COVID-19 Updates

Here's What We Know

Payer Updates Change Frequently.

Stay current on policy updates to receive proper reimbursement for telehealth services. UPA has added general guidance from payers for patient cost-sharing to our telehealth services grid below to help ensure appropriate balancing billing and copay collection for patients. Payer policies and additional resources can be found below in our Payer Source Documents section.

The Telehealth Services by Payer details provided below is current as of its publication date of 9/12/2022 and is subject to change.

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COVID-19 Payor Source Documents

Aetna

Click to view Oct 1, 2021

Click to view June 2021

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Keeping you informed on the COVID-19 vaccine

Dear health care partners,

We're here to support you and your Aetna^® patients throughout the COVID-19 vaccine rollout. That includes providing you with the latest vaccine resources you need to effectively communicate with them.

We're also educating patients on the most up-to-date vaccine information through high-impact channels that reach them the fastest. These channels include email, social media and our website. Together, we can help minimize confusion for your patients - and our members.

Increasing vaccine access

As part of the CVS Health^®family, we’re working directly with the federal government to increase access to COVID-19 vaccines around the country. Beginning February 12, select CVS Pharmacy^® locations will offer 250,000 COVID-19 vaccinations to eligible populations across participating states.

Man with a face mask next to a smartphone

Get the latest vaccine information

Overcoming vaccine hesitancy

Our research shows a growing divergence of attitudes toward the COVID-19 vaccine, with increased hesitancy from minority groups. As a primary care physician, you can play a key role in helping patients understand the necessity of this vaccine. Get the strategies you need to combat vaccine hesitancy with our Shifting Trends in Vaccine Hesitancy white paper.

Sharing the importance of that second dose

There’s a lot of information circulating about the vaccine, so it’s important for patients to get the facts from trusted health care providers like you. When you’re discussing COVID-19 vaccines with your patients, remind them how crucial the second dose is to the effectiveness of the vaccine.

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Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Aetna ^®, CVS Pharmacy^®, HealthHUB^® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic^®-branded walk-in clinics) are part of the CVS Health^® family of companies. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a health care professional.

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3/26/20

COVID-19: Taking Action

Dear Valued Partner:

We share the same goal: help people get and stay healthy. We’re your partners in health care, and act to serve you and the millions of patients who rely on us for their health care needs.

In response to the rapidly evolving COVID-19 outbreak, CVS Health and Aetna are here to support you with timely answers and information. Through CVS Health and Aetna’s combined resources and your partnership, we can best support your Aetna patients’ health and well-being, ensure their access to medication and remove barriers to care.

We’re here to help you, help your patients and recently announced these resources and enhancements when applicable:

If you request testing related to COVID-19,we’ll waive your Aetna patient’s cost sharing.

Aetna Commercial patients pay for covered telemedicine visits until June 4, 2020.

Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes.With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video.

Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay.

Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna’s Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient’s ID card to register a recently diagnosed patient.

Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.

We’re waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.

Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we’re waiving early refill limits for a 30-day supply.

Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

Please refer to the “What You Need to Know About the Coronavirus (COVID-19) - Aetna Providers” FAQs on Aetna.com for additional important information. There, you’ll find information about codes related to COVID-19 and selected labs approved to do COVID-19 testing. This page will continually be updated with information as it becomes available to help you care for your patients.

Let’s work together to provide your patients with a clear path to care. Thank you for your continued partnership.

Best Regards,

Angie Meoli
SVP, Network Strategy and Provider Experience

AMA

American Medical Association

Netters Atlas

BREAKING NEWS: AMA announces new CPT^® codes for multi-virus tests to detect COVID-19 and flu

The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT^®) code set that includes new code additions and editorial revisions for reporting medical services.

For quick reference, the two new Category I CPT code and descriptors are:

87636
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

CPT codes ranging from 87301 to 87430 were also revised by removing the undefined term “multi step method” from code descriptors. The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine.

87426
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

In accordance with the above revision, the CPT Editorial Panel approved a new category I code, 87811, to report infectious agent antigen detection by immunoassay with direct visual observation.

87811
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

In addition to the long descriptors, short and medium descriptors for CPT codes 87636, 87637, 87426 and 87811 can be accessed on the AMA website, along with several other recent modifications to the CPT code set.

For more information you can see the press release here.

Sincerely,

The AMA Team

American Medical Association

On September 8, 2020 the AMA released two new COVID related CPT codes for immediate use.

Use CPT 99072 to report the use of additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility based service, when performed during a Public Health Emergency period, due to respiratory-transmitted infectious disease. CPT 99072 is reported for practice expenses related to PPE, staff time for patient symptom screening, and increased sanitation protocols to prevent disease spread.

New CPT 86413 is used to report quantitative antibody detection for SARS-CoV-2

Reference link to the following AMA Article for more details: https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance?gclid=EAIaIQobChMIvPPH8-vr6wIVx8DACh0W3gBREAAYASAAEgL0tvD_BwE

Reference link for AAPC Article Blog post: https://www.aapc.com/blog/51794-ama-approves-2-new-cpt-codes-for-covid-19/

Amerigroup

Click to view July 2021

View September 17, 2020

July 27, 2020

Dear Episodes of Care Provider,

In light of the additional burden of caring for our TennCare members during this pandemic, TennCare has decided to waive all 2019 risk-sharing payments for the Episodes program. This news has also been posted to the TennCare website under “News and Announcements” or you can follow this link: TennCare Memo: Waiving 2019 Episodes Risk-Sharing Payments.

Providers in gain-share on their final 2019 reports will still receive those payments.

Please note the following:

Final reports for 2019 AND Quarter 1 reports for 2020 will be out on August 21^st. Please use these reports to see how you are trending. You will be notified by email when the reports are posted.
No action is required by providers in the risk-share group. You will still see the same data on the final reports but you will not be asked to submit a risk-share payment. Please take advantage of this report to impact your 2020 reports.
Providers who have a net gain-sharing payment across all episode types in their final 2019 performance report will receive those payments as planned, with no changes. This means that providers will have any risk-sharing amounts subtracted from their total gain-share to find their net gain-sharing amount. This is the same calculation that occurs every year to calculate a provider’s net gain- or risk-sharing amount.
Your Amerigroup team is eager and available to have a webex with your practice. We can review reports, offer provider education, and provide coaching on how to do well with the Episodes Initiative.
Reply to this email with requests or questions for your Amerigroup team.
TennCare is still analyzing the impact of the pandemic on the 2020 performance period and is open to input from stakeholders. You may provide feedback or suggestions to TennCare by e-mailing the state at Payment.Reform@tn.gov.

Be watching for your notification for your next reports on August 21^st.

And we sincerely thank you for your excellent care of your patients during these unprecedented times.

Julie Riedel, APRN, Family Nurse Practitioner

Provider Clinical Liaison

22 Century Blvd., Suite 220, Nashville, TN 37214

O: (615) 316-2400 x 106-126-0154| M: (615) 806-4283

AGPEpisode.Reporting@Amerigroup.com

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June 9, 2020

Click to view: Amerigroup Tenncare Telehealth Coverage Policy

June 5, 2020

Click to view: Amerigroup Medicare Advantage Telehealth Coverage Policy FAQ

June 2020

Click to view: Amerigroup Medicare Advantage Memo 6/17/2020

May 2020

Click to view: Amerigroup Medicare Advantage

BCBS

Click to view BlueCare Telehealth 7.2021

Click to view BCBST Provider FAQ 7.2.20

Click to view BCBST Provider FAQ 6.17.2020

Click to view BCBSTN FAQ 5.18.20

Click to view BCBS Telehealth Update 5.14.20

Click to view BCBS FAQ 4.24.20

Click to view BCBS FAQ 4.21.20

Click to view BCBS 4.7.20 UPDATES

Click to view BCBS 4.2.20 FAQ

Click to view PCP Lock-in Requirements

Click to view updated FAQ 3/26/20:

3/26/20 FAQ BCBS

Click to view the documents:

BCBST FAQs

BrightHealth

Click to view: Telehealth eMail 4.3.20

Click to view: DoctorOnDemand 4.3.20

Click to view: Bright 3.19.20 Utilization

Click to view: Bright 3.27.20 Claims

Cigna

Click to view 10/7/21

Click to view 4/8/21

Click to view vaccine hesitancy

Cigna Commercial Virtual Care Policy

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2.8.21

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Dec 2020

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Virtual Care Policy

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Nov 2020

Inject / Non-inject

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11.20.20

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Oct 2020

Virtual Care Policy

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7.24.20

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7.23.20

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7.16.20

Click to view update 7.16.20

5.22.20 Update

Click to view 5.22.20 Update

5.13.20 Medicare Advantage Guidelines

Click to view Cigna Medicare Advantage Guidelines

5.11.20 Update

Click to view 5.11.20 Update

Referral Guidelines

Click to view Cigna Referral Guidelines

4.24.20 Update

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FAQ 4.13.20

Click to view Cigna 4.13.20 FAQ

Interim Virtual Care Billing Guidelines (3/30/20):

Click to view 3/30/20 Interim Virtual Care Billing Guidelines

3/27/20:

Cigna has released new Telehealth guidelines to expand covered services.

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3/24/20 Data:

PCP referrals for specialist office visits are being waived temporarily until May 31^st, effective immediately, for SureFit and IFP Connect Network customers in response to the COVID-19 virus outbreak. Suspending the referral requirement will allow our providers and Clinical Intake teams to focus on COVID-19 critical care needs during this time, such as ER and Urgent admission authorizations.

Continue to follow all other processes as outlined in your summary plan description (e.g. Authorizations are still required)
Given this is a fluid situation the possibility of extending beyond the May 31^st date will be evaluated on an ongoing basis.

Your claims will not be denied without a referral.

We’ve had several providers ask if Physical Therapy could be performed virtually and below are the updates around PT.

Q: Will Cigna temporarily expand coverage of benefits for physical therapy to include virtual care?

A: Yes. There are 2 scenarios:

-A homecare agency that traditionally has provided PT services in the home does them via telehealth and bills “G” codes that will pay according to the fee schedule.

-An traditionally outpatient PT clinic performs PT services in the home via telehealth and bills E&M codes will pay according to their fee schedule

Q: Will Cigna temporarily expand coverage of benefits for physical therapy to allow in network providers to provide care in home as alternative to “in center” traditional therapy services?

A: No. Face-To-Face services in the home are the purview of Carecentrix and homecare agencies.

Click to view Cigna link 3/24/20: Cigna Makes It Easier For Hospitals To Focus On COVID-19 By Helping Accelerate Patient Transfers

Click to view 3/24/20

Click to view 3/18/20

Click to view 3/17/20