Provider Information on COVID-19 Coverage

Updated 01/18/2022

Blue Cross and Blue Shield of Texas (BCBSTX) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We've taken steps to lower costs and provide our members easier access to care related to COVID-19. We provide information as it becomes available here and on our COVID-19 Related News section.

Testing and Treatment Coverage

During the public health emergency (PHE), we are covering the Food and Drug Administration (FDA) authorized COVID-19 test to diagnose COVID-19 for our members with no prior authorization needed. COVID-19 tests are covered with no member copays, deductibles or co-insurance when an individual’s health care provider determines that it is medically appropriate to treat or diagnose COVID-19.

We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For more timely results, the following labs have agreed to provide COVID-19 testing results back to providers in two days or less:
Labs for Prompt COVID-19 Testing

Over-the-Counter (OTC) Tests: We cover COVID-19 diagnostic tests members buy without a provider’s involvement or prescription, starting Jan. 15, 2022, through the end of the federal public health emergency. OTC tests must be FDA-authorized. This applies to fully insured, self-insured and individual and family plans. Members can buy up to eight tests per covered member every 30 days. This program is through BCBSTX and Prime Therapeutics^TM pharmacy benefits. If a member does not have benefits through Prime Therapeutics, they should contact their pharmacy benefit administrator. More information is on our member microsite.

For treatment of COVID-19, we temporarily waived member cost-sharing through Dec. 31, 2020. Copays, deductibles and coinsurance now apply. Treatment will be covered in accordance with the terms of the member’s benefit plan. This applies to these types of plans:

• Fully insured employer-based
• Individual and Family
• Medicare (excluding Part D)
• Medicare Supplement

Note: Some members may not have access to out-of-network benefits. Also, many of our members are covered under a health plan that is self-funded by their employer. Some of these members may have cost-share waived for treatment of COVID-19 depending on their employer’s decision about its benefit plan. Check eligibility and benefits for more specific information.

Check Member Eligibility and Benefits

Use the Availity^® Provider Portal  or your preferred vendor to check eligibility and benefits.

COVID-19 Vaccine

For information about our COVID-19 vaccination policy, see our News & Updates article.

Claims for COVID-19 Testing

If you are collecting a COVID sample from a member, have a lab capable of testing, or are a lab testing a member, submit the claim using the appropriate collection or lab code. We are covering COVID-19 tests that are FDA-authorized, including rapid and antibody tests. Member cost-share for the test will be waived during the PHE.

Testing must be:

• For individualized diagnosis or treatment of COVID-19
• Medically appropriate
• In accordance with generally accepted standards of care, including the Centers for Disease Control (CDC) guidance as appropriate

For more detail on COVID-19 coding and guidance, refer to the American Medical Association  website or the Centers for Disease Control and Prevention .

COVID-19 Collection Codes

For details about the collection codes, see CMS' Frequently Asked Questions (FAQs) on Medicare Fee-for-Service Billing .

Codes	Description
C9803	For use by hospital outpatient departments and physician offices: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source
G2023	For use by independent clinical diagnostic labs: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
G2024	For use by independent clinical diagnostic labs: 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

COVID-19 Lab Codes

Codes	Description
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
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
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
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], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
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
87635	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
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])
U0001	CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
U0002	2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
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
U0005	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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection

COVID-19 Testing Before Non-COVID-19 Treatment or Procedures
When screening for COVID-19 before elective procedures or treatment not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will be able to identify when members should receive the cost-share waiver for COVID-19 testing, and the claim will be processed promptly. The remainder of each member’s non-COVID-19 related care will be processed according to the member’s benefit plan.

Emergency Room COVID-19 Testing with No Presenting Symptoms
Testing for COVID-19 should be for individualized treatment or diagnosis. If testing is used to screen for COVID-19 before emergency room services not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will be able to identify when members should receive the cost-share waiver for COVID-19 testing, and the claim will be processed promptly. The remainder of each member's non-COVID-19 related emergency room care will be processed according to the member's benefit plan.

Claims for COVID-19 Antibody Testing

Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with Emergency Use Authorized (EUA), regardless of the diagnosis. This waiver will last through the end of the public health emergency. Medical or invoice records may be requested to provide support if an antibody test is FDA authorized or if EUA approval has been requested.

Antibody Testing Requirements
Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care professional. We encourage members to consult with their health care provider to determine the best test clinically indicated for their condition. Refer to the current FDA position on antibody testing . Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

COVID-19 Antibody Testing Codes

Code	Description
0224U	Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed
86318	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method
86328	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method, severe acute respiratory syndrome coronavirus (SARS-CoV-2) (Coronavirus disease COVID-19)
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
86413	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
86769	Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] testing via multiple-step method

In-Network Providers and Lab Testing
Network physicians are encouraged, and pursuant to their network contracts may be required, to refer our members to participating, in-network providers. Be sure to check our online Provider Finder^® for currently contracted labs that are in-network for each patient, according to details of the member's benefit plan. Referring to in-network providers also helps members to control their health care costs and to avoid balance billing by out-of-network providers.

Out-of-Network Providers
If you are not in-network for the member’s benefit plan, we will reimburse the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website.

Claims for COVID-19 Testing and Antibody-Related Services

Use the following coding process for services that are related to COVID-19 testing or antibody testing.

COVID-19 Diagnosis Codes
To indicate services performed in conjunction with the testing for COVID-19 or COVID-19 antibodies, include one of the following diagnosis codes. The provider submitting the claim is responsible for accurately coding the service performed.

Code	Description
B34.2	Coronavirus infection, unspecified
B97.29	Other coronavirus as the cause of diseases classified elsewhere
U07.1	COVID-19
Z03.818	Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
Z11.52	Encounter for screening for COVID-19
Z20.822	Contact with and (suspected) exposure to COVID-19
Z20.828	Contact with and suspected exposure to other viral communicable diseases (actual exposure to COVID-19)

Modifier CS

For services furnished on March 18, 2020, through the end of the public health emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19. This is for testing-related services that result in an order for or administration of COVID-19 testing or antibody testing. Use the CS modifier only on the codes specified by the Centers for Medicare & Medicaid Services . The following types of claims do not need the CS modifier:

• Screenings before procedures that aren’t related to COVID-19
• COVID-19 tests
• Treatment of COVID-19.

Supplemental Oxygen at Home

Medically stable COVID-19 patients may be discharged from emergency care or in-patient acute care with the assistance of oxygen therapy at home. We do not require a predetermination or prior authorization for supplemental oxygen delivery devices for home use.

Credentialing

We are temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary changes are only in place during the COVID-19 emergency and subject to change based upon modifications to state and federal laws and regulations. Thereafter, standard credentialing and processes will apply. For more details, refer to the Credentialing Process Simplified for COVID-19 article.

Telemedicine and Telehealth

For more details, refer to the Telemedicine 2021 article as well as our Telemedicine and Telehealth Services page.

Pharmacy

We recommend members:

• Keep supplies of their medications on hand and not wait until last-minute to get refills.
• Contact their pharmacies to ask about delivery or curb-side/drive-thru options
• Use their 90-day supply fill benefits (if applies) for non-specialty medications at select retail pharmacies or mail order

Member cost share applies according to their benefit plan. All pharmacy practice safety measures, and prescribing and dispensing laws, remain in force and effect.

What is the risk of COVID-19?

According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website .

We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19. We've developed a member-facing flier about COVID-19  that you may share with your patients.

More Information

Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on our COVID-19 Related News section.

If you have any questions or if you need additional information, contact your BCBSTX Network Management Representative.

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As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.

Please note checking eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member's ID card.

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