Prior to the April 1, 2020, effective date for U07.1 COVID-19 diagnosis, the program guidelines indicate that treatment would be eligible for reimbursement if B97.29 is the primary diagnosis. Can B97.29 be used for a primary diagnosis?

For the HRSA COVID-19 Uninsured Program, the criteria for treatment to be eligible for reimbursement is as follows:

• Treatment claims for services or discharges prior to April 1, 2020, are eligible for reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.
• Treatment claims for services or discharges on or after April 1, 2020, are eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is U07.1.

To address the usage of B97.29 as a primary diagnosis, we refer providers to recent guidance released by CMS: (see CR 11764 (PDF - 183 KB)). This guidance explicitly allows for B97.29 to be included in any position on the claim.

The goal of the program is to provide consistent eligibility for reimbursement of COVID-19 treatment before and after April 1, 2020, when the U07.1 diagnosis code became effective. Prior to the effective date of the U07.1 code we rely on the B97.29 code to identify claims where COVID-19 is the primary reason for treatment.

HRSA is not providing coding guidance to providers. The program guidance is intended to define what services are eligible for reimbursement under the program.