Provider Information on COVID-19 Coverage

May. 18, 2020
Updated July 27, 2020
Updated Aug. 10, 2020

Blue Cross and Blue Shield of MT (BCBSMT) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We’ve taken steps to lower costs and provide our members easier access to care related to COVID-19.

Testing and Treatment Coverage

We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For treatment of COVID-19, we are temporarily waiving member copays, deductibles and coinsurance. The waiver applies to cost-share associated with COVID-19 treatment with providers, including facilities, from April 1 to Oct. 23, 2020, so long as the treatment is provided and consistent with the terms of the member’s benefit plan. We will reassess this waiver as events warrant. This includes these BCBSMT members: fully insured employer-based, individual and family, Medicare (excluding Part D) and Medicare Supplement.

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles, based on their employer’s election to participate in this benefit.

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through Oct. 23, 2020

Blue Cross Medicare SupplementSM members do not have network restrictions unless otherwise noted on their plans. See our FAQs for Medicare Providers PDF Document for more details.

Check Members Eligibility and Benefits

Use the Availity® Provider Portal  or your preferred vendor for eligibility and benefit verifications.

Claims for COVID-19 Testing

If you are collecting a COVID sample from a member, have a lab capable of testing, or are a lab testing a member, submit the claim using the appropriate collection or lab code. Member cost-share for the test will be waived during the public health emergency, regardless of the diagnosis. Testing must be:

  • For individualized diagnosis or treatment of COVID-19
  • Medically appropriate
  • In accordance with generally accepted standards of care, including the Centers for Disease Control (CDC) guidance

For more detail on COVID-19 coding and guidance, refer to the American Medical Association  website or the Centers for Disease Control and Prevention .

COVID-19 Collection Codes

Codes

Description

C9803

Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source


COVID-19 Lab Codes

Codes

Description

0202U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR

0223U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

87426

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

87635

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

U0001

CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

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

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


COVID-19 Testing Before Non-COVID-19 Treatment or Procedures

When screening for COVID-19 before elective procedures or treatment not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will ensure our members receive the cost-share waiver for COVID testing and the claim will be processed promptly. The appropriate benefits will apply to the remainder of each member’s non-COVID related care. The diagnosis code Z11.59 may be used on these claims but is not required.

Claims for COVID-19 Antibody Testing

Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with Emergency Use Authorized (EUA), regardless of the diagnosis. This waiver will last through the end of the public health emergency. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

Antibody Testing Requirements

Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care provider. We encourage members to consult with their health care provider to determine the best medically appropriate test for their condition. Refer to the current FDA position on antibody testing . Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

At-Home Antibody Tests

We cover at-home collection methods for antibody testing if the tests are FDA-authorized and are clinically indicated for the member as determined by the member’s health care provider. We encourage members to consult with their healthcare provider to determine whether the test is medically appropriate for their condition. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

COVID-19 Antibody Testing Codes

Codes

Description

0224U

Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed

86318

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method

86328

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method, severe acute respiratory syndrome coronavirus (SARS-CoV-2) (Coronavirus disease COVID-19)

86769

Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] testing via multiple-step method


Out-of-Network Providers

If you are not in our networks, we will reimburse the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website.

Claims for COVID-19 Testing- and Antibody-Related Services

Use the following coding process for services that are related to COVID-19 testing or antibody testing.

COVID-19 Diagnosis Codes

To indicate services performed in conjunction with the testing for COVID-19 or COVID-19 antibodies, include one of the following diagnosis codes:

Codes

Description

U07.1

COVID-19

B97.29

Other coronavirus as the cause of diseases classified elsewhere

B34.2

Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

Z20.818

Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

Z20.828

Contact with and suspected exposure to other viral communicable diseases (actual exposure to COVID-19)


Modifier CS

For services furnished on March 18, 2020, through the end of the Public Health Emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19. This is for testing-related services when COVID-19 testing or antibody testing must be performed at an alternate location and is not part of the evaluation and management claim.

Telemedicine

Many members have telemedicine benefits. For those members, telemedicine visits will be covered as a regular office visit for providers who offer the service through 2-way, live interactive telephone or digital video consultations. Some plans also provide access to MDLive, a vendor with a network of physicians who provide telehealth services.

(Note: MDLive is not available for Medicare.) Learn more on the Montana COVID-19 Telemedicine provider Q &A page, updated as needed.

Pharmacy

For members who have BCBSMT pharmacy benefits administered through Prime Therapeutics, BCBSMT will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Note on Medicare members: Members of these plans can get 90-day fills through mail order:

  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Medicare Advantage (PPO)SM

What is the risk of COVID-19?

According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19.

We’ve developed a member-facing flier about COVID-19 PDF Document that you may share with your patients.

More Information

Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSMT News and Updates.

If you have any questions or if you need additional information, please contact BCBSMT Network Management PDF Document.

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