The RCxRules Blog

COVID-19 Encounters: 5 Ways to Ensure Complete Payment for Testing and Diagnosis

The COVID-19 pandemic has led to new and rapidly changing coding/billing regulations, making an already tough job that much harder for revenue cycle teams.

To help, there are five high value coding/billing rules that top performing medical groups use to guarantee complete and accurate payment for COVID-19 related services. These rules are not one size fits all; they often require customization to meet unique payer requirements.

  1. When billing for COVID-19 tests using CPT codes 87426, 87635, and U0002 add a QW modifier if testing is performed in a facility possessing a CLIA Certificate of Waiver.
  2. For dates of service on/after March 18, 2020, add the CS modifier to any visit codes related to the testing of COVID-19.
  3. If COVID-19 was diagnosed on/after April 1, 2020, ICD-10 code U07.1 should be billed as the primary diagnosis followed by the appropriate codes for the associated manifestations, except in the case of obstetrical patients.
  4. If COVID-19 was diagnosed before April 1, 2020, remove ICD-10 code U07.1 and add the primary diagnosis code for the chief complaint followed by ICD-10 code B97.
  5. When billing ICD-10 code Z11.59, please review information to ensure patient had no known exposure to the COVID-19 virus and that their test results are either unknown or negative after patient evaluation.

To help ensure complete and accurate payment for all COVID-19 related services, check out these nine coding and billing rules that top-performing medical groups are using when administering the COVID-19 vaccine.

In addition to complex COVID-19 rules/regulations, RCxRules helps large, complex healthcare organizations manage evolving billing/coding regulations and payer requirements through custom rules.

Our Revenue Cycle Rules product allows a revenue cycle team member to create custom rules based on their organization’s unique needs. These rules are presented to billers and coders in their existing workflow.

Plus, the rules engine can autocorrect routine billing/coding issues that consistently tie up your team’s valuable time—no manual effort needed. To learn more about how our rules engine and custom rules can help you, schedule a 1:1 meeting.


For more detailed information on these telehealth billing/coding requirements please visit the Medicare fact sheet and CMS’s COVID-19 FAQ Sheet on Medicare FFS Billing.

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