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COVID-19 Updates for Providers

FDA-Authorized COVID-19 Vaccine Information

Per the Louisiana Department of Health, all Louisianans age 16 and older are now eligible for an FDA-authorized COVID-19 vaccine.

Sequestration Adjustments

The suspension of sequestration payment adjustments has been extended.

Telehealth Expansion Waivers - New End Date

In line with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain telehealth expansion waivers has also been extended.

Antibody Testing Cost-Sharing Coverage

Peoples Health patients are covered without cost-sharing for FDA-authorized COVID-19 antibody tests when ordered by a physician or appropriately licensed health care professional.

Laboratory Testing Codes

Review information on codes for use with high-throughput laboratories.

COVID-19 FDA-Authorized Testing and Testing-Related Services Cost-Sharing Waivers Extended

In accordance with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain COVID-19 cost-sharing waivers has also been extended.

Billing Guidance for Expanded Telehealth Access

Review updated billing information for various telehealth modalities.

New! The Secretary of Health and Human Services extended the nationwide public health emergency due to COVID-19 through April 20, 2021.

The health of our plan members and the safety of those who deliver care are our top priorities. COVID-19 is a rapidly evolving public health emergency, and we’re working closely with national, state and local health organizations.

On this page, we will post COVID-19-related updates to our operational processes, as well as other relevant information that will be pertinent to your provision of care to Peoples Health patients during this time. We’re monitoring the COVID-19 public health emergency closely and updating this site with new information as it’s available. Be sure to check back frequently for updates.

Last updated: 4/2/2021 10 a.m.

LATEST COVID-19 NEWS

FDA-Authorized COVID-19 Vaccine Information

Per the Louisiana Department of Health, all Louisianans age 16 and older are now eligible for an FDA-authorized COVID-19 vaccine. For the most up-to-date listing of participating vaccine locations, visit the Louisiana Department of Health website.

Vaccinations at participating locations are BY APPOINTMENT ONLY; patients must contact the location to make an appointment. Patients who arrive without an appointment will not be vaccinated.

Below is additional general information about FDA-authorized COVID-19 vaccine billing and coding.

  • Click here for more information from the FDA on emergency use authorization (EUA) of FDA-authorized COVID-19 vaccines.
  • The cost of FDA-authorized COVID-19 vaccine serums will be paid for by the U.S. government. Eligible patients receiving the vaccine will not have any out-of-pocket costs either for the vaccine or the vaccine administration, including when two doses are required. Providers should not ask patients for vaccine payment upfront or after the vaccine is received.
  • Charges for FDA-authorized COVID-19 vaccine administration should be billed to the CMS Medicare Administrative Contractor (MAC). The MAC will reimburse claims for Medicare patients with no cost share through 2021. For more information, visit the CMS COVID-19 Insurers Toolkit.
  • Peoples Health will reimburse for the office visit that is conducted in conjunction with FDA-authorized COVID-19 vaccine administration.
  • There is a limited supply of FDA-authorized COVID-19 vaccines available. The CDC and state health agencies are managing distribution and providing prioritization on which groups of people should get the vaccine first.
  • Health care professionals should use published American Medical Association (AMA) CPT® codes when submitting FDA-authorized COVID-19 vaccine administration claims to Peoples Health under the patient’s medical benefit. CPT® is a registered trademark of the American Medical Association.
  • COVID-19 vaccine resources:

Sequestration Adjustments

The suspension of sequestration payment adjustments has been extended. It is suspended for claims with dates of service from May 1, 2020, through March 31, 2021.

COVID-19 FDA-Authorized Testing and Testing-Related Services Cost-Sharing Waivers Extended

In accordance with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain COVID-19 cost-sharing waivers has also been extended:

  • Cost-sharing is waived for FDA-authorized COVID-19 testing—including antibody testing— conducted through April 20, 2021; tests must be FDA-authorized to be covered without cost-sharing. FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. Tests must be ordered by a physician or appropriately licensed health care professional.
  • Cost-sharing is waived for COVID-19 testing-related services provided through April 20, 2021, if the services are provided based on a suspected COVID-19 diagnosis

Telehealth Expansion Waivers - New End Date

In line with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain telehealth expansion waivers has also been extended:

  • Originating site restriction waiver has been extended through April 20, 2021.
  • For physical therapy, occupational therapy and speech therapy services, Peoples Health will continue to expand telehealth coverage through April 20, 2021.

Also, please note that additional CPT and HCPCS codes are eligible for use for services conducted in a telehealth setting in 2021. There are also some codes that are temporarily eligible during the COVID-19 public health emergency. For more information, review the CMS fact sheet on the CY 2021 Physician Fee Schedule Final Rule.

FDA-Authorized Antibody Testing Cost-Sharing Coverage

Peoples Health patients are covered without cost-sharing for FDA-authorized COVID-19 antibody tests when ordered by a physician or appropriately licensed health care professional. 

An antibody test may determine if a person has been exposed to COVID-19, while a COVID-19 diagnostic test determines if a person is currently infected. FDA-authorized tests include tests approved for patient use through premarket approval or emergency use pathways and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. According to the FDA, an antibody test should not be used to diagnose a current infection. Virus detection should be used to diagnose a current infection. Peoples Health strongly supports the need for reliable testing and encourages health care providers to use reliable FDA-approved tests.

FQHC and RHC Claim Guidelines

Federally qualified health centers (FQHCs) and rural health clinics (RHCs) should use the following guidelines when submitting claims for distant site telehealth services, to ensure the claims accurately indicate the services were provided via telehealth:

  • For telehealth services rendered from January 27, 2020, through June 30, 2020: Include modifier 95 and modifier CG
  • For telehealth services rendered between July 1, 2020, and the end of the COVID-19 public health emergency: Use the RHC/FQHC-specific G code, G2025

Claims will be paid according to CMS reimbursement guidelines for each time period. Note: FQHCs and RHCs are required, per Medicare, to waive cost-sharing for COVID-19 services, including telehealth. RHCs and FQHCs may also include the modifier “CS” on the service line for these services.

 

Inpatient Claims Processing With Weighted Payments

CMS has released updated, diagnosis-related group values. For contracted providers, Peoples Health is processing claims using these updated values. Claims for non-contracted providers will be processed per Medicare pricing as appropriate.

 

Prior Authorization for Drugs
The reduction in prior authorization requirements for certain prescription medications when a provider is not available to help with the authorization includes instances when a doctor is unable to complete a prior authorization request for a patient due to lack of access to the office or the patient’s medical record.
Electronic Funds Transfer (EFT)

Did you know you can enroll in EFT to receive claims payments from Peoples Health? To learn more about enrolling in EFT or to request an EFT enrollment form, email 
phn.provider@peopleshealth.com or contact your provider representative. Note that to enroll in EFT, you must also be able to receive electronic remittance advice.

 

Pharmacy Updates

Peoples Health is closely monitoring the drug supply chain to determine if any coverage changes are necessary.

Home Health Agencies

Home health agencies can provide more services to patients using telehealth within the 30-day episode of care, so long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. We acknowledge that the use of such technology may result in changes to the frequency or types of in-person visits outlined on existing or new plans of care. 

COVID-19 TESTING AND TESTING-RELATED SERVICES

Peoples Health is waiving cost-sharing for:

  • FDA-authorized COVID-19 testingconducted through April 20, 2021; tests must be FDA-authorized to be covered without cost-sharing. FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. Tests must be ordered by a physician or appropriately licensed health care professional.
  • COVID-19 testing-related services provided through April 20, 2021, if the services are provided based on a suspected COVID-19 diagnosis 

Prior authorization is not required for COVID-19 testing and COVID-19 testing-related services.

COVID-19 Claim Coding

When submitting COVID-19-related claims, follow the coding guidelines outlined below.

Diagnosis

Effective with services on and after April 1, 2020, a confirmed diagnosis of COVID-19 (2019 novel coronavirus disease) should be reported with diagnosis code U07.1, Bronchitis not otherwise specified to COVID-19; or J12.82, Pneumonia due to COVID-19. Assignment of a code is applicable to positive COVID-19 test results and presumptive positive COVID-19 test results.

While this list is not comprehensive, here are some additional ICD-10-CM codes that may be helpful for reporting encounters related to possible COVID-19 exposure as described in the ICD-10-CM Official Coding and Reporting Guidelines:

  • Z20.828:  Contact with and (suspected) exposure to other viral communicable diseases
  • Z03.818:  Encounter for observation for suspected exposure to other biological agents ruled out
  • Z20.822:  Contact with and (suspected) exposure to COVID-19

Additional resources may be available through the Centers for Disease Control and Prevention (CDC). See the links below:

For more information, download the CPT® Assistant Guide, and review the CMS Emergency Preparedness and Response for Current Emergencies for Coronavirus.

Laboratory Testing Codes

More information is available at AMA Resource Center for Physicians, or you can download the CPT Assistant Guide.

  • 87635: For lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2)
    – 
    Via high-throughput laboratories: U0003
  • U0001: For laboratory test developed by the CDC, for COVID-19 testing performed on or after Feb. 4, 2020, as outlined by CMS
  • U0002: For the laboratory test developed by entities other than the CDC, for COVID-19 testing performed on or after Feb. 4, 2020, as outlined by CMS
    – Via high-throughput laboratories: U0004

      High-throughput laboratories allow for increased testing capacity and faster results, as described in CMS-Ruling 2020-1-R.

      Please note: U0003 and U0004 are not for detecting antibodies.

      Expanded Telehealth Access

      See the following chart for a summary of descriptions, coding and additional information for specific service types. Note, billing guidance in the chart below follows Medicare guidelines.

      As a reminder, as noted earlier on this page, additional CPT and HCPCS codes will be eligible for use for services conducted in a telehealth setting starting in 2021, including some codes that are temporarily eligible during the COVID-19 public health emergency. For more information, review the CMS fact sheet on CY 2021 Physician Fee Schedule Final Rule.

       

      Type of Service

      What Is The Service

      HCPCS/CPT Code

      Additional Information

      Billing Guidance

      Type of ServiceWhat Is The ServiceHCPCS/CPT CodeAdditional InformationBilling Guidance
      Medicare Telehealth VisitsA visit with a provider that uses telecommunication systems between a provider and a patient.Common telehealth codes include:

      99201-99215

      G0425-G0427

      G0406-G0408
      Patients may be either a new or established patient.

      The patient may be located in any geographic location (not just those designated as rural), in any health care facility, or in their home.

      During the PHE, clinicians can use popular applications that allow for video chat such as Apple FaceTime and Skype, thanks in part to enforcement discretion by the HHS Office of Civil Rights.

      For medical and outpatient behavioral telehealth visits, providers can utilize both interactive audio/video and audio-only. For PT/OT/ST provider visits, interactive audio/video technology must be used.

      For a complete list of expanded telehealth codes, visit CMS.gov

      Place of service/location billed should align with the place of service that would have been billed if telehealth technology was not used

      Visits related to COVID-19 (test ordered):
      Appropriate modifiers for telehealth services: 95, CG, CS

      Visits not related to COVID-19:
      Appropriate modifiers for telehealth services: 95

      Visits for PT/OT/ST:
      Appropriate modifiers for telehealth services: 95, GT, GQ, GO
      Audio-Only VisitsIn cases where two-way audio and video technology required to furnish a Medicare telehealth service might not be available, there are circumstances where prolonged, audio-only communication between the practitioner and the patient could be clinically appropriate yet not fully replace a face-to-face visit.Reimbursable codes are based on CMS guidance listed here.For the duration of the PHE, Medicare will make separate payment for audio-only visits described by CPT codes 98966-98968 and CPT codes 99441-99443 as outlined on page 125 in the Interim Final Rule with Comment.Place of service/location billed should align with the place of service that would have been billed if telehealth technology was not used

      Appropriate modifiers for telehealth services: 95, CG, CS
      Virtual Check-InNew or established Medicare patients may have a brief communication service with practitioners from wherever they are located, including in their home, via a number of communication technology modalities including synchronous or real-time discussion over a telephone or exchange of information through video or image. We expect that these virtual services will be initiated by the patient; however, practitioners may need to educate patients on the availability of the service prior to patient initiation.G2012

      G2010
      This is NOT limited to only rural settings or certain locations, during the PHE or otherwise.Place of service/location billed should align with the place of service that would have been billed if telehealth technology was not used
      E-VisitsThese visits use an online patient portal. In all types of locations including the patient’s home, and in all areas (not just rural), new or established Medicare patients may have non-face-to-face patient-initiated communications with their doctors or other practitioners. These services are not a substitute for an in-person visit, but are exchanges with a practitioner online through a patient portal. While individual services need to be initiated by the patient, practitioners may educate patients on the availability of the service prior to patient initiation.99421 - 99423

      G2061-G2063, as applicable
      This is not limited to only rural settings. There are no geographic or location restrictions for these visits.

      Patients communicate with their doctors without going to the doctor’s office by using online
      Place of service/location billed should align with the place of service that would have been billed if telehealth technology was not used

      Visits related to COVID-19 (test ordered):
      Appropriate modifiers for telehealth services: 95, CG, CS

      Visits not related to COVID-19:
      Appropriate modifiers for telehealth services: 95

      Visits for PT/OT/ST:
      Appropriate modifiers for telehealth services: 95, GT, GQ, GO

      Emergency Waiver: Physical, Occupational and Speech Therapy Expanded Telehealth Coverage

      Peoples Health will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the patient’s plan. 

      This change is effective immediately for dates of service through April 20, 2021.

      Reimbursable codes are based on CMS guidance listed here.

      Below is a short summary of reimbursable CPT codes for physical, occupational and speech therapy telehealth services that are included as part of the temporary expansion of telehealth services as a result of the COVID-19 public health emergency:

      CPT CodeShort Descriptor
      92507Speech/hearing therapy
      92521Evaluation of speech fluenc
      92522Evaluation speech production
      92523Speech sound lang comprehen
      97110Therapeutic exercises
      97112Neuromusulcar reeducation
      97116Gait training therapy
      97161PT Eval low complex 20 min
      97162PT Eval mod complex 30 min
      97163PT Eval high complex 45 min
      97164PT re-eval est plan care
      97165OT eval low complex 30 min
      97166OT eval mod complen 45 min
      97167OT eval high complex 60 min
      97168OT re-eval est plan care
      97535Self care mngment training

      CMS TELEHEALTH TOOLKIT CMS

      For your reference, CMS created a telehealth and telemedicine toolkit for general providers, as well as versions specific to nursing homes and ESRD providers. The toolkit contains links to reliable information regarding telehealth and telemedicine. Most of the information is directed towards providers who may want to establish a permanent telemedicine program. There are specific documents identified that will be useful in choosing telemedicine vendors, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. However, there is also information that will be useful for providers who wish to care for patients through the virtual services that may be temporarily used during the COVID-19 situation.

      Visit the CMS website for the most up-to-date toolkits.

      TELEHEALTH REIMBURSEMENT

      Peoples Health reimburses telehealth services according to CMS billing guidelines.

      According to the terms of applicable patient benefit plans, Peoples Health will reimburse both participating and non-participating providers who submit appropriate telehealth claims.

      Telehealth Frequently Asked Questions

      These FAQs answer common questions about the expansion of our telehealth policies. 

      What changes has Peoples Health made to its telehealth reimbursement policies as a result of the COVID-19 public health emergency?

      Peoples Health is temporarily waiving the CMS and state-based originating site restrictions and audio-video requirement, where applicable, for patients. Providers will be able to bill for telehealth services performed using audio-video or audio only communication while a patient is at home. 

      By removing the originating site and audio-video requirement, Peoples Health has broadened access to telehealth services. Telehealth services will be reimbursed, based on national reimbursement determinations, policies and contracted rates, as outlined in a provider’s participation agreement.

      These changes apply to patients whose benefit plans cover telehealth services, and allows those patients to connect with their doctor through live, interactive audio-video or audio only visits.

      Which types of providers do the telehealth changes apply to?

      There is no change to the type of provider who may submit claims for broad telehealth services. Peoples Health generally follows CMS’ policies on the types of providers eligible to deliver telehealth services, although individual states may define eligible care providers differently. These include:

      • Physician
      • Nurse practitioner
      • Physician assistant
      • Nurse-midwife
      • Clinical nurse specialist
      • Registered dietitian or nutrition professional
      • Clinical psychologist
      • Clinical social worker
      • Certified registered nurse anesthetists
      Will Peoples Health reimburse me for audio-only services billed with E/M codes?

      It depends on the type of telehealth service being provided.

      For non-therapy services: Peoples Health has waived audio-video requirements and will reimburse telehealth services provided through live, interactive audio-visual or audio-only transmission to new or existing patients whose medical benefit plans cover telehealth services, unless otherwise permitted by state law.

      For physical, occupational, and speech therapy services, as well as annual wellness visits: Peoples Health will reimburse physical, occupational and speech therapy telehealth services, as well as annual wellness visits, provided by qualified health care professionals only when rendered using interactive audio/video technology.

      What technology is needed to use for telehealth services? Does it need to be HIPAA compliant?

      Peoples Health is following the CMS standards for technology. The Health and Human Services Office for Civil Rights (OCR) is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies.

      Providers are responsible to provide telehealth services in accordance with OCR’s Notice and may use:

      • HIPAA-approved telehealth technologies
      • The following platforms may be used during the current nationwide public health emergency: Popular applications that allow for video chats — including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype — may be utilized to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
      • Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.

      While the 1135 waiver is in force, providers may also use telephones that have audio and video capabilities during the COVID-19 public health emergency.

      For more information, see CMS FAQs.

      Are there any limitations on the location of the provider who is conducting a telehealth visit? Will services be reimbursed if the care provider is not in the office?

      Providers may conduct a telehealth visit from any private, secure location that will support patient privacy.

      Does a provider need a referral for a telehealth visit, if the patient has a benefit plans with referral requirements?

      Referrals are not required for physician visits for any of our plans.

      Previous Guidance

      REDUCED PRIOR AUTHORIZATION REQUIREMENTS

      We’re working to helping people access health care to the fullest extent possible as we come together to address this public health emergency. We’re adopting measures that will reduce administrative burden for physicians and facilities, helping patients more easily access the care they need under their benefit plan, and adjusting programs and services, as needed, to protect our plan members and help limit the spread of the COVID-19 virus in communities.

      The following authorization provisions were effective March 24, 2020, through May 31, 2020. Normal prior authorization requirements resumed June 1, 2020:

      • Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020. Details:
        • Waiving prior authorization for admissions to: long-term care acute facilities, acute inpatient rehabilitation and skilled nursing facilities.
        • The admitting facility must notify us by 6 p.m. on the next business day of transfer.
        • Length of stay reviews still apply, including denials for days that exceed approved length.
        • Discharges to home health will not require prior authorization.
      • Suspension of prior authorization requirements when a patient transfers to a new facility through May 31, 2020. Details:
        • Providers are not required to submit a new prior authorization when a patient moves to a different yet similar site of care for the same service (e.g., hospital transfers or practice transfers).
        • The admitting facility must notify us within 48 hours of transfer so that the existing authorization can be transferred. Penalties may apply.

      WAIVER OF NETWORK SPECIALIST PHYSICIAN OFFICE VISIT COST-SHARING

      For claims with dates of service from May 11, 2020, through Sept. 30, 2020, cost-sharing for all network specialist office visits, as well as network office visits for therapy services, was waived for processed claims. Standard plan cost-sharing amounts for specialist and therapy office visits applied starting Oct. 1, 2020.

      Waiver of Network Primary Care Physician Office Visit Cost-Sharing

      For claims with dates of service from May 11, 2020, through Dec. 31, 2020, cost-sharing for processed claims was waived for network primary care physician visits, including telehealth visits, between Peoples Health patients and their assigned network primary care physicians. 

      The waiver didn’t require a COVID-19 diagnosis, and it applied to physician evaluation and management services provided in physician offices, facility-based clinics, patient homes (via telehealth), rural health clinics, and federally qualified health centers, as well as to outpatient therapy services. 

      If the office visit included additional services, such as labs and diagnostic tests, a Peoples Health patient may have had cost-sharing based on their plan benefits, unless cost-sharing was already waived because it was for COVID-19-related diagnosis or treatment.

       The cost-sharing waiver did not apply to the following additional services: 

      Unless cost-sharing was already waived because it was for COVID-19-related treatment, cost-sharing was not waived for these services when performed in an office or in other settings:

      • Lab services
      • Diagnostic procedures and tests
      • Diagnostic radiological services
      • Therapeutic radiological services
      • X-rays
      • Part B drugs and chemotherapy drugs
      • Medicare-covered dental services
      • Medicare-covered eyewear
      • Part D drugs
      • DME, prosthetics/orthotics and medical supplies
      • Blood and blood products
      • Hearing aids
      • Diabetes monitoring supplies, therapeutic shoes or inserts
      • Dialysis

      Cost-sharing for any services below/rendered in the below settings was also not eligible for the waiver:

      • Inpatient hospital
      • Outpatient surgery or observation services
      • Skilled nursing facilities
      • Home health
      • Emergency services, urgently needed services and ambulance services
      Waiver of COVID-19 Treatment Cost-Sharing

      Cost-sharing for COVID-19 treatment was waived through March 31, 2021, for both inpatient and outpatient treatment, if services were provided based on a confirmed COVID-19 diagnosis. The waiver applied when care was received from either network or out-of-network providers, including when provided through telehealth.

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