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Provider Information on COVID-19 Coverage

Updated January 14, 2022

Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We’ve taken steps to lower costs and provide our members easier access to care related to COVID-19.

Testing and Treatment Coverage
For fully insured members, we are currently covering FDA-authorized testing to diagnose COVID-19 for our members with no prior authorization needed. COVID-19 tests are covered with no member copays, deductibles or co-insurance when an individual’s health care provider determines that it is medically appropriate to treat or diagnose COVID-19. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

Over-the-Counter (OTC) Tests: We cover COVID-19 diagnostic tests members buy without a provider’s involvement or prescription, starting Jan. 15, 2022, through the end of the federal public health emergency. OTC tests must be FDA-authorized. This applies to fully insured, self-insured and individual and family plans. Members can buy up to eight tests per covered member every 30 days. This program is through BCBSIL and Prime TherapeuticsTM pharmacy benefits. If a member does not have benefits through Prime Therapeutics, they should contact their pharmacy benefit administrator. More information is on our member site.

For treatment of COVID-19, we temporarily waived member cost-sharing for fully insured members through Dec. 31, 2020. Copays, deductibles and coinsurance now apply.

Some members may or may not have access to out-of-network benefits. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since an out-of-network provider may not accept the amount covered under the benefit plan as payment in full.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may have cost-share waived for treatment of COVID-19, based on their employer’s election to offer this benefit.

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth

Medicare Supplement members do not have network restrictions unless otherwise noted on their plans. Members should always call the number on their ID card for answers to their specific benefit questions.

Check Member Eligibility and Benefits
Use the Availity® Provider Portal  or your preferred vendor for eligibility and benefit verifications.

COVID-19 Vaccine
For information about our COVID-19 vaccination guidelines, see our News & Updates article.

Claims for COVID-19 Testing
If you are collecting a COVID sample from a member, have a lab capable of testing, or are a lab testing a member, submit the claim using the appropriate collection or lab code. We are covering COVID-19 tests that are FDA-authorized, including rapid and antibody tests. Member cost-share for the test will be waived during the public health emergency  (PHE) declared by the Secretary of the Department of Health and Human Services. Testing must be:

  • For individualized diagnosis or treatment of COVID-19
  • Medically appropriate
  • In accordance with generally accepted standards of care, including the Centers for Disease Control (CDC) guidance

For more detail on COVID-19 coding and guidance, refer to the American Medical Association  or the Centers for Disease Control and Prevention.  

COVID-19 Collection Codes

  • C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source
  • G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
  • G2024: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source

COVID-19 Lab Codes

  • 0202U: Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR
  • 0223U: Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
  • 0225U: Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
  • 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 B), upper respiratory specimen, each pathogen reported as detected or not detected
  • 0241U: Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected
  • 87426: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
  • 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; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B
  • 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]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
  • 87811: Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • U0001: CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
  • U0002: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types orubtypes (includes all targets), non-CDC
  • 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: 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection

COVID-19 Testing Before Non-COVID-19 Treatment or Procedures
When screening for COVID-19 before elective procedures or treatment not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will ensure our members receive the cost-share waiver for COVID testing and the claim will be processed promptly. The appropriate benefits will apply to the remainder of each member’s non-COVID related care.

Emergency Room COVID-19 Testing with No Presenting Symptoms
Testing for COVID-19 should be for individualized treatment or diagnosis. If testing is used to screen for COVID-19 before emergency room services not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will be able to identify when members should receive the cost-share waiver for COVID-19 testing, and the claim will be processed promptly. The remainder of each member’s non-COVID-19 related emergency room care will be processed according to the member’s benefit plan.

Claims for COVID-19 Antibody Testing
Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with Emergency Use Authorized (EUA), regardless of the diagnosis. This waiver will last through the end of the PHE. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

Antibody Testing Requirements
Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care provider. We encourage members to consult with their health care provider to determine the best, medically appropriate test for their condition. Refer to the current FDA position on antibody testing. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

COVID-19 Antibody Testing Codes

  • 0224U: Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed
  • 86318: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method
  • 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method, severe acute respiratory syndrome coronavirus (SARS-CoV-2) (Coronavirus disease COVID-19)
  • 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: Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] testing via multiple-step method

In-Network Providers and Lab Testing
Network physicians are encouraged, and may be contractually required, to refer our members to participating, in-network providers. Check our online Provider Finder® for labs that are in-network for each member, according to their benefit plan. Referring to in-network providers helps members control their health care costs and avoid balance billing by out-of-network providers.

Out-of-Network Providers
If you are out-of-network, we will reimburse the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website.

Claims for COVID-19 Testing and Antibody Related Services
Use the following coding process for services that are related to COVID-19 testing or antibody testing.

COVID-19 Diagnosis Codes
To indicate services performed in conjunction with the testing for COVID-19 or COVID-19 antibodies, include one of the following diagnosis codes:

  • B34.2: Coronavirus infection, unspecified
  • B97.29: Other coronavirus as the cause of diseases classified elsewhere
  • U07.1: COVID-19
  • Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

  • Z11.52: Encounter for screening for COVID-19

  • Z20.822: Contact with and (suspected) exposure to COVID-19
  • Z20.828: Contact with and suspected exposure to other viral communicable diseases (actual exposure to COVID-19)

Modifier CS
For services furnished on March 18, 2020, through the end of the PHE, please use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19. This is for testing-related services that result in an order for or administration of COVID-19 testing or antibody testing. Use the CS modifier only on the codes specified by the Centers for Medicare & Medicaid Services.  The following types of claims do not need the CS modifier:

  • Screenings before procedures that aren’t related to COVID-19
  • COVID-19 tests
  • Treatment of COVID-19.

Telehealth
BCBSIL has further expanded its access to telehealth in response to COVID-19. 

Pharmacy
We recommend members:

  • Keep supplies of their medications on hand and not wait until last-minute to get refills.
  • Contact their pharmacies to ask about delivery or curb-side/drive-thru options
  • Use their 90-day supply fill benefits (if applicable) for non-specialty medications at select retail pharmacies or mail order

Member cost share applies according to each member's benefit plan. All pharmacy practice safety measures, and prescribing and dispensing laws, remain in force and effect.

Note on Medicare members: Members of these plans can get 90-day fills through mail order.

  • Blue Cross Group Medicare Advantage (PPO)℠
  • Blue Cross Group Medicare Advantage Open Access (PPO)℠
  • Blue Cross Group MedicareRx (PDP)℠
  • Blue Cross Medicare Advantage (HMO)℠
  • Blue Cross Medicare Advantage (PPO)℠
  • Blue Cross MedicareRx (PDP)℠

What is the risk of COVID-19?
According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19. 

We’ve developed a flier about COVID-19  that you may share with your patients.

More Information
Because this is a rapidly evolving situation, you should continue to use CDC guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. Also watch BCBSIL’s News and Updates for announcements and other information and related resources.

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The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medic judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.