For the HRSA COVID-19 Uninsured Program, claims for diagnostic testing are eligible for reimbursement if one of the following diagnoses codes is included in any position on the claim:
- Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
- Z11.52 - Encounter for screening for COVID-19
- Z11.59 - Encounter for screening for other viral diseases
- Z20.822 - Contact with and (suspected) exposure to COVID-19
- Z20.828 - Contact with and (suspected) exposure to other viral communicable
- Z86.16 - Personal history of COVID-19
Claims for diagnostic testing-related visits are eligible for reimbursement if the place of service is an office visit, telehealth visit, urgent care or emergency room AND one of the following diagnoses codes is included in any position on the claim:
- Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
- Z11.52 - Encounter for screening for COVID-19
- Z11.59 - Encounter for screening for other viral diseases
- Z20.822 - Contact with and (suspected) exposure to COVID-19
- Z20.828 - Contact with and (suspected) exposure to other viral communicable
- Z86.16 - Personal history of COVID-19
While U0001, U0002, U0003, U0004, G2023, G2024 and 87635 are COVID-19 specific procedure codes, one of the Z codes above needs to be included on the claim from hospitals and physicians in order to be eligible for reimbursement for testing as part of the HRSA COVID-19 Uninsured Program.
For independent labs, single line item claims for the following procedure codes with any diagnosis are also eligible for reimbursement:
- COVID-19 tests: U0001, U0002, U0003, U0004, 87635, 87426, 87428, 87636, 87637, 87811, 0225U, 0226U, 0240U, 0241U
- Antibody tests: 86318, 86328, 86769
- Specimen collection: G2023, G2024
Claim reimbursement eligibility for diagnostic testing services performed by independent labs is different than claim reimbursement eligibility for such services performed by hospitals (including hospital labs) or physicians. This is because independent labs do not always know the reason for testing when ordered by another provider and they are dependent on the diagnosis information indicated by the provider. Therefore, HRSA reimburses for specific COVID-19 diagnostic testing services (individual procedure codes) for any diagnosis only when performed by independent labs.