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    v1.0.31
    OpenPayerPolicy UpdatesInfectious DiseaseNew Hampshire Medicaid COVID-19 Coverage | OpenPay…
    Ask Trek AI about this page
    ModifiedNew Hampshire Department of Health and Human ServicesPolicy N/A

    Guidance for Providers on the Medicaid COVID-19 Group

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    This guidance explains eligibility, covered COVID-19 testing, vaccine administration, and treatment services under New Hampshire Medicaid's COVID-19 Group for eligible uninsured or limited-benefit individuals served through Medicaid Fee-for-Service.

    Policy Summary
    PayerNew Hampshire Department of Health and Human Services
    PolicyGuidance for Providers on the Medicaid COVID-19 Group
    Policy CodePolicy N/A
    Change TypeModified
    Effective DateFebruary 2, 2022
    Next Review DateN/A
    Key ActionSubmit a clinical provider order to the testing laboratory for every COVID-19 specimen tested.
    SourceLink
    POLICY UPDATE CHANGES

    The Medicaid COVID-19 Testing Group was renamed the Medicaid COVID-19 Group.

    Coverage was expanded to include COVID-19 vaccine administration and specified COVID-19 treatment services.

    Over-the-counter at-home antigen COVID-19 tests became covered through Medicaid-enrolled pharmacies.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    8/monthMaximum covered at-home antigen tests per beneficiary
    3/18/2020Testing coverage start date
    3/11/2021Vaccine and treatment coverage start date
    No limitMedically necessary COVID-19 tests
    Fee-for-ServiceDelivery system

    Eligibility and Covered Services

    Eligibility for the Medicaid COVID-19 Group

    An individual may qualify when ALL of the following are met:

    Medicaid COVID-19 Group eligibility

    • Coverage status: The individual is uninsured, enrolled in a limited-benefit Medicaid eligibility group, enrolled in a short-term limited-duration health insurance plan that does not cover COVID-19 testing, vaccine administration, and/or treatment, or participates in a Healthcare Sharing Plan.
    • Residency and identity requirements: The individual is a New Hampshire resident, is a U.S. citizen or has qualifying immigration status, and provides a Social Security number.

    Medical Necessity for COVID-19 Testing

    Testing is covered when medically necessary as determined by an appropriate clinical provider.

    Medically necessary COVID-19 testing

    • Clinical presentation or exposure: The patient has COVID-19 symptoms, is presymptomatic or asymptomatic with potential exposure, or has another clinical circumstance supporting testing under current public-health recommendations.
    • Ordering diagnosis: The provider uses applicable symptom ICD-10 coding for symptomatic testing or Z20.828 for asymptomatic testing.

    Covered Service Categories

    Covered services include the following service categories:

    Covered COVID-19 services

    • Testing and diagnostic services: The service is a telehealth or in-person diagnostic evaluation, chest X-ray for COVID-19 diagnosis, specimen collection, PCR or antigen test, antibody test, FDA-approved saliva test, BinaxNOW Rapid Antigen Test Card, other point-of-care test, or covered at-home antigen test obtained through a Medicaid-enrolled pharmacy.
    • Vaccine administration: The service administers an FDA-approved COVID-19 vaccine, including Pfizer-BioNTech, Moderna, or Janssen vaccine doses, including first, second, third, or booster doses.
    • Treatment services: The service is a hospitalization, emergency room visit, urgent care visit, telemedicine visit, office visit, monoclonal antibody treatment or administration, FDA-approved COVID-19 treatment, or specialized equipment or therapy, including preventive therapies, for COVID-19 or its clinical manifestations.

      Specific treatment codes are maintained in MMIS.

    COVID-19 tests are excluded when they are not medically necessary or are not provided for the direct benefit of the patient.

    Providers may not bill for the actual BinaxNOW antigen test when the test cards were provided at no cost. Appropriate evaluation and management and specimen collection services may still be billed when applicable.

    Testing that lacks medical necessity as determined by an appropriate clinical provider is not covered. There is no stated limit on medically necessary testing when the testing is for the direct benefit of the patient.

    Covered Codes and Limits

    Asymptomatic COVID-19 testing ordering diagnosisICD-10Covered
    Z20.828Contact with and (suspected) exposure to other viral communicable diseases
    Specimen collectionHCPCSCovered
    G2023Typical specimen collection code for outpatient BinaxNOW Rapid Antigen testing
    At-home antigen tests
    Coverage limitMaximum of eight at-home antigen tests per beneficiary per month
    Distribution channelMedicaid-enrolled pharmacies
    Member costNo out-of-pocket costs

    Ordering, Reporting, and Billing Requirements

    Note

    Written Referral Not Required

    A written provider referral is not required for an individual to receive a COVID-19 test under the Medicaid COVID-19 Group.

    Documentation Required

    Submit Medical-Necessity Diagnosis Coding

    Submit the applicable ordering diagnosis code to establish medical necessity for COVID-19 testing. Use an ICD-10 code for the patient’s COVID-19 symptoms when symptomatic; for asymptomatic testing, use Z20.828 (contact with and suspected exposure to other viral communicable diseases).

    • These coding requirements apply to Medicaid generally and to the Medicaid COVID-19 Group.
    • Follow current CDC ICD-10-CM coding guidance.
    Documentation Required

    Policy Background

    The Medicaid COVID-19 Group was established to provide COVID-19 testing and diagnostic services for eligible uninsured or limited-benefit individuals. Coverage was expanded to include COVID-19 vaccine administration and certain COVID-19 treatment services.

    Key Terms

    Medicaid COVID-19 Group
    Current nameMedicaid COVID-19 Group
    Former nameMedicaid COVID-19 Testing Group
    Expanded coverageCOVID-19 vaccine administration and certain COVID-19 treatment services, in addition to testing and diagnostic services
    Short-term, limited-duration insurance
    PurposeHealth insurance coverage primarily designed to fill temporary gaps between other coverage
    Example gapThe period between jobs or between one health plan or coverage and another
    Eligibility consideration
    Policy Summary
    PayerNew Hampshire Department of Health and Human Services
    PolicyGuidance for Providers on the Medicaid COVID-19 Group
    Policy CodePolicy N/A
    Change TypeModified
    Effective DateFebruary 2, 2022
    Next Review DateN/A
    Key ActionSubmit a clinical provider order to the testing laboratory for every COVID-19 specimen tested.
    SourceLink
    On This Page
    Eligibility and Covered ServicesCovered Codes and LimitsOrdering, Reporting, and Billing RequirementsPolicy BackgroundKey Terms

    Submit a Laboratory Order

    A clinical provider order must be submitted to the testing laboratory before the laboratory tests the COVID-19 specimen.

    Documentation Required

    Report Point-of-Care Results

    Report results from BinaxNOW Rapid tests and all other point-of-care COVID-19 testing to the New Hampshire Division of Public Health. Follow applicable New Hampshire Health Alert Network testing and reporting guidance.

    • Reporting requirements apply to point-of-care testing, including BinaxNOW Rapid antigen testing.
    • See HAN #23 and HAN #22 for testing and reporting guidance.
    Denial Risk

    Testing Without Medical Necessity Is Not Covered

    Testing that is not medically necessary or is not for the direct benefit of the patient is not covered under the Medicaid COVID-19 Group or Medicaid generally. Medically necessary tests may be provided without a stated limit when medical necessity is determined by an appropriate clinical provider.

    Billing Rule

    Do Not Bill for Free BinaxNOW Test Cards

    Providers cannot bill for the actual COVID-19 test when BinaxNOW antigen test cards were supplied at no cost. Providers may bill the appropriate evaluation and management code and specimen-collection code when applicable.

    • The typical outpatient specimen-collection code is G2023.
    • Do not bill for the free test card itself.
    Denial Risk

    Do Not Bill the HRSA Uninsured Program Incorrectly

    Individuals enrolled in the Medicaid COVID-19 Group are considered insured for COVID-19 testing, diagnostic services, vaccine administration, and treatment. Do not submit these services to the HRSA COVID-19 Claims Reimbursement Program as uninsured claims.

    • HRSA payments for an individual with Medicaid COVID-19 Group coverage may be recouped from the provider.
    • Bill the appropriate Medicaid coverage instead; provider liability may apply if an incorrect HRSA payment is made.
    Individuals with plans that do not cover COVID-19 testing, vaccine administration, and/or treatment may qualify for the Medicaid COVID-19 Group