We’re actively working to monitor the new Coronavirus disease—COVID-19—and its impacts to make sure we provide our members the care they need when they need it while supporting our providers.
Coverage for members
THC will cover the cost of medically necessary COVID-19 tests, waiving copays and deductibles. Other services related to diagnostic testing and the administration of the test, such as office visits, blood draws or specimen handling are also covered at 100%, with no member cost share. The effective date of coverage will be retroactive to 2/4/2020.
Prior Authorization Updates
THC is not waiving any authorization requirements at this time. THC will work with our physicians and hospitals to provide required authorizations in a timely manner.
Use CR modifier for claims related to diagnosing COVID-19; facilities add condition code DR
Provider offices, urgent care and emergency rooms should bill us using a CR modifier anytime the visit resulted in a COVID-19 test being ordered. Facilities should also use condition code DR to identify when the services provided resulted in a COVID-19 test being administered.
If you have claims that resulted in the ordering of a COVID-19 test, you should rebill claims using a CR modifier dating back to February 4, 2020. Using this modifier will ensure your patients have a $0 cost share for any visit and services related to the diagnostic testing and administration of the test.
This modifier should not be added to services billed for treatment of COVID-19.
Virtual visits billing and coverage
We’re temporarily expanding billable telemedicine services
New March 26 – Effective March 26 through June 30, 2020, we’ll temporarily allow credentialed providers to bill routine practice codes with a Place of Service 02 and be paid the standard facility-based rate. The visit must follow the guidelines of the code billed, including time requirements.
What does this mean? Any credentialed practitioner can conduct a telemedicine visit and bill with a Place of Service 02 code, which identifies the visit as being virtual.
For example, office procedures billed with an evaluation and management (E/M) code of 99201-99215, when performed
in real-time by credentialed providers through an interactive video tool, can have a Place of Service 02 added and receive the standard facility-based rate.
What’s not included? You cannot:
- Use codes that specify in-person or describe services that can only be performed in person
- Bill for services you’re not contracted to provide
- Perform services outside of your scope of practice, licensure or credentialing
- Beacon Health is providing telemedicine visits at no-pay through their provider network.
Given the government’s notification, we’re temporarily suspending the requirement for HIPAA compliant systems and are also allowing for real-time, interactive audio-only telehealth encounters to service patients who don’t have internet access or audio-visual capabilities. This means that if you don’t have a virtual care tool in place, you can use non-public facing tools, like FaceTime, Facebook Messenger video chat, Skype, etc. You cannot use public-facing tools like Facebook Live, TikTok or chat rooms like Slack. See the Office for Civil Rights FAQ for more information.
Visit codes billable by physicians
THC reimburses fee-for-service for telephone visits, e-visits and hosted visits. No modifier is necessary to bill these codes. Co-pays and deductibles will be temporarily waived for services 3/26/2019 through June 30, 2020
- Telephone Visits – Commercial ONLY
- Evaluation & Management Codes – Commercial and Medicaid
- GT modifier is required for Medicaid
- Commercial can bill with modifiers GT or 95
Billing for COVID-19 lab tests
The Centers for Medicare and Medicaid Services (CMS) released two codes for COVID-19 lab tests that can be used starting Apr. 1, 2020 for dates of services starting Feb. 4, 2020. Labs can use HCPCS code U0001 when using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. Labs and health care facilities using other techniques for testing can bill U0002. For more information, see the CMS FAQ.
The American Medical Association has also released a CPT code: 87635. This code is effective immediately to report lab testing services that diagnose the presence of the novel coronavirus. See the AMA’s website for more information.
Code Base: Fee
- U0001: $29.74
- U0002: $42.48
- 87635: $42.48
For commercial rates, your contractual rate will be applied to the base fee.
The Michigan Department of Health and Human Services (MDHHS) advises you complete the Human Infection with 2019
Novel Coronavirus Person Under Investigation (PUI) and Case Report Form if a patient tests positive for COVID-19.
New ICD-10 code available April 1
Starting April 1, add ICD-10 code U07.1 COVID19 when your patients have a diagnosis of COVID-19. Until April 1, you should continue to follow the CDC’s recommendation for coding.
Note that diagnosis code B34.2, Coronavirus infection, unspecified, would in generally not be appropriate for the COVID-
19, because the cases have universally been respiratory in nature, so the site would not be “unspecified.”