Excellus BCBS – Administrative Policy AP-26 COVID-19 Viral and Antibody Testing

Modifier CG (or one of these diagnosis codes – Z02.0, Z02.1, Z02.4, Z02.5, Z02.79, Z02.89 Z02.9, Z56.89, and/or Z56.9) must be submitted with testing CPT® codes U0001, U0002, U0003, U0004, 0202U, 86328, 87635, 86769, 0223U, 0224U, 87426, C9803*, G2023, G2024, 86413 and/or 0225U when the sole purpose of the test is for pandemic control such as testing of asymptomatic individuals to assess health status as required by an employer, school, camp, common carrier, government/public health agency, or research/epidemiologic study. These testing claims are not ordered by attending providers as medically appropriate for the diagnosis or treatment of an individual(s) and are not covered.

[Syracuse University, a self-funded employer group, has advised Excellus BlueCross BlueShield that it will cover all COVID-19 viral and antibody testing for its employed members and eligible dependents.]

*In the communication dated August 10, 2020, Excellus shared the addition of CPT code C9803 effective November 16, 2020.

The Health Plan will not reimburse for 0026U, 86408, and/or 86409 per member contract. The Health Plan will not reimburse supply code 99072.

Rremember that all testing claims require the referring provider information on the claim in order to be processed.

Source: https://provider.excellusbcbs.com/documents/53971/224494/November+2020+Connection+Newsletter.pdf/b1ea2639-967d-3b03-5916-a7c028505f1f