CurrentAnthemPolicy N/A

Anthem HealthKeepers Plus Medicaid COVID-19 reimbursement and operational guidance

Guidance for Anthem HealthKeepers Plus (HealthKeepers, Inc.) providers about COVID-19 testing, telehealth, vaccine administration reimbursement, waivers of member cost sharing, and operational practices during the pandemic; applies to HealthKeepers, Inc. Medicaid products.

Policy Summary

PayerAnthem

PolicyAnthem HealthKeepers Plus Medicaid COVID-19 reimbursement and operational guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDo not require prior authorization for diagnostic COVID-19 testing; noncontracted providers may perform testing and be reimbursed per policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

not requiredPrior authorization

waivedMember copays

allowedNon-contracted labs

coveredVaccine admin

POS 02Telehealth POS

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Coverage Criteria and Operational Rules

COVID-19 coverage criteria and billing rules

Covered when ALL of the following apply:

Member cost-share waiver

All normally required member copays are waived for members (applies to COVID-19 care and non-COVID-19 care)
Waiver applies to testing and visits associated with testing

Claims processing

Claims will be processed as if there is no member cost sharing (similar to preventive services)
Reimbursement follows standard claim processing with waived member copays

Hospital settings reimbursement

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of waived copays
Applies to participating hospitals

Drive-through testing

Drive-through COVID-19 tests are recognized and reimbursed according to lab fee schedule (specific codes recognized)
Reimbursed per lab fee schedule; inclusive of waived member cost-share

Nonparticipating provider coverage

Waiver of member copays applies to COVID-19 lab tests performed by participating and non-participating providers
Noncontracted providers may perform COVID-19 tests and will be reimbursed at 100% of DMAS rates; prior authorization is not required for these tests

Vaccine administration

Administration of FDA-approved COVID-19 vaccines will be reimbursed in accordance with Federal and State mandates with no cost share for in- and out-of-network providers during the national public health emergency
Providers are not permitted under the federal mandate to balance-bill members

Telehealth billing

Professional telehealth visits: report CPT/HCPCS code with Place of Service 02
Facility telehealth visits: report CPT/HCPCS with the applicable revenue code as would normally be done for an in-person visit

Diagnosis coding

Follow CDC ICD-10-CM interim coding guidance for known or suspected COVID-19

Coverage and provider location guidance

Policy statements regarding coverage and provider operations during the COVID-19 emergency:

Contract coverage stance

Standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from an epidemic

Temporary location guidance

Providers establishing temporary locations during the COVID-19 emergency do not need to notify HealthKeepers, Inc. of the temporary address
Providers should continue to submit claims specifying the services provided using the provider's primary service address and current tax ID number

Provider contact

For questions, providers may call Anthem HealthKeepers Plus Provider Services at 800-901-0020

Coding and Testing Guidance

Suggested COVID-19 lab test codesmixedCovered

U0001	CDC 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Panel
U0002	Non-CDC lab real-time RT-PCR for SARS-CoV-2
U0003	SARS-CoV-2 sequencing CDC use (example)
U0004	CDC 2019 Novel Coronavirus molecular test
U0005	Non-CDC molecular test for SARS-CoV-2
86328	Sharply elevated antibody (example serology) — COVID-19 related
86769	Antibody; SARS-CoV-2
87635	Infectious agent detection by nucleic acid (e.g., SARS-CoV-2)

Telehealth reporting guidancemixed

Place of Service 02

Telehealth - used with CPT/HCPCS codes for professional telehealth services

COVID-19 telehealth, diagnosis, and vaccine administration codingmixed

	Use CPT/HCPCS procedure codes for services and report Place of Service 02 for professional telehealth visits; facility telehealth visits billed with usual revenue codes.
	Use CDC ICD-10-CM guidance for COVID-19 diagnosis coding (links provided).
	Use CMS guidance for COVID-19 vaccine administration coding (links provided).

Drive-through test recognition — invoicing and reimbursement

Recognized drive-through test codes87635, 87798, 87631, U0001, U0002, U0003, U0004, U0005

Reimbursement basisReimbursed according to the hospital lab fee schedule (or facility agreement for hospitals without a lab fee schedule)

Member cost-share treatmentReimbursement inclusive of waived member cost-share amounts per HealthKeepers, Inc. policy

Claims processing impact

Claims adjudication impactNo impacts to claims payment processing observed at this time

Monitoring status

Provider Actions and Requirements

Prior Authorization

Prior Authorization for COVID-19 Testing

No prior authorization is required for diagnostic services related to COVID-19 testing. Providers may use noncontracted labs for COVID-19 testing; noncontracted providers will be reimbursed 100% of DMAS rates. All other lab tests must follow existing contract requirements (for example, use of Labcorp) and applicable prior authorization rules.

Diagnostic COVID-19 testing: no prior authorization required
Noncontracted providers may perform COVID-19 tests and will be reimbursed at 100% of DMAS rates
Other lab tests: follow contracted-provider requirements and existing prior authorization rules

Billing Rule

Telehealth Billing Place of Service Guidance

For telehealth services, billing depends on the rendering provider type: professional providers should report the CPT/HCPCS procedure code and use Place of Service (POS) 02. Facility providers should report the CPT/HCPCS procedure code with the applicable facility revenue code as would be reported for an in-person visit.

Definitions and Operational Notes

Testing settings and telehealth limitations

Permitted specimen collection settingsDoctor's office, urgent care, emergency department, drive-through testing sites

Telehealth limitationA test sample cannot be obtained through a telehealth visit; telehealth providers can facilitate connection to testing

Guidance source for telehealthHealthKeepers, Inc. follows DMAS guidance for telehealth (see provider site for updates)

Place of Service 02 guidance for professional telehealth

Place of Service for professional telehealthReport CPT/HCPCS code with Place of Service 02 for professional telehealth visits

Facility telehealth billingFacility providers should report CPT/HCPCS with the applicable revenue code as for an in-person visit