This article presents a brief guide for COVID-19 billing and coding procedures with ICD-10-CM and Modifiers. It includes any E/M updates pertaining to COVID-19 in 2024. CPT coding changes that affect COVID-19 will go into effect on January 1, 2024. We hope that this guide will prove useful to your medical practice in maintaining effective billing practices during the era of COVID-19.
ICD-10-CM Diagnostic Tests Relating to COVID-19
There is one new ICD-10-CM code that went into effect on October 1, 2023:
Z11.52-Encounter for screening for COVID-19 (appropriate to use when testing a patient Covid-19 prior to surgery).
Diagnostic Tests Relating to COVID-19
For tests relating to COVID-19, other than a COVID-19 test, the usual codes are:
Z03.818 -Encounter for observation for suspected exposure to other biological agents ruled out
Z20.822 –Contact with (suspected) exposure to COVID-19
Z20.828 -Contact with and (suspected) exposure to other viral communicable diseases
Z28.310 -Unvaccinated for COVID-19
Z28.311 -Partially vaccinated for COVID-19
Z28.39 -Other under immunization status
According to the ICD-10-CM Tabular List of Diseases and Injuries, when reporting code J12.82 Pneumonia due to coronavirus disease or M35.81 Multisystem inflammatory syndrome, coders are required to first report code U07.1 for COVID-19, if it is applicable.
The usual ICD-10-CM codes used to bill virtual/face-to-face visits for suspected COVID-19 exposure are:
ICD-10 codes Z03.818, Z20.822, and Z20.828
Source: CMS.
Modifiers
As of May 12, 2023, use of Modifier CS is no longer needed to bypass cost sharing for COVID-19.
A virtual or face-to-face visit for suspected or likely COVID-19 exposure E/M visit should include modifier 95. With POS for face-to-face service normally billed.
COVID-19 Vaccines
CPT Codes for COVID-19 immunizations range in the 90000 series and HCPCS code M0201. These are valid in 2023 and for 2024, COVID-19 vaccines and their currently authorized administrations include:
| Code | Descriptor | Labeler Name | Vaccine/Procedure name |
| 90480 | Admin Sarscov2 Vacc 1 dose | N/A | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) COVID-19 vaccine, single dose |
| M0201* | COVID-19 vaccine home admin | Home vaccine admin | COVID-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient’s home |
| 91304 | Sarscov2 vac 5MCG/0.5ML IM | Novavax | Novavax COVID-19 (aged 12 years and older) vaccine, adjuvanted |
| 91318 | Sarscov2 vac 3 MCG TRS-SUC | Pfizer | Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (yellow cap) |
| 91319 | Sarscv2 vac 10MCG TRS-SUC IM | Pfizer | Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (blue cap) |
| ri | Sarscv2 vac 30MCG TRS-SUC IM | Pfizer | COMIRNATY (COVID-19 vaccine, mRNA) 2023-2024 vormula |
| 91,321.00 | Sarscov2 vac 25 MCG/.25ML IM | Moderna | Moderna COVID-19 vaccine 2023-2024 formula |
| 91,322.00 | Sarscov2 vac 50 MCG/0.ML IM | Moderna | SPIKEVAX 2023-2024 formula |
When administering an COVID-19 vaccine the selection of ICD-10-CM code Z23 Encounter for Immunization is appropriate.
Conclusion
We truly hope this guide to COVID-19 billing and coding practices has been useful to you and your medical practice.
For more information, fill out the form below. We truly hope this guide to COVID-19 billing and coding practices has been useful to you and your medical practice.
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