COVID-19 information and resources
Our latest COVID-19 updates
Throughout the COVID-19 pandemic, Mass General Brigham Health Plan was committed to ensuring timely access to high-quality healthcare services for our members. Following the end of the COVID-19 Public Health Emergency on May 11, 2023, this commitment remains a top priority. We have aligned our COVID-19 coverage policies based on public health recommendations and regulatory guidance.
Effective on May 12, 2023
COVID-19 tests and treatments* ordered by a provider, as well as COVID-19 vaccines will continue to be covered with no cost-sharing for members.
*As of 1/1/2024, cost sharing applies to COVID-19 related services for HSA qualified health plans.
Over-the-counter COVID-19 tests are no longer covered.
In alignment with MassHealth requirements, the following will continue to be covered at no cost:
- COVID-19 tests and treatments when ordered by a provider
- COVID-19 vaccines
- Two over-the-counter tests every 28 days
Medicare Advantage members can learn more about coverage for COVID-19 tests, treatments, and vaccines at Medicare.gov.
Information for providers
Please follow our standard policies and procedures as outlined in our provider resources or your contract. Our covered COVID-19 diagnosis codes are listed below.
| Code | Description |
| U07.1 | COVID-19 |
| U09.9 | Post COVID-19 condition, unspecified |
| M35.81 | Multisystem inflammatory syndrome |
| Z01.81 | Encounter for preprocedural examinations (please include 6th character for exam description) |
| Z11.52 | Encounter for screening for COVID-19 |
| Z20.822 | Contact with and (suspected) exposure to COVID-19 |
Covered diagnosis codes for COVID-19 evaluation and treatment
- Evaluation for suspected Covid-19:
- Asymptomatic individuals with actual or suspected exposure to COVID-19 or for symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown:
- Facility claims use Z20.822 as the primary diagnosis
- Professional claims use Z20.822 pointed to the line for the related service
- Asymptomatic individuals with actual or suspected exposure to COVID-19 or for symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown:
- Confirmed diagnosis for Covid-19:
- Facility claims use U07.1 as the primary diagnosis
- Professional claims use U07.1 pointed to the line for the related service
- Multisystem Inflammatory Syndrome for individuals with multisystem inflammatory syndrome (MIS) and COVID-19:
- Facility claims use U07.1 as the primary diagnosis
- Professional claims U07.1 and M35.81 pointed to the claim line for the related service
- Multisystem Inflammatory Syndrome due to post Covid-19 condition
- For facility claims use U09.9 and M35.81 billed together
- For professional claims use U09.9 and M35.81 pointed to the line claim for the related service
- Patients receiving preoperative evaluations only:
- ICD-10-CM Coding Guidelines instruct to sequence first a code from subcategory Z01.81 (Encounter for preprocedural examinations)
COVID-19-related resources
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