Audience: Physicians, Nurse Practitioners, Labs & Facilities
Excellus BlueCross BlueShield implemented Administrative Policy AP-26 COVID-19 Viral and Antibody Testing (effective March 13, 2020) to define the coverage, reimbursement and billing guidelines for this testing when it is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending provider as evidenced by an order from the attending provider.
The testing must be approved by the Food and Drug Administration or be the subject of an emergency use order request, and the lab performing the testing must be appropriately certified. The policy is in line with Centers for Medicare & Medicaid Services, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) guidelines and applies to all lines of business.
Please keep in mind that testing ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual member, is not covered. This includes tests performed on an asymptomatic individual solely to assess health status as required by parties such as a government/public health agency, employer, common carrier, school, camp, or when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status.
The following information provides updated claim billing requirements for COVID-19 testing effective November 16, 2020:
Administrative Policy 26: COVID-19 Viral and Antibody Testing
- When the sole purpose of the test is for pandemic control, such as testing of asymptomatic individuals to assess health status as required by an employer, school, camp, common carrier, government/public health agency, or research/epidemiologic study, one of the following encounter codes: Z02.0, Z02.1, Z02.4, Z02.5, Z02.79, Z02.89 Z02.9, Z56.89; and/or Z56.9; or modifier CG must be submitted with testing CPT code C9803. (Continued on the reverse)
- The Health Plan requires laboratories to bill code G2023 with place of service (POS) Home (12) or Laboratory (81).
- The Health Plan requires laboratories to bill code G2024 with POS Skilled Nursing Facility (31) or Laboratory (81).
- If code 0224U is billed with 86769, then 86769 will not be reimbursed by the Health Plan.
This policy will be reviewed pre-payment and post-payment. Pre-payment review means that claims are reviewed prior to payment. A pre-payment review results in an initial determination. Post-payment
review means that claims are reviewed after adjudication. A post-payment review may result in either no change to the initial determination or a revised determination.
These services are subject to audit and policy updates at the Health Plan’s discretion. You can access the individual policies at ExcellusBCBS.com/Adminpol (You must login with your username and password to access our administrative policies).
If you are not currently registered to view the secure section of our website, we encourage you to register today at Provider.ExcellusBCBS.com. If you need assistance registering, contact the Web Security Help Desk at 1-800-278-1247. In addition, your Provider Relations representative is available to assist with website registration and functionality training.
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