Guidelines and codes for COVID-19 diagnostic testing.


Will Capital Blue Cross cover COVID-19 diagnostic testing?

Yes. COVID-19 diagnostic testing that is consistent with the Centers for Disease Control and Prevention (CDC) guidelines and the related visit will be covered in full with no member cost share.

Please verify eligibility prior to providing services. Any treatment and related services needed once diagnosis of COVID-19 has occurred will be covered consistent with the provisions of the member’s health benefits.

What codes should be used to bill diagnostic testing for COVID-19 and what are the reimbursement rates?

Capital Blue Cross is ready to accept these codes.

Code

Rate

Test dates on or after

86328

$45.23

4/10/2020

86408

$42.13

8/10/2020

86409

$105.33

8/10/2020

86413

$42.13

9/8/2020

86769

$42.13

4/10/2020

87426

$45.23

6/25/2020

87428

$73.49

11/10/2020

87635

$51.33

3/13/2020

87636

$142.63

10/6/2020

87637

$142.63

10/6/2020

87811

$41.38

10/6/2020

0223U

$416.78

6/25/2020

0224U

$42.13

6/25/2020

0225U

$416.78

8/10/2020

0226U

$42.28

8/10/2020

0240U

$142.63

10/6/2020

0241U

$142.63

10/6/2020

G2023

$23.46

3/1/2020

G2024

$25.46

3/1/2020

U0001

$35.92

2/4/2020

U0002

$51.31

2/4/2020

U0003

$75.00

1/1/2021

U0004

$75.00

1/1/2021

U0005

$25.00

1/1/2021

If the patient is seen by a provider for an office visit and during the visit the provider orders the test for COVID-19, are both services waived of copays?

We are waiving member cost share (copay, coinsurance, and deductible) for the COVID-19 diagnostic testing consistent with the Center for Disease Control and Prevention (CDC) guidelines. We are waiving member cost share for the visit associated with the COVID-19 test whether in an office, emergency room, telehealth, or urgent care.

How is Capital Blue Cross handling providers adding additional staff and/or redeployment of existing resources that may be necessary to handle added patient volumes?

Capital Blue Cross recognizes that, during the COVID-19 crisis, additional staffing and/or redeployment of existing resources may be necessary to handle added patient volumes.

Until further notice, Capital Blue Cross will allow providers to use the Locum Tenens billing guidelines for either:

  • Using a substitute physician who is not contracted with Capital Blue Cross for reciprocal billing arrangements when a patient’s regular physician is unable to provide services.
  • Using a substitute physician who is contracted with Capital Blue Cross but is providing services in another location not currently loaded into our claims adjudication system.

Using a substitute physician who is contracted with Capital Blue Cross but is providing services in another location not currently loaded into our claims adjudication system.

In addition, Capital Blue Cross will also allow contracted providers to bill with the current provider record on file, instead of the actual place of service rendered, if this reduces the billing providers’ administrative burden.

The Referral Entry screen will not accept place of service 02. How should this be handled?

Submit the referral request as you normally would, making sure the provider information is accurate. Do not select place of service 02.