SPECIAL BULLETIN COVID-19 #62: Clinical Policy Modifications - Suspending Copays on COVID-19-related Services

Thursday, April 23, 2020

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

AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing

Contact

NCTracks Contact Center: 800-688-6696