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Modifier CG Clarification for COVID-19 Viral and Antibody Testing

Audience: Participating Physicians, Hospitals, Facilities and Laboratories

We would like to clarify the use of modifier CG (policy criteria applied) when submitting claims for COVID-19 viral and antibody testing. This applies to all Health Plan products and lines of business.

Modifier CG (or one of these diagnosis codes - Z02.0, Z02.1, Z02.4, Z02.5, Z02.79, Z02.89 Z02.9, Z56.89, and/or Z56.9) must be submitted with testing CPT® codes U0001, U0002, U0003, U0004, 0202U, 86328, 87635, 86769, 0223U, 0224U, 87426, C9803*, G2023, G2024, 86413 and/or 0225U 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, travel authority/advisory, camp, nursing home (to visit a resident), common carrier, government/public health agency, or research/epidemiologic study. These testing claims are not ordered by attending providers as medically appropriate for the diagnosis or treatment of an individual(s) and are not covered. [Syracuse University, a self-funded employer group, has advised Excellus BlueCross BlueShield that it will cover all COVID-19 viral and antibody testing for its employed members and eligible dependents.]

*In our communication to you dated August 10, 2020, we shared the addition of CPT code C9803 effective November 16, 2020.

Additionally, as we communicated in our bulletin dated July 17, 2020, please remember that all testing claims require the referring provider information on the claim in order to be processed.

We recommend that you regularly review Administrative Policy AP-26: COVID-19 Viral and Antibody Testing, for the most current list of testing CPT codes and guidelines. You can access this policy on our website.

Note: You must log in 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. 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.

Thank you for the quality care and dedicated service you are providing to our valued members.  

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