Provider Coronavirus Information
Screening and Treatment Guidance for COVID-19
NH Healthy Families is working to quickly address and support screening, testing and treatment for COVID-19, and is closely following guidance from the Centers for Medicare and Medicaid Services (CMS). As of April 1, 2020, the following guidance can be used to bill for services related to the screening and treatment of COVID-19.
COVID-19 Screening Services
- All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.
- If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:
- Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
- Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation
- This applies to services that occurred as of February 4, 2020.
- Providers billing with these codes will not be limited by provider type.
COVID-19 Treatment Services
- NH Healthy Families will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.
- For dates of service from February 4, 2020 through March 31, 2020 providers should use the ICD-10 diagnosis code:
- B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere
- For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:
- U07.1 – 2019-nCov Confirmed by Lab Testing
As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers. For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply.
Provider Billing Guidance for COVID-19 Testing
We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.
- Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
- HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
- HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
- CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
Please note: It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
- All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
- We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
- In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.
- Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
- We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
- Adjudication of claims is currently planned for the first week of April 2020.
- We are complying with the rates published on 3/12/20 by CMS:
- U0001 = $35.91
- U0002 = $51.31
- Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.
- Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.
In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.
Effective immediately, the policies we are implementing include:
- Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
- Any services that can be delivered virtually will be eligible for telehealth coverage
- All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020
- Telehealth services may be delivered by providers with any connection technology to ensure patient access to care**
*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.
**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.
Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.
We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people.