Priority Health - COVID-19 Updates

March 30, 2020

COVID-19 update for providers from Priority Health

Information about COVID-19 is changing rapidly, and we know it’s important to stay updated. We’ll send weekly email updates during this situation.

Check our COVID-19 Provider Information Center page for information as soon as it’s available.

We remain dedicated to working with you to support your practices and to get your patients the care they need.

Virtual care updates

We expanded billable telehealth codes and payments
Effective March 26 through May 31, 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. Read more about what you can and cannot do.

We’re following recommendations for HIPAA and telehealth
Given the government's notification, we're temporarily suspending the requirement for HIPAA compliant systems. All other elements of our medical policy remain in effect, including documentation requirements. Learn more.

Coding and billing updates

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. Learn more.

Rates are published for billable COVID-19 codes
Our commercial, Medicare and Medicaid fee schedules are updated to reflect rates for U0001, U0002 and CPT 87635. See our COVID-19 Provider Information Center page for the rates.

New ICD-10 code available April 1, 2020
Starting April 1, 2020, add ICD-10 code U07.1 COVID19 when your patients have a diagnosis of COVID-19. Until April 1, 2020, you should continue to follow the CDC’s recommendation for coding.

 

Prior authorizations

We have not made any changes to our prior authorization requirements, and we remain committed to serving you quickly by:

  • Processing all urgent inpatient admission and post-acute requests within 24 hours
  • Shortening the processing time for post-acute authorizations to help you discharge patients quickly
  • Never having required authorization for observation stays

Check back regularly for more ways we’re supporting you.

 

We’ll stay in touch

We’re all in this together to serve our communities during this crisis. Thank you for your ongoing partnership and dedication.

Stay safe and well,

Your Priority Health team