COVID-19 FAQ

Will Vibra Health Plan cover COVID-19 diagnostic testing?

Yes. Vibra Health Plan policies include coverage for COVID-19 diagnostic testing.

If the patient is seen by a provider for an office visit and during the visit, the provider orders the test for COVID-19, are both services waived of copays?

Vibra Health Plan is waiving member cost share (copay, coinsurance, and deductible) for the COVID-19 diagnostic testing consistent with statutory requirements. Per recently enacted additional statutory requirements, we are also waiving member cost share for the visit that resulted in a COVID-19 test whether in an office, emergency room, telehealth, or urgent care. Providers will receive the full allowed amount from Vibra Health Plan, and therefore the Provider must refund any deductibles or co-payments that were inadvertently collected from the member.

What codes should we use to bill diagnostic testing for COVID-19 and what are the reimbursement rates?

Vibra Health Plan is ready to accept these codes.

Code

Rate

Test dates on or after

86328

$45.23

4/10/2020

86408

$42.13

8/10/2020

86409

$105.33

8/10/2020

86413

$42.13

9/8/2020

86769

$42.13

4/10/2020

87426

$45.23

6/25/2020

87428

$73.49

11/10/2020

87635

$51.33

3/13/2020

87636

$142.63

10/6/2020

87637

$142.63

10/6/2020

87811

$41.38

10/6/2020

0223U

$416.78

6/25/2020

0224U

$42.13

6/25/2020

0225U

$416.78

8/10/2020

0226U

$42.28

8/10/2020

0240U

$142.63

10/6/2020

0241U

$142.63

10/6/2020

G2023

$23.46

3/1/2020

G2024

$25.46

3/1/2020

U0001

$35.92

2/4/2020

U0002

$51.31

2/4/2020

U0003

$75.00

1/1/2021

U0004

$75.00

1/1/2021

U0005

$25.00

1/1/2021

Will Vibra Health Plan cover telehealth visits?

Yes, telehealth services provided by an eligible in-network provider have been a covered benefit for Vibra health Plan members. We will continue to follow CMS guidelines for coverage of telehealth services.

Vibra Health Plan contracted providers may schedule telehealth visits with members through the provider’s normal processes and scheduling platform..

Where can I find more information regarding Vibra Health Plan and COVID-19?

If you have additional questions, contact your Provider Relations Consultant or email us.

CMS is waiving the three night acute care stay requirement for SNF coverage due to the state of emergency declaration. Will Vibra Health Plan follow this guideline?

Vibra Health Plan does not require a three-night acute stay prior to a SNF admission for Medicare Advantage products.

How do providers bill for telehealth services?

Given the current COVID-19 situation, Vibra Health Plan is temporarily allowing providers to bill and receive reimbursement consistent with an in-person visit. This change applies beginning March 6, 2020 through the end of the public health emergency.

To facilitate reimbursement, providers must:

  • Identify the place of service (POS) they would bill had the visit occurred as a face-to-face visit.
  • Providers should not use “02” as POS.
  • They must also identify that it was a telehealth service by including Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System).

Will telehealth services be eligible for coverage for Vibra Health Plan members when performed by providers that are not contracted with Vibra Health Plan?

Telehealth services are covered only when delivered by a Vibra Health Plan provider.

Will Vibra Health Plan be adjusting the length of time a preauthorization is valid before it expires?

Yes. Authorizations issued prior to August 1, 2021:

  • For services that may be delayed due to COVID-19, new preauthorizations will be valid for at least six months.
  • For services that are likely to be impacted by the pandemic, such as: OP surgery, IP electives, DME etc., we have extended existing preauthorizations by six months.

Standard authorization requirements and durations will resume for all authorizations issued on August 1, 2021 and thereafter.

If you experience a problem with preauthorization timeframes, please call the preauthorization line, and we can adjust end dates as needed.

How will other preauthorizations apply during the COVID-19 emergency?

Preauthorizations related to COVID-19 diagnostic tests:

  • Covid-19 tests: no preauthorization is required
  • Laboratory tests - CBC and electrolytes: no preauthorization is required
  • Chest X-rays: no preauthorization is required
  • CT scan chest: preauthorization is waived

Preauthorization will be waived for dates of service thru June 30, 2021. Effective July 1, 2021, preauthorization will be required.

Prior to August 1, 2021, preauthorization will be waived for most services with diagnosis codes on the CDC COVID-19 recommended list. Exclusions include: medical specialty injectable, genetic testing, transplant, reconstructive/cosmetic surgeries, MSK, and NIA.

Standard authorization requirements and durations will resume for all authorizations issued on August 1, 2021 and thereafter.

How is Vibra Health Plan handling providers adding additional staff and/or redeployment of existing resources that may be necessary to handle added patient volumes?

Vibra Health Plan recognizes that, during the COVID-19 crisis, additional staffing and/or redeployment of existing resources may be necessary to handle added patient volumes.

Until further notice, Vibra Health Plan will allow providers to use the Locum Tenens billing guidelines for either:

  • Using a substitute physician who is not contracted with Vibra Health Plan for reciprocal billing arrangements (i.e., Locum Tenens) when a patient’s regular physician is unable to provide services.
  • Using a substitute physician who is contracted with Vibra Health Plan but is providing services in another location not currently loaded into our claims adjudication system.

The Healthcare Common Procedure Coding System (HCPCS) code modifier Q6 (services furnished under a fee-for- time compensation arrangement) is required on all claims during this time when using the Locum Tenens process outlined above.

In addition, Vibra Health Plan will also allow contracted providers to bill with the current provider record on file, instead of the actual place of service rendered, if this reduces the billing providers’ administrative burden.

Is Vibra Health Plan covering Medicare Annual Wellness exams through telemedicine? Example: Codes G0438 and G0439.

Vibra Health Plan will recognize the most current published Centers for Medicare and Medicaid Services (CMS) list of covered services, excluding provider consultation services.

During this health emergency, will Vibra Health Plan give providers extra time to appeal medical necessity reviews?

For medical necessity claim denials, VHP accepts disputes submitted within 365 days of the denial.

More Information for Providers

COVID-19 FAQ

COVID-19 Information

Updated October 1, 2021
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