Provider Coronavirus Information

For coronavirus information related to Ambetter from Coordinated Care, visit our Coronavirus Guidance page for providers on our Ambetter web site. 

Skip to CMS Billing Guidelines for COVID-19 Vaccine

Screening and Treatment Guidance for COVID-19

Coordinated Care 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

• 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

• Coordinated Care will waive prior authorization requirements 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 waivers.

The Washington State Health Care Authority (HCA) has provided guidance to support opioid treatment program (OTP) medical directors relating to the corona virus (COVID-19) situation in Washington. This guidance contains recommendations and resources from state and federal partners. Review HCA's Frequently Asked Questions about COVID-19 and Opioid Treatment Programs (PDF). 

Provider Billing Guidance for COVID-19 Testing

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.”

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

Specimen transfers are currently a non-covered service per Health Care Authority (HCA) fee schedules.

COVID-19 Screening Services

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 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
• Annual face to face visit requirements have been waived for reauthorization of respiratory equipment and supplies due to the current COVID-19 crisis; initiation of treatment still requires an in person assessment to collect relevant physical examination.

As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization waivers.

Established Reimbursement Rates for COVID-19 Testing Services for All Provider Types*

• We are complying with the rates published by Health Care Authority (HCA) for the following codes:
  • U0001 
  • U0002 
  • U0003 
  • U0004 

• Any additional rates will be determined by further HCA guidance and communicated when available.

Telehealth for Apple Health (Medicaid)

For our Apple Health (Medicaid) members, Coordinated Care covers telemedicine services provided by our community providers in accordance with all Health Care Authority (HCA) policies and guidelines as outlined in HCA’s published billing guidelines and fee schedules.

• For Apple Health members, visit our Coordinated Care telehealth page.
• For Apple Health (Medicaid) providers, please refer to the HCA telehealth FAQ (PDF).
• We recommend all providers refer to the HCA clinical and policy guide for COVID-19 (PDF).
• In addition, Coordinated Care contracts with Teladoc, a telehealth provider network. Teladoc delivers 24-hour access to in-network healthcare providers for non-emergency health issues at no cost.
• Members can receive medical advice, a diagnosis, or a prescription for colds, flu, fever, rash/skin conditions, sinuses/allergies, respiratory infections, and behavioral health.
• For more information on Teladoc, visit the Teladoc web site. 
• HCA has purchased a limited number of licenses for Zoom, a video conferencing technology platform that helps providers with telehealth visits. Please visit HCA’s website to see if you are eligible and to apply for this benefit.
• For more COVID-19 information from HCA, visit their COVID-19 web page.

Behavioral Health and Billing During COVID-19

HCA's Behavioral Health Policy and Billing FAQ (PDF) reinforces the state's current policies regarding telemedicine as defined in WAC 182-531-1730 and covers new telehealth policies that will only be in effect during this health care crisis.

Health Home (HH) and Home Visits

• Per CDC guidelines and CMS guidance, we are not currently doing any home visits with our members. 
• We are following HCA’s Health Home Guidance (PDF).

Alien Emergency Medical COVID-19 Coverage Expansion

• Alien Emergency Medical (AEM) clients can access care within the provider’s office setting (outside of the emergency department, inpatient and other outpatient settings) to diagnose and treat COVID-19.
  

General claims processing, including initial bills and appeals

• We do not anticipate issues and will continue to operate as normally as possible. If there is an issue where we cannot process claims, we will notify you.
• For fastest payment, enroll in EFT.

Existing Authorizations 

• We have extended existing authorizations by an additional 60 days and we have issued written communications and outreaching to members affected by this. We will be re-evaluating extensions as needed. 
• If you have questions on a specific authorization, please check the Provider Portal for an updated status.
  
  

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

As of February 15, 2021 HCA will match Medicare's published rates for COVID-19 vaccine administration. Also, please reference revisions made to the Apple Health COVID-19 Vaccine Clinical Policy as of 2/26/21. The updated changes may be found in the Reimbursement Information and Billing Guidance section of the document and provides clarification that E/M codes should not be billed if vaccine administration is the only service provided. Up-to-date information can be found on the HCA’s website.

Coordinated Care 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 (PDF) for Apple Health (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:

• Coordinated Care will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration, in accordance with Washington’s coverage determinations for Apple Health 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 immunizations 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 Coordinated Care covers, please contact Provider Services at 1-877-644-4613.