March 19, 2020
On March 17, 2020, TennCare published guidance regarding testing and telehealth services pertinent to healthcare providers that serve TennCare beneficiaries. Effective immediately and lasting until April 30, 2020, all of TennCare’s health plans – Amerigroup, BlueCare Tennessee, and UnitedHealthcare Community Plan (“UHC”) – are allowing “home” as an originating site in response to the COVID-19 national emergency. In other words, providers can bill for telehealth services performed while a patient is at home. This change reflects the federal and state government’s recent efforts to maximize access to care and minimize the spread of COVID-19 by temporarily broadening telehealth coverage. Each TennCare health plan has published guidance regarding billing, coding, and coverage for telehealth and other services:
BlueCare
- BlueCare covers COVID-19 testing and members’ copay. Members’ cost-share for appropriate FDA-approved tests and tests pending FDA approval are waived. Once available, BlueCare will cover vaccines developed and approved to treat COVID-19. Services for members diagnosed with COVID-19 are covered in the same way BlueCare currently covers other viral respiratory infections, under patients’ usual benefit with the same cost-share. Patients quarantined in the hospital are covered under patients’ usual inpatient benefits with the same cost-share.
- BlueCare covers telehealth consultations. Providers may bill for telehealth using CPT codes 99441-99443 for telephonic provider-to-member consultation or E&M codes 99201-99215. For behavioral health consultations, providers should use codes 90791, 90792, 90832, 90834, and 90837. Providers should use place of service 02. Pricing is consistent with the BlueCare fee schedule. Patients should use PhysicianNow powered by MDLive® telehealth benefits if available and avoid the emergency room, except in the case of a true medical emergency.
- BlueCare does not cover medical supplies (e.g., masks, gloves, disinfectant).
- BlueCare pharmacy benefit members may receive early refills on most (not all) medications. BlueCare encourages ninety (90)-day refills for chronic medications. Some drugs, such as controlled substances (e.g., opioids) and certain specialty drugs are excluded. Some members may have a mail-order benefit.
- Prior authorization is not required for COVID-19 testing or treatment.
- The following codes should be used for billing COVID-19 laboratory tests: U0001 (CDC testing laboratories to test patients for SARS-CoV-2); U0002 (Non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (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)).
UHC
- Telehealth modifiers are not required for TennCare claims when claims are submitted with place of service telehealth (POS 02).
- UHC’s Medicaid plans cover “virtual check-in” patients if patients are “established” and the service is unrelated to a medical visit within the previous seven (7) days and not resulting in a medical visit within the next twenty-four (24) hours (or soonest appointment available). Such services can be provided through various communication methods (e.g., telephone – HCPCS code G2012, captured video or image – HCSPCS code G2010). UHC covers communications between patients and doctors via online patient portals using CPT codes 99421-99423 and HCSPCS codes G2061-G2063.
- HCSPCS U0001 is used for the laboratory test developed by the CDC; HCSPCS U002 is used for the laboratory test developed by entities other than the CDC; and the American Medical Association released code 87635 for laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2).
Amerigroup
- Amerigroup covers reasonable member health care costs related to COVID-19 and the novel coronavirus screening test at no out-of-pocket cost. Out-of-pocket expenses for the test used to diagnose COVID-19 for members with fully insured, individual Medicare and Medicaid plans are covered. Providers should continue to verify eligibility and benefits for members prior to rendering services. Members will generally pay other out-of-pocket expenses as required by their plans.
- Prior authorization for diagnostic services related to COVID-19 testing is not required.
- Amerigroup covers services by out-of-network providers where members have insufficient access to network providers and as medically necessary.
- Amerigroup covers telehealth services. Providers should use the same E&M code they use for in-person visits with place of service 02 (telehealth).
- There are no exclusions or limitations regarding coverage for treatment of illness resulting from an epidemic in Amerigroup’s standard health plan contracts.
Providers should utilize the federal and state government’s relaxed telehealth coverage requirements in order to provide safe and effective remote care to patients during the COVID-19 national emergency. Still, understanding the nuances regarding billing, coding, and coverage, and how the rules may apply in particular situations remains crucial. In addition to the Butler Snow hub, providers can refer to the Tennessee Department of Health and TennCare websites for guidance.