This study evaluated the real-world diagnostic performance of Radiological Society of North America COVID-19 consensus reporting guidelines among 2618 chest CT reports from the author's health care network from April 2020 through March 2021; reverse-transcriptase polymerase chain reaction served as the reference. Typical findings exhibited sensitivity of 68% and specificity of 91%, similar to performance reported in research settings. PPV of 52% was lower than previously reported, attributed to low COVID-19 prevalence. Accuracy improved from 84% in April 2020 to 92% in March 2021 (p = .03).