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Provider Information on COVID-19 Coverage

Updated September 24, 2020

Blue Cross and Blue Shield of Illinois (BCBSIL) 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.

Testing and Treatment Coverage
We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance. The waiver applies to cost-share associated with COVID-19 treatment with providers, including facilities, from April 1 to Oct. 23, 2020, so long as the treatment is provided and consistent with the terms of the member’s benefit plan. We will reassess this waiver as events warrant.

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles for treatment of COVID-19, based on their employer’s election to participate in this benefit.  

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through Oct. 23, 2020

Medicare Supplement members do not have network restrictions unless otherwise noted on their plans. Members should always call the number on their ID card for answers to their specific benefit questions. See our FAQs for Providers for more details.

Check Member Eligibility and Benefits
Use the Availity® Provider Portal  or your preferred vendor for eligibility and benefit verifications.

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. Member cost-share for the test will be waived during the public health emergency, regardless of the diagnosis. 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

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

COVID-19 Collection Codes

  • C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source
  • G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
  • G2024: 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

  • 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
  • 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])
  • 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
  • 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 orubtypes (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

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 ensure our members receive the cost-share waiver for COVID testing and the claim will be processed promptly. The appropriate benefits will apply to the remainder of each member’s non-COVID related care. The diagnosis code Z11.59 may be used on these claims but is not required.

At-Home Tests
We cover at-home collection methods for COVID-19 testing if the tests are FDA-authorized and are clinically indicated for the member as determined by the member’s health care provider. We encourage members to consult with their health care provider to determine whether the test is medically appropriate for their condition. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

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 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 provider. We encourage members to consult with their health care provider to determine the best, medically appropriate test 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

  • 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 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.

Out-of-Network Providers
If you are not in our networks, 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:

  • 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)
  • 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 when COVID-19 testing or antibody testing must be performed at an alternate location and is not part of the evaluation and management claim.

Telehealth
BCBSIL has further expanded its access to telehealth in response to COVID-19. Refer to our March 28 announcement for details. We are also temporarily lifting cost-sharing for medically necessary health services delivered by an in-network provider via telehealth for eligible fully insured members. Benefits may be different for our members covered under certain employer-funded health plans. BCBSIL will continue to evaluate the telehealth program and make adjustments to best serve our members. All new developments for providers will be posted to our News and Updates.

Pharmacy
For members who have BCBSIL pharmacy benefits administered through Prime Therapeutics, BCBSIL will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Note on Medicare members: Members of these plans can get 90-day fills through mail order.

  • Blue Cross Group Medicare Advantage (PPO)℠
  • Blue Cross Group Medicare Advantage Open Access (PPO)℠
  • Blue Cross Group MedicareRx (PDP)℠
  • Blue Cross Medicare Advantage (HMO)℠
  • Blue Cross Medicare Advantage (PPO)℠
  • Blue Cross MedicareRx (PDP)

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 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 CDC guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. Also watch BCBSIL’s News and Updates for announcements, such as updates to our COVID-19 Provider FAQs   and other information and related resources.

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Checking eligibility and/or benefit information 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 any questions, call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.