Select COVID-19 temporary cost share waivers are extended
To continue to meet your needs through the evolving COVID-19 health emergency, UnitedHealthcare is extending select COVID-19 treatment cost share waivers, which are summarized below. We also continue to make ongoing updates to our COVID-19 billing and reimbursement guidance with the latest information, including giving providers a way to look up member Medicare ID numbers when submitting COVID-19 vaccine administration claims to the Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC).
We hope these updates help you deliver care and make it easier to be reimbursed for the services you provide.
Cost share waiver updates
COVID-19 treatment – Medicare Advantage plans
For Medicare Advantage health plans, cost sharing (copay, coinsurance and deductible) will be waived for in-network and out-of-network COVID-19 treatment from Feb. 4, 2020 through March 31, 2021. This includes telehealth, inpatient and outpatient treatment. The cost share waiver was previously set to expire on Feb. 28, 2021.
Monoclonal antibody treatment – Individual and Group Market plans
UnitedHealthcare is waiving cost sharing for the administration (intravenous infusion) of monoclonal antibody treatments for in-network providers in outpatient settings through March 31, 2021.The cost share waiver was previously set to expire on Feb. 28, 2021.
Reminder: Monoclonal antibody treatment will be considered a covered benefit during the national public health emergency period, currently scheduled to end April 20, 2021. Patients should meet the emergency use authorization (EUA) criteria for FDA-authorized monoclonal antibody treatment in an outpatient setting.
Monoclonal antibody treatment – Medicare and Medicaid
As previously communicated:
- For Medicare health plans, the CMS MAC will reimburse claims for Medicare beneficiaries with no cost share (copayment, coinsurance or deductible) through 2021.
- For Medicaid health plans, coverage and cost share is determined by state requirements. Please check your state’s specific COVID-19 website for more information.
We’ve updated our summary of COVID-19 temporary program provisions with these new dates. We’ve also revised the guide to more clearly show the provisions that are currently in place and created a summary of previous (expired) provisions for your reference.
Medicare ID lookup
We’ve added the member’s Medicare ID to the Eligibility & Benefits information available on the UnitedHealthcare Provider Portal. This will help you submit claims for COVID-19 vaccine administration for Medicare beneficiaries – those claims must be billed to the CMS MAC, and the member’s Medicare Beneficiary Identifier (Medicare ID) must be included with those claims.
Note: The Medicare ID is different than the member’s UnitedHealthcare ID number, which you already have on file.
We continue to make updates to our COVID-19 administration, billing and reimbursement information. This includes AMA CPT® coding guidance for medical claims and NCPDP information for pharmacists who administer the vaccine. Note: We’ll update this information as quickly as possible when the Johnson & Johnson vaccine receives FDA-authorization.
For all of the FDA-authorized COVID-19 vaccines:
- The cost of the vaccine serums will initially be paid for by the U.S. government
- Members will not have any out-of-pocket costs for the vaccine or vaccine administration
The following items can help you manage the claim submission and reimbursement process for COVID-19 vaccine administration:
Self-paced online course: Step-by-step COVID-19 vaccine administration billing and reimbursement instructions
COVID-19 billing guide: The latest information related to vaccine administration billing and reimbursement
Vaccine guidance webpage: Additional information on submitting claims, coding guidance, member cost-share and more
Please check UHCprovider.com/COVID19 for detailed information about COVID-19 testing, treatment, telehealth, vaccines, billing and more.
Thank you for your continuous efforts to keep our members healthy and informed