Priority Health - COVID Update

June 29, 2020

In response to the COVID-19 pandemic, we implemented several temporary changes to support you and your patients.

The purpose of this communication is to give you an update on which of these changes is ending on June 30, 2020, and what’s being extended. We’ve also made a new change for July 1, 2020.

Continue to use our COVID-19 Provider Information Center page for the latest news and most up-to-date information, including a downloadable, condensed summary of the changes listed below.

 

New changes effective July 1, 2020

  • Extended $0 coverage of telehealth services for our members through Dec. 31, 2020

We recognize that in-office visits might not be an option for your practice, or your patients. We want to make sure we’re removing as many barriers for your patients as possible, so you can have more opportunities to provide needed care.

To encourage our members to continue seeking the care and services they need, we’re covering the cost of all telehealth visits, including behavioral health, at 100%, ahead of deductible, for most members*, for dates of service between July 1 and Dec. 31, 2020. 

You don’t need to collect member* cost-sharing for services provided via telehealth, so can save administrative time and expenses and focus on what matters most.

Make sure to bill using the Place of Service 02 to identify the visit as telehealth.

Learn more and share coverage information with your Priority Health patients.

*Self-funded employer group plans must opt-in.

 

Temporary changes with deadline extensions

  • Coverage for treatment of COVID-19

We’ll continue to cover COVID-19 treatment for all our members with no out-of-pocket health plan costs. That means copays, deductibles and coinsurance for COVID-19 treatment will be waived when received from an in-network provider between March 11 and Dec. 31, 2020.

Billing and coding tip: As of Apr. 1, 2020, add ICD-10 code U07.1 COVID19 when your patients have confirmed a diagnosis of COVID-19. This helps your patients get the right coverage and cost waived for their COVID-19 treatment. Learn more.

 

  • Coverage of medically necessary testing for COVID-19 (including antibody testing)

We’ll continue to cover medically necessary COVID-19 tests of any kind when ordered by a physician or advanced practice provider (APP), a physician assistant or nurse practitioner, waiving all member copays, coinsurance and deductibles.

Billing and coding tip: When you order a COVID-19 test, whether molecular, serologic/antibody, the SC modifier is not necessary to indicate that the test was medically necessary for most diagnoses. The SC modifier must be added for select codes that are generic or typically unrelated. See the complete list.

 

  • Temporary expansion of telehealth codes

We’ll continue to allow credentialed providers to bill routine practice codes in addition to existing telehealth codes, for services provided via telehealth between March 26 and Dec. 31, 2020. Any credentialed provider or facility can conduct a telehealth visit for a member with any type of plan, including commercial group and individual, Medicare and Medicaid. Learn more.

Billing and coding tip: Make sure to bill Place of Service 02 to identify the visit as telehealth.

 

  • Audio-only visits for telehealth

We’ll continue to allow credentialed providers to bill real-time, interactive audio-only telehealth encounters, so patients who don’t have internet access or audio-visual capabilities can continue to get the care they need. Learn more.

Billing and coding tip  Effective July 1, 2020, all audio-only visits must be billed using audio-only visit codes (99441 – 99443 and 98966 – 98968).

 

  • HIPAA compliance

We’ll continue the suspension of the requirement for HIPAA compliant systems for virtual visits and telehealth appointments through the end of the public health emergency. Learn more.

 

Temporary changes ending June 30, 2020

  • Reimbursement for telehealth services

Starting July 1, 2020, we’ll return to paying the standard facility-based rate for telehealth services. Learn more.