NCDHHS is directing providers to stop collecting copayments from Medicaid and NC Health Choice beneficiaries on all COVID-19 related testing, services and treatments. This change is effective retroactive to Jan. 1, 2020 through the end of the calendar quarter of the federally declared public health emergency period. Suspension of beneficiary cost sharing for COVID-19 related testing and treatment services is required of states taking advantage of additional federal Medicaid funding available through the federal Families First Coronavirus Response Act, which became law on March 18, 2020.
The affected billing codes, which include telehealth services, are shown in the table below. Applicable billing codes will be updated as new therapies and interventions are identified or if there are changes to COVID-19 coding guidance. Providers who have already collected copays for COVID-19 related services should make every effort to return those payments to beneficiaries. Note that this suspension applies only to COVID-19 related services. Providers can continue to collect copays for non-COVID-19 related services.
NC Medicaid will reimburse providers for lost copay revenue. The reimbursement may occur through claims adjustment or through a lump-sum payment. Details, including timing of the reimbursement, will be announced at a future date.
Providers may be subject to audit.
ICD-10-CM Codes for 2019 Novel Coronavirus (COVID-19)
|
ICD-10 Code |
Description |
Diagnosis |
|
U07.1 |
COVID-19 |
Confirmed Diagnosis or Presumptive Positive |
|
U07.1 and J12.89 |
COVID-19 and Other viral pneumonia |
Pneumonia |
|
U07.1 and J20.8 |
COVID-19 and Acute bronchitis due to other specified organisms |
Acute Bronchitis |
|
U07.1 and J40 |
COVID-19 and Bronchitis, not specified as acute or chronic |
|
|
U07.1 and J22 |
COVID-19 and Unspecified acute lower respiratory infection |
Lower Respiratory Infection |
|
U07.1 and J98.8 |
COVID-19 and Other specified respiratory disorders |
|
|
U07.1 and J80 |
COVID-19 and Acute respiratory distress syndrome |
Acute Respiratory Distress Syndrome |
|
Z03.818 |
Encounter for observation for suspected exposure to other biological agents ruled out |
Exposure to COVID-19 |
|
Z20.828 |
Contact with and (suspected) exposure to other viral communicable diseases |
|
|
Z11.59 |
Encounter for screening for other viral diseases |
Screening for COVID-19 |
|
R05 |
Cough |
Signs and Symptoms |
|
R06.2 |
Shortness of breath |
|
|
R50.9 |
Fever, unspecified |
|
|
O98.5 & U07.1 |
Other viral diseases complicating pregnancy, childbirth, and the puerperium |
COVID-19 Infection in Pregnancy, Childbirth, and the Puerperium |
Current Procedural Terminology (CPT) Code Currently in Effect
|
CPT Code |
Description |
|
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. |
Additional Resources
NC Medicaid COVID-19 Resources website
ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020
Contact
NCTracks Contact Center: 800-688-6696