Our work aligns with the guidance issued by the Centers for Medicare and Medicaid Services about expanding healthcare services and access.
On March 6, the Centers for Medicare and Medicaid Services (CMS) released detailed FAQ that provide information and clarifications regarding COVID-19 testing and other Medicare-covered benefits.
Benefits and Coverage
COVID-19 diagnostic testing that is medically necessary and consistent with the Center for Disease Control and Prevention (CDC) guidelines will be covered in full with no member cost share. We are also waiving prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members diagnosed with COVID-19. Please verify eligibility prior to providing services.
CMS has developed two Healthcare Common Procedure Coding System (HCPCS) codes that the Medicare claims processing systems will be able to accept starting on April 1, 2020, for dates of service on or after February 4, 2020. The first code (U0001) is used to bill for tests and track new cases of the virus, and is to be used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID 19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. When submitting diagnostic tests to Vibra Health Plan, please use the newly-created codes.
Any care needed once diagnosis of COVID-19 has occurred will be covered consistent with the standard provisions of the member’s health benefits.
Prescription Medication Refills
To help members prepare for the potential need to stay home or remain isolated for an extended period, we will waive early medication refill limits on 30-day prescription maintenance medications. We also will encourage members to use their 90-day mail order benefit.
Amwell OnLine Doctor Visits
Amwell OnLine Doctors are a sensible, secure, and convenient way for members to get care and avoid further spreading of the virus. We are encouraging members to use this service if they are concerned about seeking care at a doctor’s office or urgent care center. Vibra Health Plan currently offers $0 copay for Amwell OnLine Doctor visits. If members use the service for suspected COVID-19 symptoms, Amwell doctors are trained to help patients find the best place to be tested for the virus, if it is necessary.
Keeping You Informed
We continue to remain engaged with federal and state government officials, including the CDC and Governor Wolf’s administration. Also, we would like to remind you that Vibra Health Plan has a business continuity plan in place to continue supporting your practice and facility during this pandemic.
We will contact you with more details about how we are addressing COVID-19 and will update our COVID-19 page with the latest news and information.
For updated information on the range of CMS activities to address COVID-19, visit the CMS.gov website.
Updated October 1, 2020