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Coronavirus Updates

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.

Please review all available provider guidance, actions and resources listed below.

  • 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.
  • 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.

  • 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. 

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

New Telehealth Policies Expand Coverage for Healthcare Services

Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) (updated 05/14/2020) to help providers navigate telemedicine and telehealth reimbursement.

For more information, please refer to the guidelines below.

Superior is actively monitoring State and CMS guidance related to these policies and will continue to inform providers about any updates as we receive new information. 

HCPCS and CPT Codes for COVID-19 Testing Services

  • Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for 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.
  • 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.
  • Adjudication of claims is currently planned for the first week of April 2020.

Medicare Reimbursement Rates for COVID-19 Testing Services for All Provider Types

  • We are complying with the rates published on 3/12/20 by CMS:
    • U0001 = $35.91
    • U0002 = $51.31
    • Please note: Commercial products will reimburse COVID-19 testing 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.

Superior HealthPlan 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

  • 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

  • Superior HealthPlan will waive prior authorization requirements and member cost sharing for COVID-19 treatment for most 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, where applicable.

 

For member information, please reference the Coronavirus Updates for Members webpage.

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For any questions, please contact your Account Manager or call Provider Services at 1-877-391-5921.