Provider Information on COVID-19 Coverage

Updated Dec. 3, 2021

Updated Jan. 20, 2022

Blue Cross and Blue Shield of Oklahoma (BCBSOK) 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. We provide information as it becomes available here and on our COVID-19 Related News section.

Testing and Treatment Coverage

During the public health emergency (PHE), we are covering FDA-authorized COVID-19 tests 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 BCBSOK 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 microsite.

For treatment of COVID-19, we temporarily waived member cost-sharing through Dec. 31, 2020. Copays, deductibles and coinsurance now apply. Treatment will be covered in accordance with the terms of the member's benefit plan. This applies to these types of plans:

  • Fully insured employer-based
  • Individual and Family
  • Medicare (excluding Part D)
  • Medicare Supplement

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

Providers should use the most appropriate CPT or HCPCS code that describes the service they are rendering and append any appropriate modifiers.

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, depending on their employer’s decision about its benefit plan. Please check eligibility and benefits for more specific information. Members can call the number on their ID card for benefit questions.

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

We temporarily waived member cost-sharing for treatment of COVID-19 through Dec. 31, 2020. Copays, deductibles and coinsurance now apply.

Blue Cross Medicare SupplementSM 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 Members Eligibility and Benefits

Use the Availity® Provider Portal or your preferred vendor for eligibility and check benefit verifications.

COVID-19 Vaccine

For information about our COVID-19 vaccination policy, 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 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 website or the Centers for Disease Control and Prevention.

COVID-19 Collection Codes

Codes

Description

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

Codes

Description

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 or subtypes (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.

At-Home Tests

We cover at-home collection methods for COVID-19 testing if the tests are FDA-authorized and are clinically indicated for the member as determined by the member’s health care provider. We encourage members to consult with their healthcare provider to determine whether the test is medically appropriate for their condition. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

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

Code

Description

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 not in our networks, 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:

Code

Description

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.

Credentialing Process Simplified for COVID-19

BCBSOK is temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal orders and regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing and processes will apply.

What's Changing? We are simplifying the process of joining our network.
Subject to state actions on licensing and practice requirements, we will credential providers who meet the following conditions for the duration of the state-declared Executive Order:

  • Oklahoma Board approved healthcare professional intending to participate in Oklahoma.
  • We will accept temporary licenses.
  • We will waive accreditation requirements, CMS certification and site visits for institutional providers.
  • We will accept expired documents if they have been inactive or expired for less than six-months and the provider is unable to obtain a current document from the issuer due to the COVID-19 emergency. Licenses, accreditations or certifications that have been revoked for cause will not be accepted.

All occupational licenses extended during the Executive Order by Governor Stitt will expire fourteen (14) days following the withdrawal of termination of the Order.

Credentialing criteria and verification sources may change. Please check back often for updates.

Telemedicine

For information about our telemedicine coverage, refer to our Telemedicine page under Claims and Eligibility.

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 their benefit plan. All pharmacy practice safety measures, and prescribing and dispensing laws, remain in force and effect.

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 the COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.

More Information
Continue to use Centers for Disease Control guidance on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSOK News and Updates and Newsroom.

If you have any questions or if you need additional information, please email provider inquiries or call the Provider Contract Support Unit at 1-800-722-3730, Option 2.

 

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Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty and home delivery pharmacy.

Prime Therapeutics LLC is a pharmacy benefit management company, contracted by BCBSOK to provide pharmacy benefit management and related other services.

BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.