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COVID-19 Information For Providers

Billing and Payment

All information contained on this page is applicable only during the declared pandemic time period or other time frames specified below. In the event of any conflict or inconsistency between the information contained on this page and the contents of the UCare Provider Manual, the information on this page shall control during the identified time frame.

Please Note: UCare removed copays for Medicare primary care and mental health clinic services - including telehealth - June 1 through Dec. 31, 2020. Effective Jan. 1, 2021, UCare is reinstating cost share for UCare Medicare plans that have copays for these services.

PAGE LAST UPDATED MARCH 3, 2022

Recent Changes The Weeks of February 21 and February 28:

  • March 3, 2022 – Details surrounding no cost over-the-counter COVID-19 tests were provided.
  • March 3, 2022 – The lists of codes that should be used when billing for COVID-19 vaccines and for billing for COVID-19 monoclonal antibodies were updated.
  • March 3, 2022 – The coverage information for COVID-19 treatment was updated.
  • March 3, 2022 – The information regarding Sequestration was updated.

Telehealth Services – All UCare Products

Additional billing and payment information about telehealth services is available on the Telehealth, Telemedicine and Technology Based Services page.

COVID-19 Tests and Treatment

No Cost Over-the-Counter COVID-19 Tests Available
Rapid at-home COVID-19 tests are covered for all UCare members during the public health emergency. Coverage varies, depending on the member’s plan, and may require an order or prescription from a physician or licensed provider.

Medicare Advantage
Covered products include UCare Medicare Plans, EssentiaCare, I-SNP (UCare Advocate Choice, UCare Advocate Plus), UCare’s Minnesota Senior Health Options and UCare Connect + Medicare.

UCare covers FDA-authorized over-the-counter tests for COVID-19 when they are ordered or prescribed by a physician or licensed provider and obtained from a participating pharmacy. These tests are available at no cost to the member.

  • Members cannot be reimbursed for tests they purchase with their own money, even if the member has a prescription for a test.
  • Members with Healthy Savings over-the-counter coverage may use their Healthy Savings benefit to purchase at-home tests.
  • Coverage is limited to eight tests every 30 days for each individual member (a two-pack counts as two tests).
  • If additional tests are needed, they must be authorized in advance.

State Public Programs
Covered products include Prepaid Medical Assistance Program, MinnesotaCare, UCare Connect and Minnesota Senior Care Plus.

UCare covers FDA-authorized over-the-counter tests for COVID-19 when they are ordered or prescribed by a physician or licensed provider and obtained from a participating pharmacy. These tests are available at no cost to the member.

  • Members cannot be reimbursed for tests they purchase with their own money, even if the member has a prescription for the test.
  • Coverage is limited to eight tests every 30 days for each individual member (a two-pack counts as two tests).
  • If additional tests are needed, they must be authorized in advance.

UCare Individual & Family Plans
Members can obtain up to eight FDA-authorized over-the-counter tests for COVID-19. These test are available at no cost to the member every 30 days without a prescription.

  • Participating pharmacies - members can obtain tests at no cost when they show their ID card at the pharmacy counter.
  • Retail stores or online vendors - members who purchase FDA-authorized tests from a retail store or online vendor may request reimbursement for actual costs up to $12 per test. Additional information is available on UCare’s website.
  • Express Scripts Mail Order Pharmacy - members can order tests through UCare’s pharmacy benefit manager, Express Scripts. Members access this option through their UCare member online account or by contacting Express Scripts directly. Members will need to create an online account.

Member Out of Pocket Expenses
Effective Jan. 1, 2022, UCare will no longer waive coinsurance, copays and deductibles for Individual and Family Plan (IFP) members for in-network inpatient and hospital observation services to treat COVID-19. UCare will continue to waive coinsurance, copays and deductibles for in-network hospital observation and inpatient services to treat COVID-19 through the COVID-19 public health emergency for members in UCare Medicare Plans and State Public Programs plans.

If a member goes to the emergency department for treatment and is not admitted as an inpatient or placed under observation, cost sharing will continue to apply according to the terms of the member’s EOC/member contract for services provided in the emergency department.

UCare will continue to cover copays, coinsurance or deductibles for provider-ordered COVID-19 tests meeting Centers for Disease Control and Prevention (CDC) guidelines for members in all our plans, through the COVID-19 public health emergency.

At this time, UCare will cover copays, coinsurance or deductibles for medically necessary clinic and urgent care visits when a COVID-19 test is administered for members in all UCare plans.

Changes in Billing for COVID-19 Vaccines and Monoclonal Antibodies
Effective Jan. 1, 2022, UCare is responsible for the payment of COVID-19 vaccines, vaccine administration, monoclonal antibodies and administration of monoclonal antibodies for all products. Providers should not bill UCare for vaccines or antibodies they received for free.

For UCare Medicare Plans, effective March 1, 2020, and through the COVID-19 public health emergency, for the laboratory services outlined below, UCare will not impose any ICD-10 diagnosis restrictions, including screening diagnosis codes:

  • U0001 – U0004 - Diagnostic panels
  • 87635, 86328, and 86769 - Laboratory studies
  • G2023 and G2024 - Specimen collection codes

CPT/HCPCS for COVID-19 Related Services
Diagnostic Testing (All UCare Products)

  • U0001 – Coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
  • U0002* - Validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)
  • U0003 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01- processing more than 200 specimens per day). Effective Jan. 1, 2021, HCPCS code U0005 should be submitted as an add-on code, when appropriate.
  • U0004 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R (processing more than 200 specimens per day). (Effective April 14, 2020)
  • U0005 –Add-on code to U0003, when the laboratory:
  • --Completes the test in two calendar days or less; and

    --Completes the majority of their COVID-19 diagnostic tests that use high throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month (Effective Jan. 1, 2021, for UCare Medicare and Individual and Family Products)

  • 0202U - Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected (Effective May 20, 2020)
  • 0223U- Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected (Effective June 25, 2020)
  • 0225U - Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected (Effective Aug. 10, 2020)
  • 0240U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected (Effective Oct. 6, 2020)
  • 0241U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected (Effective Oct. 6, 2020)
  • 87426- Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) (Effective June 25, 2020)
  • 87428–Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B (Effective Nov. 10, 2020)
  • 87635* Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique (Effective Feb. 4, 2020)
  • 87636 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) (Coronavirus disease [COVID19]) and influenza virus types A and B, multiplex amplified probe technique (Effective Oct. 6, 2020)
  • 87637 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) (Coronavirus disease [COVID19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique (Effective Oct. 6, 2020)
  • 87811 – Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (Effective Oct. 6, 2020)

Specimen Collection (All UCare Products)

Three codes are available for specimen collection:

  • G2023-Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024-Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
  • C9803- Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

99211 may be billed for a specimen collection in an office place of service.

Antibody Testing (All UCare Products)

The following codes are available for antibody testing:

  • 0224U - Antibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed (Effective June 25,2020)
  • 86328-Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (Effective April 10, 2020)
  • 86413 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative (Effective Sept. 8, 2020)
  • 86769 – Antibody testing using multiple-step method; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (Effective April 10, 2020)

*Effective with dates of service on or after March 20, 2020, HCPCS codes U0002 and 87635 must have the –QW modifier appended for them to be recognized as a test that can be performed in a facility having a CLIA certificate of waiver.

COVID-19 Vaccines (All Products)

UCare will be following State and Federal guidelines regarding the coverage, availability, and distribution of vaccines. When providers receive COVID-19 vaccines free of charge, UCare members are to receive the vaccine free of charge.

UCare will add additional vaccines and vaccine administration codes as new vaccines are approved for emergency use.

COVID-19 vaccines can be furnished at temporary expansion sites including gymnasiums, or other non-clinical locations, as well as those established by the state, Army Corp of Engineers, or other governmental agencies.

UCare cannot accept roster billing for vaccines; continue to follow standard billing guidelines when submitting services to UCare.

Listed below are the codes that should be used when billing for COVID-19 vaccines:

Code Vaccines

Description

Effective Date 
0001A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose 12/11/2020
0002A

Pfizer

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose 12/11/2020
0003A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose 8/12/2021
0004A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose 9/22/2021
0011A Moderna Moderna Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose 12/18/2020
0012A Moderna Moderna Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose 12/18/2020
0013A Moderna Moderna Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose 8/12/2021
0031A Janssen Janssen Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage; single dose 2/27/2021
0034A Janssen  Janssen Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage; booster dose 10/20/2021
0051A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose 1/3/2022
0052A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose 1/3/2022
0053A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose 1/3/2022
0054A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose 1/3/2022
0064A Moderna Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage; booster dose 10/20/2021
0071A  Pfizer  Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose 10/29/2021
0072A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose 10/29/2021
0073A Pfizer Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose 1/3/2022
91300 Pfizer Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use 12/11/2020
91301 Moderna Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use 12/18/2020
91305  Pfizer Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use 1/3/2022
91306 Moderna Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use 10/20/2021
91307 Pfizer Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use 10/29/2021
M0201 Home Vaccine Admin Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home 6/8/2021

M0201 Administering the COVID-19 Vaccine in the Patient’s Home

M0201 - Covid-19 vaccine home administration, Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home. (Effective June 8, 2021)
M0201 is an add-on code and must be billed with the product specific vaccine and vaccine administration code.

Billing Guidelines for M0201 (UCare Medicare Products, Dual Integrated Products When Medicare is the Primary Benefit, and UCare Individual and Family Products)

You must bill the product and dose specific vaccine and vaccine administration codes and HCPCS code M0201 for the additional payment amount for administering the COVID-19 vaccine in the home. Additional billing guidelines for M0201 are:

  • Bill for the additional in-home payment amount only if the sole purpose of the visit is to administer a COVID-19 vaccine. You shouldn’t bill for the additional amount if you provide and bill UCare for another service in the same home on the same date.
  • Bill for the additional payment amount only once per home per date of service for dates of service between June 8 and August 24, 2021. For dates of service on or after August 24, 2021, UCare will allow the additional payment for up to a maximum of 5 vaccine administration services per home unit or communal space within a single group living location; but only when fewer than 10 Medicare patients receive a COVID-19 vaccine dose on the same day at the same group living location. When 10 or more Medicare patients receive a COVID-19 vaccine dose at a group living location on the same day, the additional payment can only be billed once per home (whether the home is an individual living unit or a communal space).
    • Bill the HCPCS Level II code (M0201) only 1 time for the additional payment rate if the date of service is between June 8, 2021 and August 24, 2021. For dates of service on or after August 24, 2021, if fewer than 10 Medicare patients are vaccinated on the same day in the same group living location, report the HCPCS Level II code M0201 for each Medicare patient vaccinated in each home that day, and up to a maximum of 5 times when multiple Medicare patients are vaccinated in the same home unit or communal location. 

UCare Medicare Products and State Public Programs Products that Includes Medicare as a Primary Benefit (Dual Eligible Product)

Claims for COVID-19 vaccines and vaccine administration should not be billed to UCare. Claims should be submitted directly to the Center for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). The MAC will reimburse vaccine administration claims with no cost share (copayment, coinsurance or deductible) for the remainder of 2020 and through 2021. CMS information about Medicare Billing for COVID-19 Vaccine Shot Administration and COVID-19 vaccines can be found here, and additional information is available here.

State Public Programs and UCare Individual and Family Plan Products

UCare will cover vaccine administration services for COVID-19 vaccines that have received approval under a federal Emergency Use Authorization (see codes listed above).

At this time the COVID-19 vaccine is currently being furnished to providers free of charge and should not be submitted to UCare for payment. If a claim for the vaccine (see codes listed above) is submitted to UCare the service will be denied.

COVID-19 vaccines can be furnished at temporary expansion sites including gymnasiums, or other non-clinical locations, as well as those established by the state, Army Corp of Engineers, or other governmental agencies. When submitting a professional claim, providers should use the most appropriate place of service code, including place of service 60 (Mass immunization center), when applicable.

UCare cannot accept roster billing for vaccines, continue to follow standard billing guidelines when submitting services to UCare.

COVID-19 Monoclonal Antibodies

UCare covers monoclonal antibody treatments that are authorized by the FDA. Treatments for COVID-19 are continually changing. Providers are encouraged to access up-to-date information at Coronavirus Disease 2019 (COVID-19) | FDA. COVID-19 monoclonal antibodies should be used for all UCare products.

Code Monoclonal Antibodies Effective Date 
Q0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg 12/8/2021
M0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring 12/8/2021
M0221 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency 12/8/2021
Q0222  Injection, bebtelovimab, 175 mg 2/11/2022
M0222 Intravenous injection, bebtelovimab, includes injection and post administration monitoring 2/11/2022
M0223 Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency 2/11/2022
Q0247 Injection, sotrovimab, 500 mg 5/26/2021
M0247 Intravenous infusion, sotrovimab, includes infusion and post administration monitoring 5/26/2021
M0248 Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency 5/26/2021
Q0249 Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg 6/24/2021
M0249 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose  6/24/2021
M0250 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose 6/24/2021

Codes Suspended by CMS as of 1/24/2022

[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, this product isn’t currently authorized in any U.S region and may not be administered for treatment or post-exposure prevention of COVID-19 under the EUA until further notice by the FDA.

Q0240 Injection, casirivimab and imdevimab, 600 mg  
M0240  Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses  
M0241 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses  
Q0243 Injection, casirivimab and imdevimab, 2400 mg  
M0243 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring  
Q0244 Injection, casirivimab and imdevimab, 1200 mg  
M0244 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency  
Q0245 Injection, bamlanivimab and etesevimab, 2100 mg  
M0245 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring  
M0246 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency  

UCare Medicare Products and SPP Products that Include Medicare as a Primary Benefit (Dual Eligible Product) – Billing Information

Per communication from CMS, providing services should submit claims for monoclonal antibodies to treat COVID-19 that are covered by Part B in accordance with Section 3713 of the CARES Act to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

Remdesivir (Veklury®) and other Treatment of COVID-19 (All UCare Products)

UCare covers current FDA-approved inpatient and outpatient indications for Remdesivir (Veklury®) J0248.

UCare covers COVID-19 convalescent plasma in the inpatient and outpatient setting C9507. 

99072 for Additional Supplies, Materials, and Clinical Staff Time Over and Above Those Usually Included in an Office Visit or Other Non-Facility Service(s), When Performed During a Public Health Emergency as Defined by Law, Due to Respiratory-Transmitted Infectious Disease
UCare (Medicare Advantage, and Individual and Family Products)

No separate payment will be made for CPT code 99072 billed for the supplies and clinical staff time to perform safety protocols during the public health emergency. These services are included in the service or procedure furnished to the patient.

UCare State Public Programs

Effective for dates of service March 1, 2021, and thereafter, UCare will consider CPT code 99072 billed for PPE services/items incidental to the primary service furnished by the provider. CPT code 99072 billed with dates of on or after March 1, 2021, will be denied.

99702 for PPE services/items are covered for dates of service Sept. 8, 2020, through Feb. 28, 2021.

Retroactive for dates of service on or after September 8, 2020, and until the peacetime emergency is suspended, CPT code 99072 will be covered when providers are billing for the additional supplies and staff-time associated with providing care for COVID-19. UCare requires information in the comment field of the 837-P that indicates providers are billing PPE and/or additional staff time. If there is no information the comments field, the claim may be denied.

Modifier CS (UCare Medicare Plans and UCare Individual & Family Plans Products)

Effective for dates of service starting March 18, 2020, and through the public health emergency, UCare waived member cost-share for services related to testing and evaluation of COVID-19. The most current list of CMS waivered services can be found here.

The -CS modifier should only be used when related to COVID-19 testing for the CMS list of waivered services. Based on internal review of claims, we are finding that providers are appending the CS modifier in situations where no testing has been done, the service provided is not waiver eligible, and/or the diagnosis is unrelated to COVID-19. As a result, UCare may audit previously paid claims and make any necessary adjustment to claims if they do not meet the criteria for COVID-19 waivered services.

Pricing

Refer to your UCare Provider Contract for specific information regarding fee schedules and pricing.

Interpreter Services (State Public Programs)

Effective for dates of service June 1, 2021, and through the COVID-19- PHE, UCare will cover interpreter services provided telephonically for any covered medical condition to eligible UCare members. Interpreter services are limited to 4 hours per patient encounter and should be billed using the 837-P format, using HCPCS code T1013 appended with the -U4 modifier. The allowed amount for telephonic interpreter services will be the same as if the service was provided face-to-face.

Disaster Related (DR) Condition Code and Catastrophe/Disaster (CR) Modifier – UCare Medicare Plans

With the exception of telehealth eligible services, use of the “DR” condition code and “CR” modifier are mandatory for facility and professional providers in billing situations related to COVID-19 for any claim for which Medicare payment is conditioned on the presence of a formal waiver.

The DR condition code is used only for facility billing when claims are submitted using the 837-I institutional claim format.

The –CR modifier is used by both facility and professional providers to identify Part B line item services/items in billing situations related to COVID-19 waiver. See the grid to identify when the –CR Modifier and DR condition code should be used.

The DR condition code and –CR modifier are used to identify claims associated with waivered services and are informational. Claims will not be denied if the condition code or modifier are not submitted on the claim.

Sequestration

UCare follows CMS guidelines regarding sequestration.

Increase to the MS-DRG for Confirmed COVID-19 Cases - UCare Medicare Plans and Individual & Family Plans Products

Effective for hospital discharges on Jan. 27, 2020, and through the COVID-19 public health emergency, the weighting factor of the assigned Diagnosis-Related Group (DRG) to inpatient claims for individuals diagnosed with COVID-19 will be increased by 20 percent (20%). The increase will be accomplished by implementing an adjustment factor to increase the MS-DRG relative weight applied when determining IPPS operating payments (labor and supply costs) for hospital discharges described above.

Discharges of an individual diagnosed with COVID-19 will be identified by the presence of the following diagnosis codes:

  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after January 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID -19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency.

The links below offer additional ICD-10 CM coding guidance:

Remote Patient Monitoring - UCare Medicare Plans and Individual & Family Plans Products

Through the COVID-19 public health emergency eligible providers can furnish remote patient monitoring services to both new and established patients. These services can be provided for both acute and chronic conditions, and can be provided for patients with only one disease. Providers may bill the following CPT codes:

  • 99091 - Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
  • 99454 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

Note: CPT guidelines indicates remote physiologic monitoring service described by CPT code 99454 cannot be reported for monitoring of less than 16 days. For purposes of treating suspected COVID-19 infections, services can be reported for time periods of less than 16 days as long as the other code requirements are met.

  • 99457 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
  • 99458 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)
  • 99473 - Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration
  • 99474 - Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
  • 99493 - Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
  • 99494 - Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure).

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