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. This policy will cover the test kit, and the physician visit that results in a COVID-19 test, which can be done at any approved lab location. This requirement also applies to self-insured plans, in alignment with the Families First Coronavirus Response Act.
- Telemedicine: Aetna commercial plans also will waive member cost-sharing for any covered telemedicine visits, regardless of diagnosis, through June 4 through the Aetna-covered Teledoc offerings and in-network physicians. Note that preventive visit codes are not covered. Self-insured plan sponsors will be able to opt out of this program at their discretion. Aetna also has extended its Medicare Advantage virtual evaluation and management (E&M) visit (audio-only phone visit) benefit to all fully insured members. See Aetna’s telemedicine FAQs for a list of telehealth codes you can bill through June 4.
- 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 plan sponsors and is effective immediately for any such admission through June 1.
Remember, Aetna will transition its provider portal from NaviNet to Availity on April 30. You can register for the new portal now. After April 30, you’ll lose your access to Aetna on NaviNet, including electronic transactions for Aetna and Aetna-specific tools. If you submit electronic claims or get electronic remittance advice from NaviNet, start downloading your activity before you lose access.
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 covers medically necessary health benefits, including physician services, hospitalization, and emergency services consistent with the terms of each member's benefit plan.
- 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 E&M codes 99201-99215 billed with place of service code 02 as telemedicine, 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 claims with dates of service beginning March 20.
The company will waive patient cost-sharing related to COVID-19 screening, FDA-approved testing, and treatment through May 31.
In addition, effective 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.
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 orother necessary consults. In addition:
- Cigna has waived all referrals as required by some benefit plans through April 12.
- Authorizations are not required and will not be processed for services requested or delivered by noncontracted physicians through April 12.
- Patient cost-share for COVID-19-related services provided by out-of-network physicians is waived until May 31.
- Patient cost-share is waived for treatment (inpatient and outpatient) of confirmed cases of COVID-19 with dates of service of Feb. 3 to May 31. In-network physicians will be paid for services consistent with their fee schedules. Out-of-network physicians will be paid at 100% of Medicare or Medicaid allowable depending on the customer’s benefit plan.
Find details in Cigna’s billing guidelines and FAQs document.
- 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. See the Humana website for a chart about 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.
- Telemedicine: Humana will follow Centers for Medicare & Medicaid (CMS) rules. Humana will 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.
- 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.
As of May 1 and through the end of the year, Humana is waiving
cost sharing for its Medicare Advantage members for ALL in-network
primary care, behavioral health, and telehealth visits.
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. Most plans also already provide zero-pay telemedicine services. In addition, Oscar has created a resource center.
- Testing: UnitedHealthcare (UHC) has waived cost-sharing for COVID-19 diagnostic testing and 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.
will cover U.S. Food and Drug Administration (FDA)-authorized COVID-19 antibody
tests ordered by a physician or appropriately licensed health care
professional without cost sharing (copay, coinsurance, or deductible). The
coverage applies to Medicare Advantage, Medicaid, individual, and group market
health plans during the national public health emergency period. FDA-authorized
tests are FDA-approved tests and tests used in an office or lab that are
developed and administered in accordance with FDA specifications or through
state regulatory approval. 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
- Treatment: UHC also is waiving members’ costs for treatment of COVID-19 through May 31. 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, announced April 1 it is waiving cost-sharing for in-network telehealth medical services, including audio-only, from March 31 until June 18 for Medicare Advantage, Medicaid, commercial fully insured members. Out-of-network physicians also qualify for telehealth; member benefit and cost-sharing will apply, if applicable. UHC is waiving CMS’ originating site restriction and audio-video requirement from March 18 until June 18. For additional information, see UHC’s: Provider Telehealth Policies). UHC pays for HCPCS virtual check-in code G2012 for established patients.
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 has 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.