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COVID-19 Guidance for Providers | Ambetter
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. At this time, most people in the United States will have little immediate risk of exposure to this virus. 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.
- Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.
- Instruct symptomatic patients with travel history to China or other infected areas 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 with travel history to China or other infected areas 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.
- Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
- Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
- 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.
- 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.
Provider Billing Guidance for COVID-19 Testing
We are working to quickly address and support screening, testing and treatment for COVID-19, and are 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
- Ambetter 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.
Guidance will be updated as more information becomes available.
NEW TELEHEALTH POLICIES EXPAND COVERAGE FOR HEALTHCARE SERVICES
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:
- Waiving all member liability (copays, cost sharing, etc.) for care delivered via telehealth, including Health Savings Account (HSA) eligible plans.
- 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*
*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.