| S. No. | Service | Codes | Description | Place of Service |
|---|---|---|---|---|
| 1 | 1 | Z03.818, Z20.828 | Z03.818 for suspected exposure to COVID-19. Z20.828 for exposure to a confirmed case of COVID-19. | (23) Emergency room (20) Urgent care (11) Office visits/telehealth |
| 1 | COVID-19 Treatment | ICD-10 Code: B97.29 or U07.1 | COVID-19 diagnosis codes need to be billed in order for the cost share waiver to be applied. | (02) Telehealth, (11) Office, (15) Mobile Unit , (19) Off Campus-Outpatient Hospital , (20) Urgent Care Facility , (21) Inpatient Hospital , (22) On Campus-Outpatient Hospital , (23) Emergency Room – Hospital , (31) Skilled Nursing Facility , (32) Nursing Facility , (41) Ambulance - Land , (61) Comprehensive Inpatient Rehabilitation Facility , (81) Independent Laboratory. |
| Revenue Code: 760 and 762 | Cost share will be waived (self-insured customer benefit plan designs vary). |
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