute respiratory distress syndrome (ARDS)
  • Intracranial hemorrhage
  • Ischemic CVA
  • Post-CABG: IP stay related to CPT codes 33510-33545
  • Other specified systemic involvement of connective tissue

COVID-19 Monoclonal Antibodies Codes

Here are some resources about the use of monoclonal antibodies as a treatment related to COVID-19:

  The codes listed below are not a guarantee of reimbursement. Providers/facilities should refer to their respective fee schedules and/or contracts for additional information.

Code and DescriptionLabeler NameEffective Date
Q0240:Injection, casirivimab and imdevimab, 600 mgRegeneron7/30/2021
M0240: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat dosesRegeneron7/30/2021
M0241: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat dosesRegeneron7/30/2021
Q0243: Injection, casirivimab and imdevimab, 2400 mgRegeneron11/21/2020
M0243: Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoringRegeneron11/21/2020
M0244: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergencyRegeneron5/6/2021
Q0245: Injection, bamlanivimab and etesevimab, 2100 mgEli Lilly2/9/2021
M0245: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoringEli Lilly2/9/2021
M0246: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergencyEli Lilly5/6/2021
Q0247: Injection, sotrovimab, 500 mgGlaxoSmithKline5/26/2021
M0248: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergencyGlaxoSmithKline5/26/2021
Q0249: Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mgGenentech6/24/2021
M0249: Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first doseGenentech6/24/2021
M0250: Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second doseGenentech6/24/2021

 

Diagnosis Codes

In March, the CDC announced a new ICD-10 emergency code was established by the World Health Organization. This code, U07.1, should be used for confirmed COVID-19 cases only, for dates of service beginning April 1, 2020.

CodeDescriptionComment
U07.12019-nCoV acute respiratory diseaseThis code should be used for confirmed COVID-19 cases only, for dates of service beginning April 1, 2020.
B97.29

Other coronavirus as the cause of diseases classified elsewhere

Instruction is to bill this code for confirmed cases of COVID-19, in addition to the code for the presenting illness.

If the provider documents “suspected,” “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever and Z20.828).

Z03.818Encounter for observation for suspected exposure to other biological agents ruled out.Use if a there is a concern that a patient has had a possible exposure to COVID-19, but this is ruled out after evaluation.
Z20.828Contact with and (suspected) exposure to other viral communicable diseases.Use if a patient has been exposed to someone with a documented case of any form of the virus including COVID-19.
B34.2Coronavirus infection, unspecifiedThis code is not generally appropriate for COVID-19 because confirmed cases have universally been respiratory in nature, so the site would not be unspecified.

Reference: https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

Note: Effective January 1, 2021, the CDC implemented new ICD-10 codes that can be used to identify conditions resulting from COVID-19.

Confirmed Cases

Per the CDC, to identify patients who have tested positive for COVID-19, current CDC guidance instructs to code first for the presenting illness followed by "B97.29 - Other coronavirus as the cause of diseases classified elsewhere." 

For confirmed cases of pneumonia due to COVID-19:

  • J12.89, Other viral pneumonia, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed cases of acute bronchitis due to COVID-19:

  • J20.8, Acute bronchitis due to other specified organisms, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For bronchitis not otherwise specified (NOS) due to COVID-19:

  • J40, Bronchitis, not specified as acute or chronic, along with code
  • B97.29, other coronavirus as the cause of diseases classified elsewhere

For lower respiratory infections, NOS, or an acute respiratory infection, NOS, with associated documented COVID-19:

  • J22, Unspecified acute lower respiratory infection, with code
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For respiratory infections, NOS, with associated documented COVID-19:

  • J98.8, Other specified respiratory disorders, with
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed acute respiratory distress syndrome (ARDS) due to COVID-19:

  • J80, Acute respiratory distress syndrome, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

Unconfirmed Cases

To code a concern about COVID-19 exposure that was ruled out after evaluation:

  • Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out

To code actual COVID-19 exposure to a confirmed coronavirus case:

  • Z20.828, Contact with and (suspected) exposure to other viral communicable diseases

For patients presenting with symptoms where a definitive coronavirus diagnosis is not established, assign the appropriate codes for each presenting symptom, such as:

  • R05, Cough
  • R06.02, Shortness of breath
  • R50.9, Fever, unspecified

Prescription Medication Updates

Warnings About Use of Ivermectin to Treat COVID Patients

Effective August 26, 2021, Blue Cross and Blue Shield of Alabama implemented a prior authorization for ivermectin that requires a U.S. Food and Drug Administration (FDA) labeled or CMS-approved indication for coverage.

In recent weeks, the FDA, the World Health Organization (WHO) and other leading agencies have issued warnings about the use of ivermectin to treat patients with COVID-19.

The FDA has published:

Additionally, the WHO states that “ivermectin only be used to treat COVID-19 within clinical trials.”

On August 25, 2021, the Alabama Department of Public Health issued a warning about ivermectin via its Health Alert Network.

Here are some important considerations about the use of ivermectin:

  • Ivermectin tablets are approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis.
  • Some topical forms of ivermectin are approved to treat external parasites like head lice and for skin conditions such as rosacea.
  • Ivermectin is not approved by the FDA for the treatment of any viral infection.
  • Some forms of ivermectin are also used in animals to prevent heartworm disease and certain internal and external parasites. These products are different from the ones for people, and safe when used as prescribed for animals only.
  • Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in cell cultures. However, pharmacodynamic studies suggest that achieving the plasma concentrations necessary for the antiviral efficacy detected in vitro would require administration of doses up to 100-fold higher than those approved for use in humans. 
  • Ivermectin can be very toxic at higher doses, such as those required to achieve inhibition of the COVID-19 virus.
  • The results of several randomized trials and retrospective cohort studies of ivermectin use in patients with COVID-19 have been published in peer-reviewed journals or have been made available as manuscripts ahead of peer review. 
  • Most of these clinical studies showed no benefits or worsening of disease after ivermectin use; others reported shorter time to resolution of disease manifestations that were attributed to COVID-19, greater reduction in inflammatory marker levels, shorter time to viral clearance, or lower mortality rates in patients who received ivermectin than in patients who received other treatments or placebo. 
  • However, almost all of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias and therefore makes it impossible to draw any meaningful conclusions from the studies.

Other Impacted Programs and Services

DME Update for Oxygen Therapy

In response to the ongoing COVID-19 Public Health Emergency, we are resuming suspension of the oxygen saturation requirement for both certification and recertification. This action is effective March 1, 2020, and expires at the end of the federal public health emergency.

For information about coverage of oxygen therapy, please refer to our medical policy MP-317 on AlabamaBlue.com/providers/policies.

Coronavirus Codes Added to List of Services Carved Out of EAPG Pricing

The Services Carved Out of EAPG Pricing document has been updated with three coronavirus HCPCS codes and their corresponding fees.

Blue Advantage® Home Health Services Update

Blue Cross is following CMS’ home health modifications that allow nurse practitioners, clinical nurse specialists or physician assistants to perform the following for Blue Advantage patients:

  • Order home health services.
  • Establish and periodically review a plan of care for home health services (e.g., sign the plan of care).
  • Certify and recertify that the patient is eligible for Medicare home health services.

This update is included in the online document Home Health Agencies: CMS Flexibilities to Fight COVID-19.

CPT Code 99072 Not Billable 

We do not reimburse providers for CPT code 99072, which is defined as: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.”

Code 99072 has been added to our List of Procedures and Services Not Separately Paid, which outlines CPT and HCPCS codes that are not separately payable services.

Attention Dentists: Blue Cross Not Allowing PPE Charges

Blue Cross and Blue Shield of Alabama is not reimbursing for CDT code D1999 (unspecified preventive procedure, by report) when used to document and report the use and cost of additional personal protective equipment (PPE).

Our global allowance for the major procedure includes the cost of PPE. As a result, PPE is not billable either separately or to the patient. Code D1999 will be rejected if submitted on a claim. Additionally, if Blue Cross patients have paid additional fees for PPE, we expect providers to refund the amount charged to them.