https://www.humana.com/coronavirus/coverage-faqs. We expect providers to code for COVID-19 testing and treatment using guidelines provided by the CDC. All Rights Reserved. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. https://www.ambettermeridian.com/coronavirus/covid-19-home-testing-kits.html. Members will have the option of online submission through the secure member website or sending a paper submission. up to $12 per test under the safe harbor (for plans that provide access to the tests . DIFS has surveyed health insurers operating in Michigan and prepared the information below to help Michiganders understand this benefit and how it will be offered. All rights reserved. https://www.phpmichigan.com/?id=175&sid=1. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Network of Preferred Providers: Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells), Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors), Other therapies currently under investigation without published supporting evidence. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Providers should document ALL of the following for coverage: Inpatient cognitive rehabilitation for cognitive impairment resulting from COVID-19 is not covered unless the patient otherwise meets criteria for inpatient level of care. To avoid paying any extra fees, please usenetwork locationsfor testing. How can I tell if the OTC at-home test is authorized by the Food and Drug Administration (FDA)? A diagnostic test is used to determine if a person has COVID-19. Members can register for Teladoc by visiting fepblue.org/coronavirus. You will have to pay for your tests up front and should save your receipts and test boxes for submission to your insurance company for reimbursement. Learn more about the different types of tests. I have BCBSIL insurance, but don't live in Illinois. Yes, CVS pharmacies. Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. For Federal Employee Program members, we've removed the member cost for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. 3. Who can order a test? Test kit cost $ Reimbursement Process Link or Description: We now give 180 days for services to be completed on new authorizations. Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. Symptoms consistent with COVID-19, such as fever, cough, shortness of breath, chills, muscle pain, sore throat, anosmia, and gastrointestinal distress, Asymptomatic patients with direct exposure and/or close contact to another individual with a confirmed case of COVID-19, Close contact is defined by the CDC as someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period* starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated, Asymptomatic patients who have been identified by contact tracing, Symptomatic or asymptomatic patients who require testing prior to a medical procedure or surgery, Admission to a facility including but not limited to a hospital operated or licensed by the Department of Public Health or Mental Health, a long-term acute care hospital, or a skilled nursing facility, The patients home (using a testing kita patient self-swab), For public health or surveillance purposes, For periodic or serial testing of asymptomatic high-risk individuals (examples include congregate housing and occupational safety), Tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, Member transportation to or from testing sites (unless the member meets requirements for ambulance services), for public health or surveillance purposes, for periodic or serial testing of asymptomatic individuals (examples include congregate housing such as dormitories and residential facilities, and occupational safety), For tests that have been denied FDA approval, an Emergency Use Authorization from the FDA, or laboratories that have not submitted an Emergency Use Authorization request within a reasonable timeframe, For member transportation to or from testing sites (unless the member meets requirements for ambulance services), To screen for eligibility to donate plasma, pre-surgical testing for elective and non-elective procedures, We extended existing authorizations issued for the first six months of 2020 to December 31, 2020. Your plan may require you to sign an attestation that the test was purchased: Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Please choosein-network locationsfor testing to avoid paying any extra fees. Members can register for Teladoc by visiting fepblue.org/coronavirus. This is in place for the duration of the Massachusetts state of emergency. What do I need to do? See our COVID-19 Temporary payment policy, Do not bill 87635 and U0002 on the same day for the same patient. Then, complete and submit the online form. Please remember that COVID-19 testing and vaccination requirements vary worldwide. Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. There is a limit of . Many Americans can now get home Covid-19 tests at no cost through their private insurance. What to do if you think you have COVID-19. You may also call the customer service phone number on your member ID card. Phone Number: *These modifiers do not apply to Federal Employee Program members. Bill for administration of first dose of CPT 91300 (Pfizer-BioNtech COVID-19 vaccine), Bill for administration of second dose of CPT 91300 (Pfizer-BioNTech COVID-19 vaccine), Bill for administration of first dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of second dose of CPT 91301 (Moderna-COVID-19 vaccine), Bill for administration of CPT 91303 (Janssen COVID-19 Vaccine). If you have a Medicare Advantage Plan, you must have a healthcare provider order for your OTC at-home test purchases to be reimbursed by Blue Shield. Please note that Blue Shield does not offer tax advice for HSAs. Access+ HMO is a registered trademark of Blue Shield of California. Your insurance company will reimburse you for the full purchase price of each covered test. You have a few options for where to get a test: Diagnostic testing performed by out-of-network health care providers is also covered at no cost to members during thepublic health emergency. As of January 1, 2022, most members can get reimbursed for up to eight OTC at-home tests per member per month without a provider order. Billing for partial hospitalization and intensive outpatient using telehealth. If you would like to find a new mental healthcare provider in your network, learn. Consumers who have questions or concerns that cannot be directly resolved with their insurer can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or file a complaint online at Michigan.gov/DIFScomplaints. UnitedHealthcare (UHC) Similarly, FEP will waive any copays or deductibles for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Blue Cross Blue Shield of Massachusetts covers the following drugs when usedoutside a clinical trialfor patients who are in aninpatienthospital setting and require treatment beyond respiratory support, at the discretion of their treating provider: Please note that standard inpatient payment policy rules apply. Member cost still applies for an in-person, outpatient visits and for inpatient and residential services. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form. Well allow the use of these modifiers for any service on your fee schedule. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: During the federal public health emergency, Blue Shield will continue to waive out-of-pocket costs for copays, coinsurance, and deductibles for: There are no prior approvals needed for COVID-19 screenings, evaluations, or testing. Please enter the NDC or UPC number from the cash register receipt. Network of Preferred Providers: California Physicians' Service DBA Blue Shield of California 1999-2023. Providers who are approved under this process will receive a Welcome Letter with their effective date. Standard out-of-pocket costs will apply for treatments received. 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. 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, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. . This information is provided for informational purposes only. https://www.molinamarketplace.com/Marketplace/MI/en-us/Coronavirus.aspx/, Network of Preferred Providers: COVID-19 Testing Coverage Website: Since the vaccine is supplied free, we will not reimburse separately for the vaccine, regardless of the modifier. This benefit is available to Blue Shield and Blue Shield Promise members in the following plans: You should bring your red, white, and blue Medicare card to get your free OTC COVID-19 tests. www.bcbsm.com/coronavirus. For more options to get free OTC tests. Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. There are no age limits for members who need care through telehealth or phone services. Learn More Coronavirus Resource Center CareFirst is working to ensure that our members, employees and community partners stay informed about COVID-19. CHICAGO -- Blue Cross Blue Shield Association (BCBSA) announced today that its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations and increase coverage for COVID-19 as described below. Reimbursement Process Link or Description: On the test kit package, look for a message that states the test has been authorized for emergency use by the FDA. Please note that if you have previously visited an out-of-network provider and received a check payment from Blue Shield, our process has changed. Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines. See the information below to determine if your insurer is reimbursing for these tests. https://www.hioscar.com/at-home-covid-test-reimbursement, COVID-19 Testing Coverage Website: 800-942-0954 (main). No. COVID-19 Information for our clinical partners We are here to support you as you care for your patientsour members. COVID-19 Vaccine Information | CareFirst BlueCross BlueShield At-Home Rapid Tests Are Now Covered Over-the-counter COVID-19 tests are now covered for qualifying members. Covered testing sites include (but are not limited to): Whats not covered Standard office visit copays may apply based on your plan benefits. Serologic testing for the presence of SARS-CoV-2 IgM/IgG antibodies is covered for FDA and Emergency Use Authorization tests (as described above) when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice, including the Centers for Disease Control (CDC) and Massachusetts Department of Public Health (DPH) guidelines. Medicare Prescription Drug Plan (PDP) if you also have Medicare Part B coverage. Neuropsychological testing services Talk to board-certified doctors24/7 by phone or video. The Biden administration has also set up a website where people can order four free COVID-19 rapid tests per household. For more details, please see fepblue.org. Please be aware that this statement isnota bill. How can I find pharmacies near me? The modifier should be 95 or GT. Effective for claims with discharge dates or dates of service on or after April 1, 2020, for all commercial products, we have updated our APR-DRG grouper with the ICD-10 diagnosis codes below. Some out-of-network providers may charge added fees. Plus learn how to safely resume healthcare visits. Additional doses are given to boost the immune response from the vaccine. COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. You do not need health insurance to receive your free tests. If you have any questions, call the number on the back of your Blue Cross ID . Note: Telephonic codes (98966-98968, 99441-99443) do not require the use of any telehealth modifier. If you plan to provide a previously approved service under an authorization that expired on December 31, 2020 to a patient in 2021, please call our Clinical Intake Department at the appropriate number and we will create a new authorization or update the existing one. Varies by plan. https://www.hioscar.com/at-home-covid-test-reimbursement, Network of Preferred Providers: Y0118_22_338A1_C 09272022 How you will bill for services by phone depends upon your specialty. Network of Preferred Providers: Starting Saturday, private insurers must cover the cost of up to eight at-home Covid-19 tests per month, the Biden administration announced on Tuesday. PCR or antigen testing to detect SARS-CoV-2 is not covered in the following scenarios: Antibody testing For Commercial/HMO inquiries, please call 517-364-8500 or (toll-free) 800-832-9186.