Provider Coronavirus Information

Public Health Emergency Period Extended Information

On July 23, 2020, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue for another 90 days.

With this renewal the various testing, screening, billing, and telehealth coverages that were implemented in response to the COVID-19 Public Health Emergency earlier this year will be extended to YouthCare members through late October, until the PHE is either terminated or extended again.  This extension does not affect coverages that had already been made effective through December 31, 2020. 

In accordance with this extension, YouthCare has updated the General Guidance for COVID-19 Testing, Screening, and Treatment document, as well as the COVID-19 Telehealth Guidance for Providers documents posted on our website.

If you have any questions about this extension or the covered benefits impacted by it, please contact Provider Services at 844-289-2264 (TTY: 711).

Coronavirus disease 2019 (COVID-19) is an emerging illness.  Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.  New information, obtained daily, will further inform the risk assessment, treatment options and next steps.  We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.                                                                                                  

Guidance:

• Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches.  Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.  
• However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
• Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
• Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
• Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
• Monitor and manage ill and exposed healthcare personnel.
• Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

Take Action:

1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.
3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
4. Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
5. Be familiar with the intended scope of available testing and recommendations from the FDA.    

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

Last Updated: 5.13.2020

Provider Billing Guidance for COVID-19 Testing, Screening & Treatment Services

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).

COVID-19 Testing Services

Providers performing the COVID-19 test can bill us for testing 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.”
• PLA 0202U - Effective May 20, 2020. Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.

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.

• These codes should not be used for serologic tests that detect COVID-19 antibodies.
• 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.

COVID-19 Antigen Testing Services

 Providers performing COVID-19 antigen tests can bill us for testing services that occurred after June 25, 2020, using the following HCPCS codes:

• 87426 - Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg SARS-CoV, SARA-CoV-2 (COVID-19).
• 0223U - Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
• 0224U - Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19) includes titer(s), when performed (Do not report 0224U in conjunction with 86769).

All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the above COVID-19 antibody testing codes.

In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. This includes non-participating providers.

Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

Reimbursement rates are still pending from CMS and this communication will be updated when available.

High-Throughput Technology Testing Services

Providers performing high production COVID-19 diagnostic testing via high-throughput technology can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes:

•  HCPCS U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
•  Please note: U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
• HCPCS U0004 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
•  Please note: U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.

Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.

We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these codes to indicate high production testing.

Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

COVID-19 Specimen Transfers

For specimen transfer related claims, the following codes can be used:

• G2023 - Spec Clct for SARS-COV-2 COVID 19 ANY SPEC SRC
• G2024 - SP CLCT SARS-COV2 COVID19 FRM SNF/LAB ANY SPEC
• C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. This is effective for services provided on or after March 1, 2020.

Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

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

We 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.

Reimbursement Rates for COVID-19 Services for All Provider Types

We are complying with the rates published by CMS for the following codes:

• U0001 = $35.91
• U0002 = $51.31
• U0003 = $100.00
• U0004 = $100.00
• G2023 = $23.46
• G2024 = $25.46

NOTE: Commercial products will reimburse COVID-19 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.

We will follow these CMS published rates except where state-specific Medicaid rate guidance should supersede.  

COVID-19 Testing Services

• Providers performing the COVID-19 test can bill us for testing 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.
• These codes should not be used for serologic tests that detect COVID-19 antibodies.
• 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.

High-Throughput Technology Testing Services

• Providers performing high production COVID-19 diagnostic testing via high-throughput technology can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes:
  • HCPCS U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
  • Please note: U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
  • HCPCS U0004 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
  • Please note: U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
• Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
• We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these codes to indicate high production testing.
• Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

COVID-19 Specimen Transfers

• For specimen transfer related claims, the following codes can be used:
  • G2023 - Spec Clct for SARS-COV-2 COVID 19 ANY SPEC SRC
  • G2024 - SP CLCT SARS-COV2 COVID19 FRM SNF/LAB ANY SPEC
  • C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. This is effective for services provided on or after March 1, 2020.
• Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

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

• We 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.

Reimbursement Rates for COVID-19 Services for All Provider Types

• We are complying with the rates published by CMS for the following codes:
  • U0001 = $35.91
  • U0002 = $51.31
  • U0003 = $100.00
  • U0004 = $100.00
  • G2023 = $23.46
  • G2024 = $25.46
• Commercial products will reimburse COVID-19 services in accordance with our negotiated commercial contract rates.
• We will follow these CMS published rates except where state-specific Medicaid rate guidance should supersede.
• Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

Last Updated: 5.13.2020

New Telehealth Policies Expand Coverage for Healthcare Services

In order to ensure that all of our members have needed access to care, we have increased the scope and scale of our use of telehealth services for all products for the duration of the national COVID-19 public health emergency.  These coverage expansions 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.

The policies we have implemented include:

• Continuation of zero member liability (copayments, coinsurance and/or deductible cost sharing) 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 October 25, 2020
• Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state. For further billing and coding guidance for telehealth services, we recommend following what is being published by:

• Centers for Medicare and Medicaid (CMS)
• Department of Health and Human Services (HHS)
• American Medical Association (AMA)

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. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

Last Updated: 08.03.2020

YouthCare HealthChoice Illinois from MeridianHealth EXTENDS $0 MEMBER LIABILITY FOR Primary Care, Behavioral Health, and Telehealth SERVICES for Remainder of 2020

Since March, YouthCare HealthChoice Illinois from MeridianHealth, has waived pre-authorizations, co-pays, and other costs related to COVID-19 testing, screening and medically necessary treatment. We also have waived prescription refill limits, and members are able to refill prescriptions prior to their refill date during this crisis.

As seniors face increased social and economic barriers to care amid the pandemic, we are now offering a number of expanded benefits to help our eligible Medicare Advantage members address issues such as out-of-pocket medical costs, food insecurity, and medication assistance.

Effective July 1, 2020, expanded benefits will include:

• $0 Member Liability Extension: We are waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits and are extending telehealth cost share waivers for all telehealth visits—primary care, specialty, and behavioral health—for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states.
• Extended Meal Benefits – Members eligible for meal benefits due to a chronic condition or recent discharge may receive an additional 14 meals delivered to their home at no cost.
• Increased Annual Wellness Visit Incentives – Members may be eligible for an increased incentive for completing their Annual Wellness Visits, a benefit offered at no cost to the member.
• Additional Over-The-Counter (OTC) Benefits – Plans with an OTC benefit may now receive additional allowance dollars in monthly or quarterly increments, adding up to as much as $150 for the remainder of 2020, depending on plan.
• Access to WellCare’s Community Connections Help Line – The Community Connections Help Line – a toll-free line provided by our partners at WellCare and available to anyone in need – is staffed by peer coaches and support specialists who can refer individuals and caregivers in need to a database of more than half a million social services in local communities across the country. By calling the line at 1-866-775-2192, members can also receive help coordinating of the expanded meal program benefits, OTC allowances, and annual wellness visit incentives via the line.

Beginning July 1, 2020, providers should waive the member liability for the eligible primary and behavioral health care claims at the point of service, and forego the collection of the member cost share. This is a benefit change for our members and our claims system will be configured to administer these adjusted benefits. We recognize that providers have different reimbursement/accounting arrangements with us, and the costs associated with this benefit change will follow the accounting processes as outlined in the provider’s contract with YouthCare from MeridianHealth. For services rendered to Medicare members with state benefits, providers should continue to collect that member cost share from their State Medicaid Agency as per usual.

Last updated: 6.2.2020

Medicare DRG Increases for COVID-19 Treatment Services Under Coronavirus Aid, Relief, and Economic Security (Cares) Act

The Centers for Medicare & Medicaid Services (CMS) have released guidance for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. YouthCare HealthChoice Illinois will be following this guidance as we adjudicate Medicare claims for applicable COVID-19 inpatient treatment services.

The CARES Act provides for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. The increase will be applied to claims that include the applicable COVID-19 ICD-10-CM diagnosis code and meet the date of service requirements, as follows:

• Discharges occurring on or after January 27 and on or before March 31:
  • B97.29 – Other coronavirus as the cause of diseases classified elsewhere
  • CDC coding guidance for cases discharging on March 31 and prior (PDF)
• Discharges occurring on or after April 1:
  • U07.1 – COVID-19
  • CDC coding guidance for cases discharging on April 1 and after (PDF)

For discharges with the diagnosis codes above, YouthCare will follow the Medicare billing guidance published by CMS. Inpatient claims for these COVID-19 discharges that have already been received will be automatically reprocessed to reflect the payment increase.

This guidance is in response to the COVID-19 pandemic and may be retired at a future date.

Sources:

The Centers for Medicare and Medicaid (CMS)

• https://www.cms.gov/files/document/se20015.pdf
• https://www.cms.gov/files/document/mm11764.pdf

The Centers for Disease Control (CDC)

• https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
• https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

Last updated: 6.15.2020

THE CENTERS FOR MEDICARE AND MEDICAID (CMS) RELEASE BILLING GUIDELINES FOR COVID-19 VACCINE

YouthCare is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have published billing guidance for Medicaid and Children’s Health Insurance Program (CHIP) providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

•   YouthCare will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Illinois’s coverage determinations for Medicaid beneficiaries
•  Member liability will be $0
• Non-participating provider pre-auth requirements will be waived
•  Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural

Terminology (CPT®) code set that includes new vaccine-specific codes to report immunization for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of November 10, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services YouthCare covers, please contact Provider Services at 844-289-2264 (TTY: 711).