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.

Streamlined LTACH Admissions Process for COVID Patients Ending June 30

Effective July 1, 2021, we are returning to our standard process for admissions to long-term acute care hospitals (LTACHs) for all Blue Cross and Blue Shield of Alabama members.

We are not extending the streamlined LTACH admission process for Blue Cross members with a specified COVID-19 diagnosis beyond June 30.

We will continue to monitor admission rates related to COVID-19 and consider changes to our admission policy accordingly.

    COVID-19 Monoclonal Antibodies Codes

    CPT Code and DescriptionLabeler NameEffective Date        
    Q0239: Injection, bamlanivimab-xxxx, 700 mgEli Lilly11/10/2020
    M0239: Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoringEli Lilly11/10/2020
    Q0243: Injection, casirivimab and imdevimab, 2400 mgRegeneron11/21/2020
    M0243: Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoringRegeneron11/21/2020

    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

    FDA Revokes Emergency Use Authorization for Hydroxychloroquine and Chloroquine

    The U.S. Food and Drug Administration (FDA) in a June 15, 2020, statement revoked the emergency use authorization (EUA) for hydroxychloroquine sulfate and chloroquine phosphate to treat certain hospitalized patients with COVID-19.

    “Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use,” the FDA said in the statement.

    Additional resources about use of these medications for COVID-19:

    Dispensing Limits on Hydroxychloroquine, Chloroquine and Azithromycin

    Blue Cross is discontinuing the dispensing limits on these drugs as of August 1, 2020:

    • Effective April 2, 2020, Blue Cross placed a dispensing limit, or quantity limit, on new prescriptions of hydroxychloroquine and chloroquine.
    • Effective April 7, 2020, Blue Cross placed a dispensing limit on new prescriptions for azithromycin. This will include a cumulative limit of 60 tablets per 180 days for all dosage strengths.

    Early-Refill Restrictions Lifted

    • We are working with Prime Therapeutics® to allow our members to obtain early refills of their medications.
    • Diabetic supplies filled under the patient's prescription benefits are subject to the same early-refill allowance as other prescription medications.

    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.