ICD-10 U07.1
Billable / Specific MCCCOVID-19
About ICD-10-CM U07.1
ICD-10-CM code U07.1 represents COVID-19. This is a billable/specific code in the Codes for Special Purposes chapter (block U07). The 2026 edition of ICD-10-CM U07.1 became effective on October 1, 2025.
Coding Tips for U07.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
U07.1 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 2 Excludes
Not included here, the excluded code is not part of U07.1, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- coronavirus as the cause of diseases classified elsewhere (B97.2-)
- pneumonia due to SARS-associated coronavirus (J12.81)
Use Additional Code
When coding U07.1, also report these additional codes when applicable.
- code to identify pneumonia or other manifestations, such as:
- pneumonia due to COVID-19 (J12.82)
Inpatient DRG Impact, MCC
code COVID-19. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for U07.1
Local Coverage Determinations (LCDs) from CMS MACs that list U07.1 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing U07.1.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but U07.1 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with U07.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To U07.1
Other codes in section U00-U49 (Provisional assignment of new diseases of uncertain etiology or emergency use).
ICD-10 U07.1, Billing FAQ
Is ICD-10 code U07.1 billable? +
Yes, U07.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for U07.1? +
Type 2 Excludes (may be coded together when both conditions exist): coronavirus as the cause of diseases classified elsewhere (B97.2-); pneumonia due to SARS-associated coronavirus (J12.81)
Is U07.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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