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Provider COVID-19 Information

The Coronavirus disease 2019 (COVID-19) is a new sickness that the world is facing. Many details about this disease are still unknown, such as what treatment options we have, how the virus works, and what the total impact of the sickness will be. New information daily helps us determine what risks our patients are facing, their treatment options, and the next steps. We count on our providers to take care of our members, and we want you to know about the tools that can help you identify the virus and care for your patients during this time.

Guidance

Symptoms can include:

Respiratory symptoms
Fever
Cough
Shortness of breath
Fatigue
Excess mucus
Muscle aches

Note: Some patients have also had stomach problems, such as diarrhea and nausea, prior to noticing respiratory symptoms.

Infected people can be contagious before symptoms start. Symptoms may start 2-14 days after the patient has been exposed

Tell patients with symptoms to wear a face mask in your office. Be sure to put the patient in a private room with the door closed as soon as they arrive.

Healthcare workers who see patients with symptoms should wear eye protection, N95 masks, and other Personal Protective Equipment.

Refer to the Center for Disease Control’s (CDC) guidance for a patient who is being tested for COVID-19. Alert local and/or state health departments if one of your patients might have COVID-19. Keep a log of all healthcare workers who care for a patient who might have COVID-19.

Watch and manage exposed personnel.

Safely triage patients with respiratory symptoms, including COVID-19. Explore alternatives to face-to-face visits when possible. Treat mild COVID-19 cases at home where able. 

Take Action

Watch for patients who meet the criteria for someone who should be tested for COVID-19. Plan lab testing as needed.

Review your disease prevention and control policies. Follow the CDC's guidance for healthcare facilities when dealing with COVID-19.

Know how to report a potential COVID-19 case or exposure to disease control leads and public health officials. Reach out to your local and/or state health department to let health officials know that you have a patient being tested for COVID-19.

Refer to the CDC and the World Health Organization (WHO) for current guidance about C19, including signs and symptoms, testing, and treatment options.

Know the scope of available testing and recommendations from the FDA.

This guidance is in response to the current COVID-19 pandemic and may be changed in the future.

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

PROVIDER BILLING GUIDANCE FOR COVID-19 TESTING, SCREENING, & TREATMENT SERVICES

We are watching and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released. This is to make sure we can address and support the prevention, screening, and treatment of COVID-19. The below guide can be used to bill for services related to COVID-19 testing, screening, and treatment. This guide is in response to the current COVID-19 pandemic and may be changed or retired in the future. For more guidance on COVID-19 billing and coding, please visit the resource Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).

COVID-19 Testing Services

Providers performing using the COVID-19 test can bill us for tests that occurred after February 4, 2020. Use the newly created HCPCS codes below:

  • HCPCS U0001 — 2019-nCoV Real-Time RT-PCR Diagnostic Panel. This code is for CDC-developed tests only.
  • HCPCS U0002 — 2019-nCoV Real-Time RT-PCR Diagnostic Panel. This code is for all other commercially available tests.

It is not clear if CMS will change the more general HCPCS Code U0002 for non-CDC lab tests that the Medicare claims processing system began accepting on April 1, 2020.

  • These codes should not be used for serologic tests that detect COVID-19 antibodies.
  • All member cost share (copayment, coinsurance, and/or deductible) will be waived across all products for any claim billed with the new COVID-19 codes.
  • We will apply $0 member Cost Share Liability for claims submitted with these new COVID-19 codes.
  • Prior authorization requirements will be waived for any claim that is received with the specified codes.
  • Providers billing with these codes will not be limited by provider type.
  • For the time being, we will waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they provide services when they are licensed in another state.

High-Throughput Technology Testing Services

  • Providers using high-production COVID-19 testing via High-Throughput Technology (HTT) can bill us for services that happened after February 4, 2020, using the below HCPCS codes:
    • HCPCS U0003 — 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, making use of HTT as described by CMS-2020-01-R.
    • HCPCS U0004 — 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of HTT as described by CMS-2020-01-R.
    • U0004 should identify tests that would normally be identified by U0002 but are being used with these HTT.
  • Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
  • We will apply $0 member cost share liability for claims submitted using these codes for HTT.
  • Providers billing with these codes will not be limited by provider type.

COVID-19 Screening Services

  • All member cost share (copayment, coinsurance and/or deductible) will be waived for COVID-19 screening visits billed with a COVID-19 testing code.
  • If no testing occurs, providers may still bill for COVID-19 screening visits for possible contact with the virus using the below Z codes:
    • Z20.828 — Contact with a possible exposure to other viral diseases.
    • Z03.818 — Exposure to COVID-19 and the virus is ruled out after evaluation.
  • This applies to services rendered on or after February 4, 2020.
  • Providers billing with these codes will not be limited by provider type.

COVID-19 Treatment Services

  • We will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.
  • For dates of service from February 4, 2020, through March 31, 2020, providers should use the ICD-10 diagnosis code below.
  • B97.29 — Confirmed Cases — other coronavirus as the cause of diseases classified elsewhere.
  • For dates of service on or after April 1, 2020, providers should use the ICD-10 code below.
  • U07.1 – 2019-nCov Confirmed by Lab Testing.
  • Only services that involve screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers. For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply.

Reimbursement Rates for COVID-19 Services for All Provider Types

  • We are complying with the CMS rates for the below codes:
    • U0001 = $35.91
    • U0002 = $51.31
    • U0003 = $100.00
    • U0004 = $100.00
  • Commercial products will reimburse COVID-19 services in accordance with our commercial contract rates.
  • We will follow these CMS rates except where state-specific Medicaid rate guidance should replace them.
  • Any other rates will be determined by CMS and/or state-specific rules and communicated when available.

Supplemental Support Services are being discontinued

Throughout the COVID-19 pandemic, DHS has allowed the use of supplemental supports by OBH and CES waiver providers. These Supplemental Support Services have helped to improve community living during a difficult time.

Arkansas Total Care has used these services since March 23, 2020. However, the following supplemental services will no longer be available for our members beginning March 2, 2023:

  • T2020 Modifier U1  — Telephonic service. This service should be used to check on members to make sure that their health, safety, medical, and BH needs are being met. This can be billed in 15-minute units and is limited to six units of service per week (1.5 hours). The rate for this service is $7.55. No PA requirement when billed with the below modifier and locations.
    • T2020 U1 GT — Location 02
  • T2020 Modifier UB — Face-to-Face Service. This service should be used when the member needs to have a face-to-face interaction to check on health and safety or to deliver supplies (food, medicine, groceries, etc.). This can be billed in 15-minute units and is limited to 12 units of service per week (three hours). The rate for this service is $15.10. No PA requirement when billed with the following modifier and locations.
    • T2020 UB — Location 12, 14 or 99. 

If you have any questions or concerns regarding this change, please contact Provider Services at 1-866-282-6280 (TTY: 711).