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COVID-19 Updates for Providers

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

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Last updated: 4/21/2021 10 a.m.

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 post COVID-19-related updates to our operational processes, as well as other relevant information that is 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.

FDA-Authorized COVID-19 Vaccine Information

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

Sequestration Suspended Through Dec. 31, 2021

The suspension of sequestration payment adjustments has been extended.

Telehealth Expansion Waivers - Extended Through July 19, 2021

In line with the federal government extending the end date for the COVID-19 public health emergency to July 19, 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 Through July 19, 2021

In accordance with the federal government extending the end date for the COVID-19 public health emergency to July 19, 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.

LATEST COVID-19 NEWS

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FDA-Authorized COVID-19 Vaccine Information

Per the Louisiana Department of Health, all Louisianans age 16 and older are now eligible for a 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 is 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.
  • The CDC and state health agencies are managing distribution.
  • 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:
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Sequestration Suspended Through Dec. 31, 2021

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

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COVID-19 FDA-Authorized Testing and Testing-Related Services Cost-Sharing Waivers Extended Through July 19, 2021

In accordance with the federal government extending the end date for the COVID-19 public health emergency to July 19, 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 July 19, 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 July 19, 2021, if the services are provided based on a suspected COVID-19 diagnosis
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Telehealth Expansion Waivers Extended Through July 19, 2021

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

  • Originating site restriction waiver has been extended through July 19, 2021.
  • For physical therapy, occupational therapy and speech therapy services, Peoples Health will continue to expand telehealth coverage through July 19, 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.

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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.

ADDITIONAL COVID-19 INFORMATION

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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.

 

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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.

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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.

 

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Pharmacy Updates

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

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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.
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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.

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COVID-19 TESTING AND TESTING-RELATED SERVICES

Peoples Health is waiving cost-sharing for:

  • FDA-authorized COVID-19 testing conducted through July 19, 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 July 19, 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 and Treatment

While this list is not comprehensive, here are some 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

Beginning Feb. 4, 2020, if a member receives treatment under a confirmed positive diagnosis of COVID-19 or has a COVID-19 admission, providers may bill with codes U07.1 and B97.29. As of Jan. 1, 2021, providers may also bill with code J12.82.

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.

  • HCPCS U0001 (on or after Feb. 4, 2020): For laboratory test developed by the CDC for COVID-19 testing (description: 2019 – nCoV diagnostic P)
  • HCPCS U0002 (on or after Feb. 4, 2020): For laboratory test developed by entities other than the CDC for COVID-19 testing (description: COVID-19 lab test non-CDC)
  • HCPCS U0003 (on or after March 18, 2020): For clinical diagnostic laboratory tests that use high-throughput amplified probe technologies to detect and diagnose COVID-19
  • HCPCS U0004 (on or after March 18, 2020): Use when billing under Medicare Part B for clinical diagnostic laboratory tests that use high-throughput technologies to detect and diagnose COVID-19
  • CPT 87426 (on or after June 25, 2020): For infectious agent antigen detection testing
  • HCPCS U0005 (on or after Jan. 1, 2021): For add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory a) completes the test in 2 calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput technology in 2 calendar days or less for all of their patients (not just their Medicare patients) in the previous month

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.

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EXPANDED TELEHEALTH ACCESS

Originating Site Expansion

Any originating site requirements that apply under Original Medicare are temporarily waived, as described below, so that telehealth services provided through live interactive audio-video can be billed for patients at home or CMS originating site. Peoples Health will extend the expansion of telehealth access for in-network and out-of-network providers through the national public health emergency period.

 

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 the CY 2021 Physician Fee Schedule Final Rule.

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

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. Benefits will be processed in accordance with the patient’s plan.

 

This change is effective for dates of service through July 19, 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

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. During this expansion time frame, we will temporarily reimburse providers for telehealth services at their contracted rate for in-person services. Reimbursable codes are based on CMS guidance listed here.

 

Audio-Only

For PT/OT/ST and home health provider visits, interactive audio-video technology must be used.

 

In accordance with CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at the rate they would receive for audio-video or in-person codes. CMS rates for audio-only telephonic evaluation and management (E/M) codes, as well as virtual check-ins (which may be done by telephone) and e-visits for established patients for dates of service on or after March 1, 2020.

 

Audio-only visits and other services not requiring video technology include:

  • Audio-only (telephone) E/M services (CPT codes 99441-99443)
  • Online digital E/M services/e-visits (CPT codes 99421-99423 and 98970-98972)
  • Virtual check-ins (HCPCS codes G2010, G2012 and additional codes starting Jan. 1, 2021 G2250-G2252)

Eligible Care Providers

Peoples Health generally follows CMS’ policies on the types of providers eligible to deliver telehealth services. 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
  • Care providers are required to check with the applicable professional licensing boards for guidelines on where they are able to practice during the COVID-19 national public health emergency period

Telehealth Technology

Peoples Health is following the CMS standards for technology. The U.S. Department of 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:

 

  • The following HIPAA-approved telehealth platforms may be used during the national public health emergency: Popular applications that allow for video chats — including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom 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.

These platforms are NOT approved: Facebook Live, Twitch, Snapchat, TikTok and similar video communication applications are public facing and should not be used in the provision of telehealth to plan members by covered health care providers.  

 

While the 1135 waiver is in force, providers may also use telephones that have audio and video capabilities for telehealth services during the COVID-19 public health emergency. For more information, visit cms.gov.

 

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CMS TELEHEALTH TOOLKIT

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.

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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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