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EHP Coronavirus (COVID-19)

COVID-19 Testing

The following additional testing codes have been added:

Effective April 10, 2020, during the Public Health Emergency:

Antibody Testing

  • 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). Reimbursement rate $45.23.
  • 86769: Antibody testing using multiple-step method; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). Reimbursement rate $42.13.

Effective April 14, 2020, during the Public Health Emergency:

  • 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 high throughput technologies as described by CMS-2020-01-R. Reimbursement rate $100.
  • 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 high throughput technologies as described by CMS-2020-01-R. Reimbursement rate $100.

Effective March 1, 2020, during the Public Health Emergency:

  • G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. Reimbursement rate $23.46.
  • G2024: Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source. These codes are billable by clinical diagnostic laboratories. Reimbursement rate $25.46.
  • EHP cost shares waived for all claim lines when U0001, U0002, U0003, U0004, 87635, G2023 or G2024 is present on claim, for visits with an in-network or out-of-network provider.
  • EHP cost shares waived for all visits that lead to COVID-19 testing.

Effective Feb. 4, 2020:

  • Testing for COVID-19 is covered with an in-network or out-of-network provider.
  • Members will have no cost-sharing (copayments, coinsurance and deductibles) for COVID-19 testing or visits that result in COVID-19 testing, items and services provided during an office visit (including in office or telehealth provider office visits, urgent care and emergency department visits) that results in the administration of a COVID-19 test or an order for such test, but only to the extent that the items and services relate to the COVID-19 test.
  • Prior authorizations waived for COVID-19 testing and the associated visit.
  • Reimbursement for CMS codes: U0001 ($35.92) or U0002 ($51.33) and AMA code 87635 ($51.33).

Prescriptions

  • To increase access to prescription medications, EHP is waiving the early medication refill limits for supplies of at least 30 days (for EHP members with pharmacy benefits through CVS/caremark).

Telemedicine

  • Telemedicine is covered; originating site can be patient’s home. Services for diagnosis, consultation and treatment provided through telemedicine must meet all requirements of face-to-face visits between a licensed health care provider and patient consistent with the provider’s scope of practice.
  • Please reference the Johns Hopkins HealthCare Medical Policy CMS00.27 Telemedicine/Telehealth Medical Policy for guidance on covered codes.
  • Additional covered telemedicine services include preventative visits, additional behavioral health, PT/OT/Speech Therapy codes, home health, otolaryngology, and inpatient consultation services. A list of additional covered codes can be found here
  • The following telemedicine code has also been added:
    • G2025 - For telehealth distant site services furnished between July 1, 2020, and the end of the COVID-19 PHE, RHCs and FQHCs will use an RHC/FQHC specific G code, G2025, to identify services that were furnished via telehealth. Reimbursement $92.00.
  • Claims must be submitted with proper modifier (GT, GQ or 95 in accordance with how administered and in accordance with NCCI edits).
  • There is no restriction on place of service (POS) of rendered services.
  • Same authorization requirements apply for telemedicine as for face-to-face visits.
  • Same copayments/co-insurance apply for telemedicine as for face-to-face visits.
    • JHU members-all telemedicine visits covered with no cost share
  • Telemedicine provided by out-of-network providers is covered and payable under member’s out-of-network benefits, if applicable.
  • Telephonic consultation is covered. See list of covered codes in link above.