Revenue Performance Advisor and COVID-19

Change Healthcare has been closely monitoring coding changes related to COVID-19 to provide general guidance specific to codes used within healthcare transactions involving patient diagnosis, care, or treatment.  The following are ICD-10, HCPCS, and AMA code additions relative to COVID-19, along with actions required and links to additional information.


COBA Alert--Additional Important Information Regarding Medicare Claims and COVID-19

The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Agreement (COBA) wants to make all COBA trading partners aware of additional information regarding Medicare claims in relation to COVID-19 that was brought to the COBA team’s attention May 7, 2020. This additional information includes the following:

1) Not all services billed to Medicare result in the waiver of deductible and coinsurance amounts. 

Please see the March 23, 2020 CMS COVID-19 Facts Sheet.

Some key examples covered in this documentation include, but are not limited to:

  • Inpatient hospital admissions are exempted from the waiver of cost sharing. (In other words, inpatient deductibles and applicable coinsurance amounts continue to apply.)
  • Additionally, Part B deductible and coinsurance amounts still apply to emergency ambulance transports.

2) New Modifier Used in Certain Billing Situations 

In a recent MLN Matters article, Medicare announced its acceptance of a new modifier in conjunction with certain COVID-19 billed services

  • Highlights:
    • Medicare now permits the billing of modifier “QW” in association with HCPCS code U0002 and code 87635 for claims submitted by facilities with a valid and current Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver for dates of service March 20, 2020, and after.

Action Required: Payers should ensure that their claims adjudication systems will accept the HCPCS/Modifier combination.


COVID-19 Impacts on COBA Crossover Claims

This notice is for Coordination of Benefits Agreement (COBA) trading partner representatives from the CMS and Benefits Coordination & Recovery Center (BCRC) COBA teams regarding CMS MLN Matters Special Edition, released on March 18.  Although this outreach information is targeted towards providers, it will also be useful to our COBA trading partners.

COBA trading partners may be seeing 837 institutional coordination of benefits (COB) claims containing a “DR” (disaster-related) condition code, and 837 professional COB claims containing a “CR” (catastrophe/disaster-related) modifier, for situations where Section 1812(f) waivers have been announced. Additionally, the publication includes useful information regarding Medicare’s coverage of telehealth/telemedicine in association with the COVID-19 pandemic.

For questions regarding this notification, please contact your designated BCRC COBA EDI representative using the following contact information:
Tel. # 646-458-6740
Fax # 646-458-6761


ICD-10 Code Addition for COVID-19

On February 20, 2020, the CDC released a notification for a new ICD-10 code for the 2019 Novel Coronavirus (COVID-19) for reporting that will be effective October 1, 2020.  For more information read the CDC Announcement: New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), October 1, 2020.

New HCPCS Code Additions for COVID-19

There have been two HCPCS code announcements from the CMS related to COVID-19 additions, including: 

  1. HCPCS Code U0001: On February 13, 2020, the CMS announced the addition of code U0001 for providers and laboratories to bill for laboratory testing of patients for SARS-CoV-2.
  2. HCPCS Code U0002: On March 5, 2020, the CMS announced the addition of code U0002 for providers and laboratories to bill for laboratory testing of patients for COVID-19.

For more information visit the CMS Fact Sheet: Coverage and Payment Related to COVID-19 Medicare.

New AMA CPT Code 87635 for COVID-19

On March 13, 2020, the AMA announced the addition of CPT code 87635 for laboratory testing services that detect the presence of COVID-19 effective immediately.

For more information visit the AMA Press Release: New CPT code announced to report novel coronavirus test.

Action Required: Please ensure your clinical and administrative provider software systems are updated to support these recent code set updates. Reach out to your software vendor(s) as applicable. New information is being published daily as a response to COVID-19; please continue to monitor CMS and your payer sites for the latest information. Refer to your MAC and payer guidelines to determine if services are covered.

Action Taken: Change Healthcare has obtained all code set updates specific to COVID-19 for immediate deployment across all Change Healthcare systems, solutions, and services. We continue to monitor this situation and will respond accordingly as conditions change.

Additional Resources