CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

Medicaid COVID-19 Group Covered Services

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This notice governs COVID-19-related diagnostic evaluation, treatment, and vaccine administration covered for individuals enrolled in the New Hampshire Medicaid COVID-19 group. It applies to all New Hampshire Medicaid providers.

Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyMedicaid COVID-19 Group Covered Services

Policy CodePolicy N/A

Change TypeClarification

Effective DateApril 14, 2022

Next Review DateN/A

Key ActionDocument and submit an appropriate COVID-19-related ICD-10 diagnosis code for diagnosis and treatment services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Covered service categories

3COVID-19 vaccine manufacturers listed

All NH Medicaid providersNotice audience

COVID-19-related onlyCoverage limitation

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CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

Medicaid COVID-19 Group Covered Services

Customize your policy alerts

Sign up for all New Hampshire Department of Health and Human Services policy alerts

Know when New Hampshire Department of Health and Human Services releases new policies or updates existing guidance.

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Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyMedicaid COVID-19 Group Covered Services

Policy CodePolicy N/A

Change TypeClarification

Effective DateApril 14, 2022

Next Review DateN/A

Key ActionDocument and submit an appropriate COVID-19-related ICD-10 diagnosis code for diagnosis and treatment services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Covered service categories

3COVID-19 vaccine manufacturers listed

All NH Medicaid providersNotice audience

COVID-19-related onlyCoverage limitation

Covered COVID-19 Services

Covered COVID-19 services

Covered when the service is COVID-19-related and falls within one of the following covered categories:

Covered COVID-19 service category

Diagnostic evaluation: The service evaluates COVID-19 and may include telehealth or in-person office visits, chest x-rays for diagnosing COVID-19, specimen collection and PCR or antigen testing, antibody testing, FDA-approved saliva or nasal swab testing, BinaxNOW Rapid Antigen Test Cards, or other point-of-care testing.
COVID-19 treatment: The service treats COVID-19 and may include inpatient stays, emergency room or urgent care visits, telemedicine or office visits, monoclonal antibody treatment and administration, FDA-approved treatments for COVID-19-specific diagnoses or other clinical manifestations, and specialized equipment or therapies, including preventive therapies, related to COVID-19.
Vaccine administration: The service administers an FDA-approved vaccine or a vaccine granted emergency use authorization, including Pfizer, Moderna, or Johnson & Johnson (Janssen) vaccines.FDA approval or EUA
Coverage is for vaccine administration under this group.

COVID-19 diagnosis and medical necessity coding

COVID-19-related diagnosis and treatment services must be supported by appropriate diagnosis coding.

Diagnosis coding support: Associate the COVID-19-related diagnosis or treatment service with an appropriate COVID-19 ICD-10 diagnosis code, including a code indicating medical necessity for symptomatic or asymptomatic testing.

Use confirmed COVID-19 coding when infection is confirmed; otherwise code the applicable symptom, exposure, or observation circumstance.

Services unrelated to a COVID-19-related diagnosis are excluded from coverage under the Medicaid COVID-19 group, even when they are rendered concurrently with covered COVID-19-related services. These unrelated services should not be billed under the group.

Documentation and Billing Requirements

Documentation Required

Support COVID-19 services with diagnosis coding

Document and submit an appropriate COVID-19-related ICD-10 diagnosis code for diagnosis and treatment services. For testing, the diagnosis code should indicate the medical necessity for symptomatic or asymptomatic testing and reflect the reason for the encounter, exposure, observation, or confirmed COVID-19 diagnosis, as applicable.

Denial Risk

Do not bill unrelated services

Services unrelated to a COVID-19-related diagnosis are not covered, even when rendered concurrently with COVID-19-related services. Do not bill unrelated services under the Medicaid COVID-19 group.

Denial Risk

Use appropriate COVID-19 diagnosis codes

COVID-19-related diagnosis and treatment services should be associated with an appropriate COVID-19 ICD-10 diagnosis code, including codes that indicate medical necessity for symptomatic and asymptomatic testing. Missing or inappropriate coding can result in the service not meeting the coverage requirements and should not be billed under the Medicaid COVID-19 group.

Program Background

The Medicaid COVID-19 group provides limited coverage for individuals without insurance or with limited insurance that does not cover COVID-19-related services. Covered services are limited to COVID-19-related diagnostic evaluation, treatment, and vaccine administration; diagnostic and treatment encounters should be supported by the applicable clinical circumstances and diagnosis coding.

Coverage Group and Testing Terms

Medicaid COVID-19 group

EligibilityIndividuals with no health insurance or limited health insurance that does not cover COVID-19-related services.

Coverage scopeThe group covers COVID-19-related services as outlined in the policy.

Covered service categoriesDiagnostic evaluation, COVID-19 treatment, and vaccine administration.

COVID-19 testing

PCR and antigen-based testingSpecimen collection and testing for COVID-19 using PCR or antigen-based testing.

Antibody testingAntibody testing for COVID-19.

FDA-approved testingFDA-approved saliva and nasal swab tests.

BinaxNOW testingBinaxNOW Rapid Antigen Test Cards.

Other point-of-care testingOther point-of-care testing identified as covered in the policy.

Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyMedicaid COVID-19 Group Covered Services

Policy CodePolicy N/A

Change TypeClarification

Effective DateApril 14, 2022

Next Review DateN/A

Key ActionDocument and submit an appropriate COVID-19-related ICD-10 diagnosis code for diagnosis and treatment services.

SourceLink

On This Page

Medicaid COVID-19 Group Covered Services

Sign up for all New Hampshire Department of Health and Human Services policy alerts

Medicaid COVID-19 Group Covered Services

Sign up for all New Hampshire Department of Health and Human Services policy alerts

Covered COVID-19 Services

COVID-19 Diagnosis Coding

Documentation and Billing Requirements

Program Background

Coverage Group and Testing Terms