COVID: Recent coding and billing changes


In the last few weeks the CMS has made significant billing and coding changes to make it even easier to use telemedicine, engage in e-visits, and obtain COVID testing and treatment.

We are writing to update you on the most important recent updates. We hope this helps your employees that may be getting medical bills and incorrect denials.

New COVID-19 illness modifiers

Insurance companies are required to cover COVID testing and related services. When submitting claims related to COVID19 illnesses, a cost sharing code must be included in order for claims to be processed correctly. If this code is not present on a COVID-related claim submitted by a provider, your employee may receive an incorrect bill.  

Telemedicine and e-visit coding

The explosion of telemedicine and e-visits for COVID and non-COVID related medical visits has been well reported. This applies to traditional hospitals and all types of physician's offices. The CMS and AMA will now allow hospitals to bill as the originating site even when patients are at home and speaking to a provider on the telephone, so long as the patient is registered as a hospital outpatient. As of April 30, physical therapy and occupational therapy codes are also eligible for telehealth when performed by an eligible provider. Providers submitting a telemedicine claim should use the place of service that would have been used if the patient had been seen face-to-face. Federal licensing regulations can also be waived so out-of-state physicians can treat patients via telehealth.

COVID testing changes

As testing is ramping up at providers' offices and independent labs, it’s required these be coded correctly in order for claims to be processed. The place of testing and office personnel that perform the test must be recorded. COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. A written practitioner’s order is no longer a requirement and pharmacists are able to assess and provide services and in certain cases may be able to perform laboratory test. The expansion of point-of-care codes are an important part of expanding testing capacity.

Antibody testing

New codes have been created for antibody testing: 86328 and 86769. Many insurance companies are covering these tests - if claims are rejected, these would be the first places to look.

We are curious to see how these changes will persist after the crisis has passed.

We will continue to follow the situation and keep you updated.