Many health insurers in Texas are waiving patient costs associated with COVID-19.
On March 10, Gov. Greg Abbott and the Texas Department of Insurance (TDI) asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention (CDC) guidance, and telemedicine visits. TDI also asked insurers to:
- Cover necessary medical equipment, supplies, and services;
- Waive penalties, restrictions, and claims denials for necessary out-of-network services;
- Waive requirements for preauthorization, referrals, notification of hospital admission, or medical necessity reviews for care consistent with CDC guidance;
- Allow extra time for physicians and facilities to file claims; and
- Authorize payment to pharmacies for up to a 90-day supply of any prescription medication for individuals, regardless of when the prescription was filled.
The governor has asked the Employees Retirement System of Texas, the Teacher Retirement System of Texas, the Texas A&M University System, and The University of Texas System to provide these same benefits to employees and retirees covered by their PPO and HMO plans.
Health Plans in Texas
While meeting the governor’s and TDI’s requests is voluntary, these payers have announced the following policies related to COVID-19:
- Testing: Aetna will waive copays for all diagnostic testing related to COVID-19 for all commercial, Medicare, and Medicaid managed care plans. The test can be done by any approved testing facility. This requirement also applies to self-insured plans.
- Treatment: Aetna will waive member cost-sharing for inpatient admissions at all in-network facilities for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured commercial and Medicare Advantage plans and is effective for any such admission through Sept. 30. For Medicare Advantage plans, effective May 13 through Sept. 30, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason,
- Telemedicine: Aetna commercial plans’ waiver of Aetna’s member cost-sharing for telemedicine visits ended June 4. For these plans, Aetna will continue to cover limited minor acute care evaluation and care management services rendered via telephone until Aug. 4. Aetna reimburses all physicians and providers for telemedicine at the same rate as in-person visits. See Aetna’s telemedicine FAQs for a list of telehealth codes you can bill.
Blue Cross and Blue Shield of Texas
- Testing: Blue Cross and Blue Shield of Texas (BCBSTX) covers testing to diagnose COVID-19 for its members with no prior authorization needed and no member copays or deductibles.
- Treatment: For treatment of COVID-19, BCBSTX is temporarily waiving member cost-sharing, including copays, deductibles, and coinsurance. The waiver applies to treatment with physicians and providers, including facilities, from April 1 to June 30, so long as the treatment is consistent with the terms of the member’s benefit plan. BCBSTX says it will reassess this waiver as events warrant. The policy applies to commercial, Medicare, Medicare supplement, and Medicaid plans.
- Telemedicine: Telemedicine/telehealth visits are covered as a regular office visit for physicians who offer the service through two-way live interactive telephone or digital video consultations; BCBSTX says audio-only consultations will be covered on a temporary basis when provided in accordance with applicable regulations and rules. There is no member cost-sharing for covered, medically necessary medical services delivered via telemedicine or telehealth by a qualified in-network physician. BCBSTX will pay in-network physicians at least the same rate for a telemedicine/telehealth service as it pays for the same service when provided in person. BCBSTX is recognizing CPT evaluation and management (E&M) codes 99201-99215 billed with place of service code (POS) 02 or the POS the physician typically bills for in-person visits, along with applicable modifiers -95,-GQ, or -GT with associated codes. BCBSTX also covers telephone evaluation codes 99421-99423. BCBSTX’s telemedicine policy applies to commercial plans through July 31 and Medicare Advantage plans through Dec. 31.
- Testing and treatment: Cigna will waive patient cost-sharing related to COVID-19 screening, Food and Drug Administration (FDA)-approved testing, and treatment for its commercial members through July 31. For Medicare Advantage customers, patient cost-sharing is waived until Dec. 31 for FDA-approved tests performed by a CLIA-certified lab. Patient cost-sharing also is waived for these customers, for in-network and out-of-network physicians, until Dec. 31
- Telehealth: As of March 6, Cigna allows physicians to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19. This means you can perform services for commercial Cigna customers in a virtual setting and bill as though you performed them face to face. Bill using a face-to-face E&M code with modifier -GQ, and use the place of service code you typically would bill if the service were delivered face to face. Claims will be processed consistent with these rules for dates of service March 2 until at least July 31.
You also can bill HCPCS virtual check-in code G2012 for five- to 10-minute phone conversations with a patient, and Cigna will waive cost-sharing for the patient. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults. See also Cigna’s Medicare Advantage billing and authorization guidelines.
- Testing: Humana fully covers COVID-19-related testing, including viral panels that rule out COVID-19. This applies to Humana’s Medicare Advantage, Medicaid managed care, and commercial employer-sponsored plans. Cost-share waivers apply to lab testing, specimen collection, and certain related services that result in the ordering or administration of the test, including physician office or emergency department visits. This policy applies retroactively to services delivered on or after Feb. 4, 2020. See the Humana website for a chart showing which HCPCS or CPT codes lab providers should use to bill COVID-19 testing, as well as how to submit charges for COVID-19 specimen collection services. Append modifier CS to a claim line to identify a service as related to COVID-19 testing and therefore subject to the cost-sharing waiver.
- Treatment: Humana is waiving consumer costs for treatment related to COVID-19-covered services, including inpatient hospital admissions, for enrollees of Medicare Advantage plans, fully insured commercial members, Medicare supplement, and Medicaid managed care. The waiver applies to all medical costs as well as FDA-approved medications or vaccines when they become available. There is no current end date. In addition, Humana is waiving member cost share for all in-network primary care visits retroactive to May 1.
- Telemedicine: Humana will waive patient cost-sharing for telehealth visits with all participating/in-network providers, including primary care, through the end of the year. Humana will follow Centers for Medicare & Medicaid (CMS) rules and temporarily pay for telehealth visits with participating/in-network providers at the same rate as in-office visits. Telehealth visits must be medically necessary and meet all applicable coverage guidelines. For physicians or patients without access to secure video systems, Humana also will temporarily accept telephone (audio-only) visits; these visits can be billed as telehealth visits. See Humana’s telehealth FAQs for details.
Visit Humana's coronavirus webpage for the payer’s latest information.
Molina Healthcare is waiving all member costs associated with coronavirus testing. Any related visit to a primary care doctor, urgent care, or emergent care does not require prior authorization.
Oscar will waive cost-sharing for physician-recommended diagnostic testing for COVID-19. Oscar will waive cost-sharing for its individual and small group members for the treatment of COVID-19 through July 31 when delivered by in-network physicians. At out-of-network facilities, the cost share will be waived with prior authorization. Most plans also already provide zero-pay telemedicine services. See Oscar’s resource center for more information.
- Testing: During the national public health emergency period, UnitedHealthcare (UHC) will cover medically necessary COVID-19 virus detection and antibody testing with no cost-sharing when ordered by a physician or health care professional for purposes of diagnosis or treatment of an individual member. Tests must be FDA-approved. UHC is requesting physicians who perform and bill for COVID-19 antibody tests to register the tests you use with UHC; see the UHC website for instructions. UHC also has waived cost-sharing for testing-related visits, whether at a physician’s office, an urgent care center, an emergency department, or through a telehealth visit (including audio-only) – for its fully insured individual and group plans Medicaid, and Medicare Advantage members, and optionally for self-funded plans.
- Treatment: UHC is waiving patient cost sharing waiver for COVID-19-related care and treatment for in-network and out-of-network services through July 24. Some services or facility exclusions may apply. This applies to Medicare Advantage, Medicaid, and individual and group market fully insured health plans. In addition, UHC will waive all specialist and primary care physician cost-sharing for its Medicare Advantage customers from May 11 at least through Sept. 30.
- Telemedicine: UHC, which follows CMS guidelines, is waiving cost-sharing for in-network telehealth medical services, including audio-only for some plans and services, from March 31 until Sept. 30 for Medicare Advantage and commercial fully insured members. For Medicaid plans, UHC will adhere to state-specific regulations for date expansion, billing, and payment. For additional information, see UHC’s COVID-19 Teleheath page. UHC pays for HCPCS virtual check-in code G2012 for established patients.
See also UHC’s summary of COVID-19 policy dates by program
During this public health emergency, physicians and other clinicians can provide an array of services to new and established Medicare patients via telehealth, including emergency department visits, critical care services, and initial hospital care and discharge day management.
In addition, CMS announced that:
- Physicians may supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.
- Physicians and other clinicians may temporarily enroll in Medicare.
- The agency is temporarily eliminating paperwork requirements. Medicare will cover respiratory-related devices and equipment for any medical reason determined by the physician.
- CMS is providing temporary relief from audits.
Telehealth: Physicians can bill for telehealth visits at the same rate as in-person visits. Medicare also will cover audio-only CPT telephone codes 99441-99443 (provided by a physician) and 98966-98968 (provided by a qualified nonphysician professional) for new and established patients, in addition to HCPCS virtual check-in codes G2010 and G2012.
For dates of services on or after March 1 and for the duration of the public health emergency, use the place-of-service (POS) code you would bill if the service were delivered face to face, along with modifier -95, indicating you performed the service via telehealth. Thus, telehealth claims submitted with POS code 11, for example, will pay at the office rate. POS 02 will continue to pay at the facility rate.
Physicians can provide remote monitoring services to patients with acute and chronic conditions, and for patients with only one disease. In addition, certain services no longer have limitations on the number of times they can be provided by Medicare telehealth. They are:
- Subsequent inpatient visits (CPT 99231-99233),
- Subsequent skilled nursing visits (CPT 99307-99310), and
- Critical care consults (CPT G0508-G0509).
Medicaid and the Children’s Health Insurance Program (CHIP): The Federal Families First Coronavirus Prevention Act requires coverage for COVID-19 testing, services, and treatment, including vaccines, without cost-sharing for Medicaid enrollees, and coverage of COVID-19 testing without cost-sharing for CHIP and CHIP-Perinatal enrollees. Medicaid and CHIP health plans have flexibility to provide teleservices, including in a member’s home. For services delivered on March 20 through June 30, physicians may bill codes 99201-99205 and 99211-99215 for telephone (audio-only) medical (physician-delivered) evaluation and management services delivered.
CPT copyright American Medical Association. All rights reserved.