Prevea360 Health Plan is taking measures to support our valued in-network providers who are caring for our members amid concerns of the coronavirus COVID-19 spreading in our area.
Check our provider communications for updates.
If you have questions, contact your Provider Network Consultant directly and email your question to [email protected] for a prompt reply.
We are complying with CMS coding guidelines for COVID-19 testing.
The American Medical Association created new CPT codes effective for dates of service on or after April 10, 2020, to describe COVID-19 antibody testing.
The American Medical Association created a new CPT code effective for dates of service on or after March 13, 2020, to describe COVID-19 testing by amplified probe technique:
As the public health emergency stabilizes, the Health Plan is determining appropriate timing for resumption of pre-COVID-19 operations.
Prevea360 Health Plan is waiving authorization requirements for outpatient services directly for and related to COVID-19. Providers must bill for these services using the COVID-19 ICD-10 codes to appropriately bypass authorization requirements for services that qualify for the waiver.
Prevea360 Health Plan does not require prior authorization for antibody testing; however, we do expect that all antibody tests be physician-ordered. Because of the variety of testing options available on the market currently, we encourage providers to know the efficacy of the antibody tests they are ordering.
Postponing elective surgeries and non-essential procedures
On March 18, 2020, CMS released a recommendation that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the COVID-19 outbreak for the preservation of personal protective equipment, beds, and ventilators. In response, Utilization Management is evaluating all approved prior authorizations on file for elective inpatient admissions with a surgery/admit date on or before March 16, 2020, to determine if the surgery was rendered:
Providers who are not equipped to handle COVID-19 patient inquiries or collect specimens for testing can contact us for the nearest in-network provider at [email protected].
Providers who do not have access to a qualifying laboratory for COVID-19 testing can contact one of the following in-network FDA-approved laboratories:
We are referring to the CMS Medicare Telemedicine Health Care Provider Fact Sheet for our expanded telemedicine coverage guidance effective for dates of service beginning March 6, 2020. Our expanded coverage will remain in effect until further notice.
To support needed provider network adequacy, protect members and providers, and promote access to care, we are offering Zoom meeting licensure to providers without the ability to conduct telemedicine services during the COVID-19 public health emergency. Providers may contact their Provider Network Consultant if they are interested in obtaining a Zoom license to provide telehealth services.
To accommodate Medicare beneficiaries who don’t have access to or are hesitant to use the interactive audio-video technology required for telehealth services, the Centers for Medicare & Medicaid (CMS) is waiving the video requirement for certain telehealth services. Prevea360 Health Plan is adopting this waiver for all products during the public health emergency to allow members to receive these services via telephone (audio-only). The services that can be rendered via telephone have been added to CMS’s List of Medicare Telehealth Services.
Because practitioners are providing audio-only services in instances that would have been provided as in-person or telehealth visit under non-COVID-19 circumstances, CMS established new Relative Value Units (RVUs) for audio-only assessment and management services. The RVUs are based on crosswalks to the most analogous office/outpatient evaluation and management (E&M) services resulting in increased reimbursement for CPT codes 99441, 99442, and 99443. Prevea360 Health Plan is adopting the increased reimbursement rates for these codes on claims with dates of service on and after March 1, 2020, across all Prevea360 Health Plan products.
In alignment with CMS guidance, these temporary services should be billed with the Place of Service (POS) equal to what would have been billed if not for the public health emergency.
Modifier 95 should be appended to indicate that the service rendered was actually performed via telehealth. Traditional telehealth services performed using an originating-site facility and distant-site practitioner should continue to be billed with POS ‘02’.
Communication technology-based services
Communication technology-based services (CTBS) are furnished via telecommunications technology but are not considered telehealth services. Our coverage of CTBS services includes:
Telephone services (for all health plan products)