The HRSA COVID-19 Claims Reimbursement Program provides claims reimbursement to health care providers who provide COVID-19 testing, treatment for COVID-19, and COVID-19 vaccine administration to uninsured individuals.
Claims reimbursement for COVID-19 treatment
The HRSA COVID-19 Claims Reimbursement Program provides claims reimbursement to health care providers who are providing treatment for uninsured individuals when COVID-19 is the primary reason for treatment, except when a claim includes an excluded code as noted.
For dates of service or discharges on or after April 1, 2020, providers will use primary diagnosis U07.1 to indicate COVID-19 is the primary reason for treatment except for pregnancy for which providers will use O98.5- as primary diagnosis and U07.1 as the secondary diagnosis.
For dates of services or discharges prior to April 1, 2020, there is no equivalent diagnosis to indicate COVID-19 is the primary reason for treatment. To address this issue, HRSA has established separate guidance for this program to use B97.29 as the primary diagnosis when COVID-19 is the primary reason for treatment except for pregnancy for which providers would use O98.5- as the primary diagnosis and B97.29 as the secondary diagnosis (similar to how U07.1 is used). CMS also released guidance (PDF) indicating pricing can occur when B97.29 is included in any position on the claim, including primary, for dates of service before April 1, 2020. Given this guidance, services or discharges prior to April 1, 2020, will be eligible for reimbursement from the HRSA COVID-19 Claims Reimbursement program if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.
HRSA recognizes that the use of B97.29 as the primary diagnosis as described above is different from the ICD-10-CM Official Coding Guidelines – Supplement for Coding encounters related to COVID-19 Coronavirus Outbreak. HRSA is not providing coding guidance to providers. Rather, HRSA is providing billing guidance to allow providers to identify and submit only claims eligible for reimbursement under this program, which is exclusively for reimbursing providers for COVID-19 testing of uninsured individuals and for treatment for uninsured individuals when COVID-19 is the primary reason for treatment, except as noted.
HRSA COVID-19 Uninsured Program Coding Information
Treatment Codes
For services related to treatment to be eligible for reimbursement, claims submitted must meet the following criteria:
The COVID-19 diagnosis code must be the primary diagnosis code submitted. The current exceptions are as follows:
- The COVID-19 code may be listed as secondary in the case of pregnancy (O98.5-).
- Any claim that includes one of the following codes is not eligible for reimbursement: 59812, 59820, 76815.
COVID-19 diagnosis code for dates of service or dates of discharge prior to April 1, 2020
(see recent guidance CMS CR 11764 (PDF) for additional information):
- B97.29
- Other coronavirus as the cause of diseases classified elsewhere COVID-19 diagnosis codes.
COVID-19 diagnosis code for dates of service or dates of discharge on or after April 1, 2020:
- U07.1
- 2019-nCoV acute respiratory disease.
Rehabilitation care, including inpatient rehabilitation care, is covered by the program as long as it is related to a confirmed COVID-19 diagnosis and that COVID-19 diagnosis is the primary reason for providing rehabilitation treatment. Rehabilitation providers must submit claims for treatment based on a COVID-19 positive diagnosis from the referring provider. The same referring COVID-19 diagnosis must be the primary diagnosis code submitted on the rehabilitation claim.
Procedural coding for all services except rehabilitation care should follow normal billing practices for this program using the correct ICD-10 diagnosis to identify testing-related or treatment-related services as described above.
Testing Codes - Hospitals (Including Hospital Labs) and Physicians
For diagnostic testing and testing-related services to be eligible for reimbursement, claims submitted for testing-related visits rendered in an office, urgent care or emergency room or via telehealth setting must include one of the following diagnosis codes:
- 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 (confirmed exposure to COVID-19)
- Z11.59
- Encounter for screening for other viral diseases (asymptomatic)
- Z11.52
- Encounter for screening for COVID-19, asymptomatic
- Z20.822
- Contact with and (suspected) exposure to COVID-19
- Z86.16
- Personal history of COVID-19
For antibody testing and testing-related services to be eligible for reimbursement, claims submitted for testing-related visits rendered in an office, urgent care or emergency room or via telehealth setting must include one of the following procedure codes:
- 86318
- Immunoassay for infectious agent antibody, qualitative or semi-quantitative, single step method (e.g., reagent strip)
- 86328
- Immunoassay for infectious agent antibody(ies), qualitative or semi-quantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
- 86769
- Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])
- 86408
- SARS-CoV-2 neutralizing antibody screen
- 86409
- SARS-CoV-2 neutralizing antibody titer
Claim reimbursement eligibility for diagnostic testing services performed by independent labs is different than claim reimbursement eligibility for such services performed by hospitals (including hospital labs) or physicians. This is because independent labs do not always know the reason for testing when ordered by another provider and they are dependent on the diagnosis information indicated by the provider. Therefore, HRSA will reimburse for specific COVID-19 diagnostic testing services (individual procedure codes) for any diagnosis only when performed by independent labs.
Testing Codes - Independent Labs
For testing to be eligible for reimbursement billed by an independent lab, claims submitted must include one of the following diagnosis codes:
- 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 (confirmed exposure to COVID-19)
- Z11.59
- Encounter for screening for other viral diseases (asymptomatic)
- Z11.52
- Encounter for screening for COVID-19, asymptomatic
- Z20.822
- Contact with and (suspected) exposure to COVID-19
- Z86.16
- Personal history of COVID-19
In addition, single line item claims for the following procedure codes with any diagnosis will also be eligible for reimbursement:
- COVID-19 tests: U0001, U0002, U0003, U0004, 87635, 87426, 87636, 87637, 87811, 0225U, 0226U
- Antibody tests: 86318, 86328, 86769
- Specimen collection: G2023, G2024
Vaccination Codes
Claims submitted for the administration of a FDA-licensed or authorized vaccine must be submitted as single line item claims, and must include one of the following codes to be eligible for reimbursement:
- Pfizer: 0001A, 0002A
- Moderna: 0011A, 0012A
Please note that only the administration of the vaccine is eligible for reimbursement.
