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Frequently Asked Questions

Based on user feedback from this site and recent program webcasts, we have identified and answered your top questions to ensure this process is as simple and easy to use as possible. Please see our frequently asked questions.

HRSA
COVID-19 Claims Reimbursement

to Health Care Providers and Facilities for Testing and Treatment of the Uninsured

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Billing Codes

The HRSA COVID-19 Claims Reimbursement program provides claims reimbursement to health care providers who provide COVID-19 testing and treatment for 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 recent 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 treatment for uninsured individuals when COVID-19 is the primary reason for treatment, except as noted.


HRSA COVID-19 Uninsured Program Coding Information

Health Screening

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.

Procedural coding for all services should follow normal billing practices using the correct ICD-10 diagnosis to identify testing-related or treatment-related services as described above.

Health Screening

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)

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])

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.

Health Screening

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)

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
  • Antibody tests: 86318, 86328, 86769
  • Specimen collection: G2023, G2024

Customer Support

Our service staff members are available to provide real-time technical support, as well as service and payment support. Hours of operation are 8 a.m. to 8 p.m. Monday – Friday in the caller's local time zone.

Provider Support Line: 866-569-3522 for TTY dial 711

We're listening

We are committed to making the HRSA COVID-19 Uninsured Program as simple and accessible as possible. We are also monitoring your inquiries and working hard to answer your questions. Let us know how we're doing, and we'll update our resources based on your input.

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