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If a provider tests for COVID-19 as part of pre-operative or other medical treatment unrelated to COVID-19, is the test eligible for reimbursement?

If a provider tests for COVID-19 as part of pre-operative or other medical treatment unrelated to COVID-19, is the test eligible for reimbursement?

For the HRSA COVID-19 Uninsured Program, COVID-19 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

Related treatment visits and services are not eligible for reimbursement given the primary reason for treatment is not COVID-19.

Eligibility Questions
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