CurrentAnthemPolicy N/A

Anthem HealthKeepers Plus COVID-19 reimbursement and operational guidance

Guidance for Anthem HealthKeepers Plus (HealthKeepers, Inc.) providers on reimbursement, coding, telehealth, testing, vaccine administration, and member cost-sharing adjustments related to COVID-19; applies to HealthKeepers, Inc. Medicaid products (Virginia).

Policy Summary

PayerAnthem

PolicyAnthem HealthKeepers Plus COVID-19 reimbursement and operational guidance

Policy CodePolicy N/A

Change TypeAdministrative update (vaccine reimbursement added)

Effective DateJune 2021

Next Review DateN/A

Key ActionDo not require prior authorization for diagnostic COVID-19 testing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

no prior authPrior authorization

copays waivedMember cost share

U0001-U0005Lab test codes

POS 02Telehealth POS

reimbursedVaccine reimbursement

Coverage and Reimbursement Criteria

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COVID-19 coverage and reimbursement criteria

Key coverage positions and reimbursement practices:

Member cost sharing is waived for COVID-19 testing and visits; HealthKeepers, Inc. will process claims as if there is no member cost sharing.

The waiver of member copays applies to services provided by both participating and non-participating providers for COVID-19 laboratory tests.

Participating hospitals performing COVID-19 diagnostic testing in an emergency room or inpatient setting will be reimbursed based on existing contractual rates inclusive of the waived member copays.

Drive-through, urgent care, office, ER and other settings where test samples are obtained are recognized testing sites; testing performed by noncontracted labs for COVID-19 does not require prior authorization and noncontracted providers will be reimbursed 100% of DMAS rates.

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; balance‑billing of members is not permitted during the national public health emergency.

COVID-19 coverage statements

Coverage stance regarding epidemics and member cost-share waivers:

Standard HealthKeepers, Inc. health plan contracts do not contain exclusions or limitations for treatment of illnesses resulting from an epidemic.

Use CDC diagnosis coding guidance for known or suspected COVID-19 and CMS guidance for vaccine administration coding as referenced in this guidance.

For services where member cost shares are waived, follow the referenced CDC COVID‑19 diagnosis coding guidance; no slowdown in claim adjudication was observed at the time of this guidance.

Coding and Telehealth Reporting

Suggested COVID-19 lab test codesCPT | HCPCS | mixedCovered

U0001	CDC 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Panel (example)
U0002	2019-nCoV/2019 novel coronavirus detection
U0003	SARS-CoV-2 testing code (as referenced)
U0004	SARS-CoV-2 testing code (as referenced)
U0005	SARS-CoV-2 testing code (as referenced)
87635	Infectious agent detection by nucleic acid (e.g., SARS-CoV-2)
86328	Antibody test (serology) example
86769	Antibody test (serology) example

Telehealth reporting guidanceModifier

POS 02

Place of Service 02 for professional telehealth services

COVID-19 vaccine administration coding referencesmixed

CMS guidance for COVID-19 vaccine administration coding (link provided)

COVID-19 diagnosis coding referencesICD-10

CDC guidance for diagnosis coding for known or suspected COVID-19 (links provided)

Facility telehealth reporting — billing guidance

Facility telehealth reportingReport the CPT/HCPCS procedure code and include the applicable facility revenue code the same way you would for an in-person visit.

Professional vs. facilityUse POS 02 for professional telehealth services; facilities should continue to use facility CPT/HCPCS + revenue code for claims.

Billing consistencyFollow normal in-person billing conventions for revenue codes when submitting facility-based telehealth claims.

Provider Actions and Operational Guidance

Prior Authorization

Prior authorization not required for COVID-19 diagnostic testing

No prior authorization is required for diagnostic services related to COVID-19 testing.

Documentation Required

No notification required for temporary provider locations

Providers operating temporary locations during the COVID-19 emergency do not need to notify HealthKeepers, Inc.; continue to submit claims using the provider's primary service address and current tax ID number. For questions, contact Anthem HealthKeepers Plus Provider Services at 800-901-0020.

Do not change the service address on claims to the temporary location — continue using the primary service address.
Include your current tax ID number on claims.

Definitions and Billing Notes

Telehealth billing place-of-service and guidance

DMAS guidanceTelehealth (video + audio) and telephonic care follow Department of Medical Assistance Services (DMAS) guidance; refer to Anthem provider site for updates.

Place of Service for professional visitsProfessional telehealth visits should be billed with Place of Service 02.

Telephonic careTelephonic care is included within the telehealth guidance and follows DMAS direction.

COVID-19 laboratory test codes

Suggested lab test codesU0001, U0002, U0003, U0004, U0005, 87635, 86328, 86769 are appropriate to bill based on the test performed.

Drive-through testing recognitionParticipating hospitals with a lab fee schedule: codes including U0001–U0005 and 87635, 87798, 87631 will be recognized and reimbursed per lab fee schedule.

Non-standard lab codesUse the specific code that matches the laboratory method performed; Anthem encourages billing the code that corresponds to the test used.

Telehealth coding — professional and facility reporting

Professional telehealth codingReport telehealth services rendered by a professional provider with the CPT/HCPCS code and Place of Service 02.

Facility telehealth codingReport telehealth services rendered by a facility with the CPT/HCPCS code plus the applicable facility revenue code as for an in-person visit.

Follow standard coding rulesApply standard CPT/HCPCS coding practices when reporting telehealth services; differentiate professional vs facility reporting.

Temporary provider location notification (COVID-19 emergency)

Temporary locations permittedDuring the COVID-19 emergency, providers may operate temporary locations to provide healthcare services without notifying HealthKeepers, Inc., provided claims use the provider's primary service address and current tax ID number.

Claims submissionContinue to submit claims specifying the services provided using the provider's primary service address and current tax ID.

Questions and contactFor questions, providers may call Anthem HealthKeepers Plus Provider Services at 800-901-0020.