Guidelines and codes for COVID-19 diagnostic testing.
Collapsible Panel DnD
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.
Collapsible Panel DnD
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
Collapsible Panel DnD
Collapsible Panel DnD
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.
Collapsible Panel DnD
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.
Collapsible Panel DnD
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.
