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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 OCTOBER 13, 2021 

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

  • UCare will 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, for the immediate future.
  • During this time, we 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 of our plans.
  • UCare will waive coinsurance, copays and deductibles for in-network hospital observation and inpatient services to treat COVID-19 through December 31, 2021, for members in all of our 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 apply according to the terms of the member’s EOC / member contract for services provided in the emergency department.
  • For UCare Medicare Plans, effective March 1, 2020, and through the COVID-10 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:

Pfizer

Coronavirus Vaccine

  • 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mLdosage, diluent reconstituted, for intramuscular use. (Manufactured by Pfizer, Inc.) (Effective Dec. 11, 2020)

Coronavirus Vaccine Administration Codes

  • 0001A - 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. To be reported for administration of vaccine 91300. (Effective Dec. 11, 2020)
  • 0002A - 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. (Effective Dec. 11, 2020)
  • 0003A – 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, SARSCOV2 30MCG/0.3ML, 3RD Pfizer-Biontech Covid-19 Vaccine Administration – Third Dose. ( Effective August 12, 2021)
  • 0004A – 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, SARSCOV2 30MCG/0.3ML, 3RD Pfizer-Biontech Covid-19 Vaccine Administration – Booster. (Effective Sept 22, 2021)

Moderna

Coronavirus Vaccine

  • 91301 - 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, for intramuscular use (Manufactured by Moderna, Inc.) (Effective Nov. 21, 2020)

Coronavirus Vaccine Administration Codes

  • 0011A - 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.
  • 0012A - 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.
  • 0013A - 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; third dose. (Effective August 12, 2021)

Johnson and Johnson

Coronavirus Vaccine

  • 91303 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage, for intramuscular use. (Effective March 1, 2021)

Coronavirus Vaccine Administration Codes

  • 0031A - Immunization administration by intramuscular injection of SARS-CoV-2 (COVID-19) vaccine, DNA, spike protein, Ad26 vector, preservative free, 5x1010 viral particles/0.5 mL dosage, single dose.

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 M0021 (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 M02021 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

The Food and Drug Administration (FDA) has authorized Emergency Use Authorization (EUA) and approved multiple monoclonal antibody therapies for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients who are at high risk for progressing to severe COVID-19 and/or hospitalization. These agents include the combination of casirivimab and imdevimab, and the combination of bamlanivimab and etesevimab. As of March 24, 2021, the government has halted distribution of bamlanivimab monotherapy, and on April 16, 2021, revoked the EUA for use as monotherapy, due to the increase of resistance of variants. Providers are encouraged to consider local variant trends before using monoclonal antibody therapy. The HCPCS codes listed below for injection or infusion of COVID-19 monoclonal antibodies should be used for all UCare products.

Drug Codes

  • Q0239 – Eli Lilly, Bamlanivimab, Injection, bamlanivimab, 700 mg (Effective 11/10/2020 – 04/16/2021). On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. Due to this revocation, UCare will not pay for claims with HCPCS codes M0239 or Q0239 with dates of service after 4/16/2021.
  • Q0240 – Casirivi and imdevi 600mg, Regeneron, Injection, casirivimab and imdevimab, 600 mg. (Effective 07/30/2021). On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. Due to this update, CMS has issued a new product code for casirivimab and imdevimab of 600 mg (Q0240), and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers and suppliers administering casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose, and M0240 or M0241 for administering.
  • Q0243 - Casirivimab and imdevimab, Regeneron, Injection, casirivimab and imdevimab, 2400 mg. (Effective 11/21/2021)
  • Q0244 - Casirivi and imdevi 1200 mg, Regeneron, Injection, casirivimab and imdevimab, 1200 mg. (Effective 06/03/2021)
  • Q0245 - Bamlanivimab and etesevima, Eli Lilly, Injection, bamlanivimab and etesevimab, 2100 mg. (Effective 02/09/2021)
  • Q0247 – Sotrovimab, GSK, Injection, sotrovimab, 500 mg. (Effective 05/26/2021)
  • Q0249 - Tocilizumab for COVID-19, Genentech, 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. (Effective 06/24/2021)

Administration Codes

  • M0239 – Eli Lilly, Bamlanivimab, Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring. (Effective 11/10/2020 – 04/16/2021). On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. Due to this revocation, UCare will not pay for claims with HCPCS codes M0239 or Q0239 with dates of service after 4/16/2021.
  • M0240 - Casiri and imdev repeat, Regeneron, Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses. (Effective 07/30/2021). On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. Due to this update, CMS has issued a new product code for casirivimab and imdevimab of 600 mg (Q0240), and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers and suppliers administering casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose, and M0240 or M0241 for administering
  • M0241 - Casiri and imdev repeat hm, Regeneron, 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. (Effective 07/30/2021). On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. Due to this update, CMS has issued a new product code for casirivimab and imdevimab of 600 mg (Q0240), and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers and suppliers administering casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose, and M0240 or M0241 for administering
  • M0243 - Casirivi and imdevi injection, Regeneron, Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring. (Effective 11/21/2021)
  • M0244 - Casirivi and imdevi injection hm, Regeneron, 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. (Effective 05/06/2021)
  • M0245 - Bamlan and etesev infusion, Eli Lilly, 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. (Effective 05/06/2021)
  • M0247 - Sotrovimab infusion, GSK, Intravenous infusion, sotrovimab, includes infusion and post administration monitoring. (Effective 05/26/2021)
  • M0248 - Sotrovimab infusion home administration, GSK, Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a member’s home that has been made provider-based to the hospital during the COVID-19 public health emergency. (Effective 05/06/2021)
  • M0249 - Administration Tocilizu COVID-19 1st, Genentech, 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. (Effective 06/24/2021)
  • M0250 - Administration Tocilizu COVID-19 2nd, Genentech, 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. (Effective 06/24/2021)

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®) for Treatment of COVID-19 (All UCare Products)

Veklury® is covered when administered intravenously in an inpatient setting based on the FDA-approved indication for the treatment of adults and pediatric patients (12 years of age and older and weighing at least 40 kg) with COVID-19. Through the COVID-19 public health emergency when there are no available hospital beds, alternatively covered waivered healthcare settings will temporarily be considered an inpatient hospital setting.

At this time there is insufficient evidence of safety and efficacy in patients with mild-to-moderate COVID-19 who do not require hospitalization, as a result UCare does not cover Veklury© in an outpatient setting.

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 has continued to suspend sequestration beyond March 31, 2021, and based on recent notification from CMS will continue to do so through December 31, 2021.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31, 2020. On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law extending the Sequestration suspension period to March 31, 2021. The Sequestration suspension period has been extended to December 31, 2021, for all Medicare impacted claims.

UCare Claim payment system updates are already underway. There is no need to resubmit claims, UCare will reprocess any incorrectly paid claims when system updates are completed.

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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