Guidance for Health Care Providers
Diagnostic Testing
In compliance with state and federal regulations, MVP does not apply a cost-share to visits for testing for COVID-19 when deemed medically necessary, including any fees associated with an in-network office, Emergency Department (ED), or Urgent Care Center (UCC) or an out-of-network ED, or UCC Provider for the purpose of getting tested for COVID-19. The following CPT codes should be used for COVID-19 testing:
| CPT Code | Description |
| U0001 | Reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. |
| U0002 | Reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). |
| 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 |
| U0005 | Infection agent detection by nucleic acid (DNA OR RNA); Sever acute respiratory syndrome coronavirus 2 (SARS-COV-2) (coronavirus disease [COVID-19]), amplified probe technique |
| 86318 | Immunoassay for infection agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip) |
| 86328 | Immunoassay for infections agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); sever acute respiratory syndrome coronavirus 2 (SARS-COV-2) |
| 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 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (coronavirus disease [COVID-19]); |
| 87426 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative |
| 87428 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; |
| 87631 | Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Reverse Transcription And Amp Probe Tech, 3-5 Targets |
| 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 |
| 87636 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique |
| 87637 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-COV-2(coronavirus disease [COVID-19]) and influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique |
| 87811 | Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) |
| 87426 | Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) |
| 87428 | Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B |
| 0202U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome corona |
| 0223U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome corona |
| 0224U | Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (coronavirus disease [COVID-19]), includes titer(s), when performed |
| 0225U | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNO or RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) |
| 0226U | Surrogate viral neutralization test (SVNT), severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (coronavirus disease [COVID-19]), ELISA, plasma, serum |
| 0240U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2], influenza A, influenza |
| 0241U | Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2], influenza A, influenza |
Claims billed with the following ICD-10 codes in the first position for office, ED, or UCC visits that are for the primary purpose of testing will not apply a cost-share:
- Z20.828
In addition, effective March 13, 2020, the following codes will be covered at no cost-share for commercial Members:
- R05
- R06.02
- R50.9
MVP has updated diagnosis codes that waive cost share for visits for diagnostic testing. Effective January 1, 2021, diagnosis codes Z20.822 and Z86.16 waive Member cost share. Effective May 1, 2021 diagnosis code Z11.59 will no longer waive cost share but will still be covered. The following diagnosis codes will waive cost share for Members who have a visit for diagnostic testing:
| Diagnosis Code | Description |
|---|---|
| Z20.828 | Contact with and exposure to other viral communicable diseases |
| R05 | Cough |
| R06.02 | Shortness of breath |
| R50.9 | Fever, unspecified |
| Z20.822 | Contact with and (suspected) exposure to COVID-19 |
| Z86.16 | Personal history of COVID-19 |
New HCPCS Lab Code
Effective for dates of service January 1, 2021 and after, in order to receive the higher payment from CMS during the Public Health Emergency, the new HCPCS code U0005 must be used to signify that the laboratory is effectively turning around their high throughput test (i.e., they were “completed within two calendar days of the specimen being collected, meaning, the results of the test[s were] finalized and ready for release”). This code should be submitted along with U0003 or U0004.
Pre-op Testing
Pre-op COVID-19 diagnostic testing is covered for all Members with no cost share. MVP will not reimburse separately for diagnostic pre-op testing for MVP commercial and Medicaid Members as it will be considered global to the surgery, as are all other pre-op tests. Providers billing for MVP Medicare Members will be reimbursed based on CMS Guidelines.
COVID-19 Antibody Testing
Only a small number of the serologic assays to identify antibodies to SARS-CoV-2are officially approved by the FDA. Providers are strongly encouraged to only use the tests officially approved by the FDA. Information about the tests is found on the FDA’s website.
If performed, use the following codes to ensure Member cost-share is waived
| CPT Code | Description |
|---|---|
| 86328 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) |
| 86769 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) |
Providers should be aware of the following when ordering serologic assays for COVID-19:
- Serologic tests should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection
- Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus
- Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus strains seen with the common cold
- Testing will not provide any information on a person’s immunity or risk of re-infection, but rather just that someone has been exposed
In addition, the following lab codes will also be covered at no cost-share to the Member:
| CPT Code | Description |
| 87631 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
| 87635 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19), amplified probe technique |
| U0001 | Reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. |
| U0002 | Reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). |