Diagnosis Codes

When submitting COVID-19-related claims for your Humana-covered patients, follow the appropriate CDC guidance on diagnosis coding for the date of service.

For dates of service prior to April 1, 2020, follow interim code guidelines published by the CDC (ICD-10-CM Official Coding Guidelines – Supplement: Coding encounters related to COVID-19 Coronavirus Outbreak, PDF opens new window):

  • Report the appropriate diagnosis code combination outlined in the CDC interim guidance for a claim if a COVID-19 diagnosis is confirmed
    • B97.29 and J12.89; or
    • B97.29 and J20.8; or
    • B97.29 and J40; or
    • B97.29 and J22; or
    • B97.29 and J98.8; or
    • B97.29 and J80; or
  • Report ICD-10-CM code Z03.818 for a claim if there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation; or
  • Report ICD-10-CM code Z20.828 for a claim if there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the test results for the exposed individual are either unknown or negative.

For dates of service beginning April 1, 2020, use the new code published by the CDC, as appropriate (New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1, 2020, PDF opens new window) (ICD-10-CM Official Coding Guidelines for COVID-19, PDF opens new window):

  • Report ICD-10-CM code U07.1 for a claim if a COVID-19 diagnosis is confirmed; or
  • Report ICD-10-CM code Z03.818 for a claim if there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation; or
  • Report ICD-10-CM code Z20.828 for a claim if there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the test results for the exposed individual are either unknown or negative; or
  • Report ICD-10-CM code Z11.59* for a claim if there is a screening for COVID-19 when there is no known exposure or symptoms and the test results are either unknown or negative

* Note: Some combinations of diagnosis codes and procedure codes might not be sufficient to indicate that services were COVID-19-related. For example, because ICD-10-CM code Z11.59 is not specific to COVID-19, the simple claim coding combination of only ICD-10-CM code Z11.59 and only a charge for an office visit evaluation and management procedure code would not clearly indicate that the service was related to COVID-19 testing. In such a situation, follow the modifier CS guidance here to indicate that the service was related to COVID-19 testing.