U07.1 — COVID-19

Clinical Definition

ICD-10-CM code U07.1 is used to report a confirmed diagnosis of COVID-19, the disease caused by SARS-CoV-2. This code was activated by the WHO in March 2020 under Chapter 22 (Codes for Special Purposes). A confirmed diagnosis requires a positive SARS-CoV-2 molecular (PCR/NAAT) or antigen test, or a provider clinical diagnosis based on symptoms and epidemiological context. U07.1 applies to all confirmed cases regardless of severity, from asymptomatic positive results to critical illness requiring mechanical ventilation.

Sequencing of U07.1 follows the ICD-10-CM Official Guidelines for Coding and Reporting. When COVID-19 is the reason for the encounter, U07.1 is the principal or first-listed diagnosis, with additional codes for manifestations such as pneumonia (J12.89), ARDS (J80), sepsis (A41.89), or acute kidney injury (N17.9). If the patient is admitted for an unrelated condition but found to have active COVID-19, U07.1 may be assigned as a secondary diagnosis. For exposure without confirmed infection, use Z20.822 instead.

As of the 2025-2026 coding cycle, U07.1 remains valid and billable. The public health emergency ended in May 2023, but the code continues in use for confirmed cases. Special pandemic-era guidelines — including the allowance of provider clinical diagnosis without a positive test — have been retained. Post-acute sequelae of COVID-19 (long COVID) should be coded with U09.9, not U07.1, when the acute infection has resolved.

When to Use U07.1

• ✓The patient has a confirmed positive SARS-CoV-2 test (PCR, NAAT, or antigen) and the provider documents a diagnosis of COVID-19 as the reason for the encounter.
• ✓The provider documents a clinical diagnosis of COVID-19 based on symptoms, exposure history, and clinical judgment, even in the absence of a positive laboratory test.
• ✓A hospitalized patient is being treated for COVID-19 pneumonia, COVID-19-related ARDS, or other acute manifestations of SARS-CoV-2 infection — U07.1 is sequenced first, followed by manifestation codes.
• ✓The patient presents to the emergency department with acute COVID-19 symptoms (fever, cough, dyspnea, anosmia) and testing confirms SARS-CoV-2 infection during the encounter.
• ✓A patient admitted for another condition (e.g., hip fracture) is incidentally found to have active COVID-19 — U07.1 is assigned as a secondary diagnosis to capture the concurrent infection.
• ✓The patient is being treated for a COVID-19-related complication such as multisystem inflammatory syndrome (MIS) with confirmed current or recent SARS-CoV-2 infection.

Common Coding Mistakes

Related & Differential Codes

Documentation Requirements

• 1Confirmed diagnosis: document the basis for the COVID-19 diagnosis — positive SARS-CoV-2 PCR/NAAT, positive antigen test, or provider clinical diagnosis with supporting rationale (symptoms, exposure, imaging consistent with COVID-19).
• 2Test type and date: specify the type of diagnostic test performed (molecular PCR, rapid antigen, or clinical diagnosis) and the date of the positive result to support coding accuracy and medical necessity.
• 3Severity and manifestations: document the severity of the illness (mild, moderate, severe, critical) and all associated manifestations such as pneumonia, ARDS, sepsis, acute kidney injury, myocarditis, or thromboembolic events.
• 4Oxygen requirements: document the patient's respiratory status including SpO2 levels, supplemental oxygen requirements (nasal cannula, high-flow, BIPAP/CPAP, mechanical ventilation), and any ventilatory support to justify the level of care.
• 5Comorbidities and risk factors: document relevant comorbid conditions (diabetes, hypertension, obesity, immunocompromised status, chronic lung disease) as these affect treatment decisions and support additional diagnosis codes.
• 6Treatment provided: document COVID-19-specific treatments administered (antivirals such as nirmatrelvir/ritonavir, remdesivir; monoclonal antibodies; corticosteroids such as dexamethasone; anticoagulation) to support medical necessity.
• 7Clinical course and disposition: document the progression of illness, response to treatment, and discharge status (improved, transferred, deceased) to support the encounter's coding and billing.
• 8Sequencing rationale: when COVID-19 is coded alongside other conditions, ensure documentation clearly establishes the causal relationship between COVID-19 and its manifestations to support correct code sequencing.

Reimbursement & Billing Notes

ICD-10-CM code U07.1 is a valid, billable code accepted by Medicare, Medicaid, and all commercial payers for encounters involving confirmed COVID-19. Following the end of the federal public health emergency in May 2023, COVID-19-related testing, treatment, and vaccination have transitioned back to standard insurance coverage models. Inpatient admissions for COVID-19 are no longer eligible for the 20% Medicare add-on payment that was in effect during the PHE. However, U07.1 remains fully valid for DRG assignment and contributes to the severity of illness calculation, which can significantly affect hospital reimbursement — particularly when documented with manifestation codes such as J12.89 (pneumonia), J80 (ARDS), or J96.00 (acute respiratory failure).

For risk adjustment purposes, U07.1 does not map to a CMS-HCC category as a standalone code, but the associated manifestation and comorbidity codes (e.g., J96.00, A41.89, N17.9) do carry HCC weight and affect MA plan capitation payments. Outpatient encounters for COVID-19 are reimbursed under standard E/M coding with U07.1 supporting medical necessity for diagnostic workup and treatment. Providers should ensure that documentation supports the level of service billed, including all manifestations, complications, and treatments rendered. For telehealth encounters involving COVID-19 evaluation and management, U07.1 is a valid primary diagnosis; telehealth flexibilities enacted during the PHE have been largely retained through current CMS policy for qualifying conditions.

Frequently Asked Questions