If a patient presents to the emergency department with cough and fever and then tested negative for COVID-19, would the test and the emergency room visit be eligible for reimbursement?

The test and visit are eligible for reimbursement if they otherwise meet the criteria defined by the program.

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 (possible exposure to COVID-19)
• Z11.59 - Encounter for screening for other viral diseases (asymptomatic)
• Z20.828 - Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
• Z11.52 - Encounter for screening for COVID-19 (asymptomatic)
• Z20.822 - Contact with and (suspected) exposure to COVID-19
• 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 (possible exposure to COVID-19)
• Z11.59 - Encounter for screening for other viral diseases (asymptomatic)
• Z20.828 - Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
• Z11.52 - Encounter for screening for COVID-19 (asymptomatic)
• Z20.822 - Contact with and (suspected) exposure to COVID-19
• 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.