Since the outbreak of COVID-19 global pandemic, healthcare organizations and industry associations have worked together to release medical codes to report the novel coronavirus. Medical billing and coding companies helped providers document COVID-19 using the new codes. The ICD-10-CM code COVID-19: U07.1 developed by the World Health Organization (WHO) was adopted by the Centers for Disease Control and Prevention (CDC) for a confirmed diagnosis, effective April 1, 2020.

New Diagnosis Codes for COVID-19

When COVID-19 meets the definition of the principal diagnosis, code U07.1 should be used on the claim. The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) added six new diagnosis codes for COVID-19 effective January 1, 2021. These new codes are expected to be used as secondary diagnosis codes to report COVID-19 status or secondary or associated manifestations of COVID-19. The six new codes are:

  • J12.82 – Pneumonia due to COVID-19
    • Pneumonia due to SARS-CoV-2
  • M35.81 – Multisystem Inflammatory Syndrome
    • Multisystem inflammatory syndrome in children
    • Pediatric inflammatory multisystem syndrome
  • M35.89 – Other specified systemic involvement of connective tissue
  • Z11.52 – Encounter for screening for COVID-19 (this code replaces Z11.59 (Encounter for screening for other viral diseases), which the CDC had previously stated should be used when patients being screened for COVID-19 have no symptoms, no known exposure to the virus, and test results that are either unknown or negative).
  • Z20.822 – Contact with and suspected exposure to COVID-19
    • Contact with and (suspected) exposure to SARS-CoV-2
  • Z86.16 – Personal History of COVID-19

New ICD-10-PCS Codes for the Vaccination and Treatment of COVID-19

CMS also released 21 new ICD-10-PCS codes for the vaccination and treatment of COVID-19. CMS stated that the new procedure codes will “describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment.” These codes came into effect on January 1, 2021.

XW013H6 Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
XW013K6 Introduction of leronlimab monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
XW013S6 Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6
XW013T6 Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6
XW013U6 Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6
XW023S6 Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6
XW023T6 Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6
XW023U6 Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6
XW033E6 Introduction of etesevimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033F6 Introduction of bamlanivimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033G6 Introduction of REGN-COV2 monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033H6 Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033L6 Introduction of CD24Fc immunomodulator into peripheral vein, percutaneous approach, new technology group 6
XW043E6 Introduction of etesevimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043F6 Introduction of bamlanivimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043G6 Introduction of REGN-COV2 monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043H6 Introduction of other new technology monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043L6 Introduction of CD24Fc immunomodulator into central vein, percutaneous approach, new technology group 6
XW0DXM6 Introduction of baricitinib into mouth and pharynx, external approach, new technology group 6
XW0G7M6 Introduction of baricitinib into upper GI, via natural or artificial opening, new technology group 6
XW0H7M6 Introduction of baricitinib into lower GI, via natural or artificial opening, new technology group 6

The six codes for vaccine administration are XW013S6, XW013T6, XW013U6, XW023S6: XW023T6, and XW023U6.

CMS has provided regulations for ensuring the availability of COVID-19 vaccines without cost-sharing obligations for Medicare beneficiaries, Medicaid recipients, and enrollees in most private health plans.

Medicare Billing Guidelines

CMS has stated that it will provide Medicare reimbursement for COVID-19 vaccines and their administration if the vaccines are authorized for emergency use or approved by the FDA. Providers can receive appropriate reimbursement for acquiring and administering the COVID-19 vaccine to patients by ensuring proper coding and documentation. Medications should be reviewed and drugs used by the facility should be identified. Documentation in the electronic health record should be communicated to the medical coding service provider. When coding vaccination procedures, ICD-10 code Z23, Encounter for immunization, should be also assigned.

For Medicare billing purposes, CMS provides the following instructions for COVID-19 shot Administration:

  • Providers can bill on single claims for COVID-19 shot administration, or submit claims on a roster bill for multiple patients at one time.
  • When COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
  • Providers participating in a Medicare Advantage Plan, COVID-19 claims should be submitted to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

There have been many updates to COVID-19 (SARS-CoV-2) since the outbreak of the pandemic and more changes expected in the future. The best option for providers is to rely on expert medical billing and coding company to ensure accurate claim submission and reimbursement.