2022 Coding and Billing Updates for COVID-19 Services and Testing

covid testing cpt codes June 29, 2022

Many things have changed in the healthcare industry since the emergence of COVID-19 (2019-Novel Coronavirus). Besides straining medical supplies and personnel, it also sped up the process of producing and publishing coding guidelines. 

This blog article provides a guide to 2022 coding and billing updates for COVID-19 services and testing.

When to use the cs modifier for COVID-19? 

We use modifier CS on visits related to testing for COVID-19. The latest COVID-19 billing guidelines also state that physicians can apply it to two contexts relating to coding and billing.

  • The visit could be virtual or in-person for suspected or probable exposure to COVID-19.
  • Tests for diagnosing COVID-19 without including a COVID-19 test

Let’s examine each case individually.

Suspected or Probable Exposure to COVID-19 

When billing for virtual/in-person for suspected COVID-19 exposure, you typically use the following E/M codes:

  • ICD-10 codes Z03.818, Z20.822, and Z20.828
  • Modifier CS
  • If the patient is receiving virtual care, append the modifier GQ, GT, or 95

Modifier CS can also apply for these services:

  • If the result of the service involves the order for or the administration of a COVID-19 test
  • If the service relates to delivering or administering tests
  • If the purpose of the service is to evaluate and determine if the patient needs COVID-19 testing

The cost-share will be waived through April 20th, 2021. Thus, providers need to understand that the cost-share will be waived only when they bill the correct ICD-10 code and modifier CS.

What is Modifier CR? 

It indicates whether Medicare payment for a service is subject to the Centers for Medicare & Medicaid Services (CMS) approval. As a reminder, the CMS has informed us that the CR modifier does not apply to claims recently added to the CMS list of services that may be provided by telehealth.

It is also possible to bill modifier CR or condition code DR in place of modifier CS. Also, a customer cost-share will apply to services unrelated to COVID-19.

Tests for Diagnosing COVID-19

These are the common codes used for tests relating to COVID-19:

  • ICD-10 codes Z03.818, Z20.822, or Z20.828
  • Modifier CS

These codes are used for laboratory tests in cases where COVID-19 may be suspected. These tests must be reasonable practices to rule out the presence of COVID-19.

Only the code for the panel test will be reimbursed if the COVID-19-related test is part of the laboratory panel code.

If the test is not part of a laboratory panel but rather part of a series of pathogen tests, the relevant unbundling edits may be applicable.

Source: Journal of Ahima, 2021

Monoclonal Antibody Treatment Administration for Commercial Health Plans 

  • This billing guidance applies only to urgent care facilities with an all-inclusive rate per case, per diem, per visit, and per unit.
  • We are following the place of service testing and case rate guidelines per the Centers for Medicare & Medicaid Services (CMS).
  • An in-network urgent care center must bill with the place of service 20 on a CMS-1500 form
  • Accordingly, we will pay 100% of the CMS allowable rate for the codes below.

Service: COVID-19 Testing at Urgent Care Facilities

ServiceCodes to billAdditional Information
COVID-19 testing at urgent care facilities*87635
Through the end of the Public Health Emergency (PHE), COVID-19 testing at urgent care facilities will be reimbursed if billed with a COVID-19 procedure code along with one of the appropriate Z codes (Z20.828, Z03.818, and Z20.822). Whenever a health care professional bills a visit code on the same date of service as a COVID-19 testing code, the assigned medical practice will deny the testing code with remark Code: I4.
COVID-19 vaccine administration at urgent care facilities*0001A 
Through the end of the public health emergency, COVID-19 vaccine administration will be reimbursed for in-network health care professionals if billed with the appropriate codes.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 vaccine code claim for the same patient, the assigned medical practice will deny the vaccine code.
Monoclonal antibody treatmentCodes available through Jan. 31, 2022: 

M0247 (Outpatient) 

Codes available through April 5, 2022: 
• Q0247 
• M0247 (Outpatient) 
• M0248 (Home) 

Codes available after April 6, 2022: 

Bebtelovimab HCPCS code: Q0222 

Administration code: 
• M0222 (Outpatient) 
• M0223 (Home Infusion)

Evusheld HCPS Code: 
• Q0220 

Administration Code:
• M0220 (Outpatient) 
• M0221 (Home)

*These codes will price at $0 because of funds provided by the government.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 monoclonal antibody treatment claim for the same patient, the assigned medical practice will deny the vaccine code.

Newly Added Vaccine and Administration CPT Codes 2022

CPT CodeDescription
0074AAdministration, booster dose
91309Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use 
(Report 91309 with administration code 0094A) 
(Do not report 91309 in conjunction with administration codes 0011A, 0012A, 0013A, 0064A) 
0094AAdministration, booster dose
91310Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use 
(Sanofi Pasteur)(Report 91310 with administration code 0104A)
0104AAdministration, booster dose

New Guidelines for Outpatient Services Under COVID-19 Cost Share Waiver

Use the CS modifier on appropriate outpatient claim lines for services provided through the end of the Public Health Emergency (PHE). This illustrates that the service is eligible for a cost-share waiver for COVID-19 testing-related services contracted for and related to the provision or administration of a COVID-19 test. 

Providers will receive a waiver of cost-share when they: 

  • Submitting a claim line with CS modifier (professional, facility, telehealth) with a specific outpatient E&M or HCPCS code and when billed of probable or suspected exposure to COVID-19: ICD Z20.822 as the primary diagnosis, as needed.
  • Submits a COVID-19 CPT/HCPCS claim line testing for preoperative procedures. 
  • Z01.810 – preprocedural cardiovascular examination 
  • Z01.811 – preprocedural respiratory examination 
  • Z01.812 – preprocedural laboratory examination 
  • Z01.818 – other preprocedural examination
  • For each additional lab test other than the COVID-19 diagnostic test, a CS modifier must be added to each claim line. If the lab test was ordered specifically to determine a diagnosis of COVID-19 and if billed with probable or suspected exposure to COVID-19, a primary diagnosis of Z20.822 should be put forth.
For Billing Guidelines
Dates of service on or after March 1, 2020, and for the duration of the PHEEffective January 1, 2022 

The POS 02 description was revised and a new code, POS 10, was developed. The place of service billed is dependent on where the patient is located during the telehealth service. When billing for telehealth services, use: 

POS 02: Telehealth Provided Other than in Patient’s Home 
Patients are not located in their homes when they receive health services or related services via telecommunication.

POS 10: Telehealth Provided in Patient’s Home 
In the case of receiving health services or health-related services via telecommunication, the patient is located at home (other than a hospital or other facility where they receive care in a private residence).

We hope that this guide to COVID-19 updates in coding and billing for 2022 has been useful to you. Visit the American Medical Association (AMA) for more information on COVID-19 codes, services, and vaccine updates.

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