Cost-sharing waivers for COVID-19 testing begin to expire Thursday, May 11
Waived cost-sharing for telehealth services remains through May 11, 2023
Public health emergency ending
The federal public health emergency (PHE) is ending on Thursday, May 11. During the PHE, cost-sharing for COVID-19-specific services (e.g., testing, vaccines, treatments and telehealth services) was waived. After the PHE ends, Geisinger Health Plan will continue to cover the cost of vaccinations. However, cost-share for inpatient treatment and COVID-19 testing performed at a provider, urgent care or pharmacy will be reinstated. Members will be responsible for their plan-specific copay, coinsurance or deductible.
Coronavirus information for providers
Updated March 14, 2023
The Department of Health and Human Services is planning for the federal public health emergency (PHE) for COVID-19 to expire on Thursday, May 11. Geisinger Health Plan (GHP) members will continue to get the care they need as the PHE unwinds — we’ll work with you, our healthcare providers, to make sure of it.
GHP’s COVID-19 response
Vaccine
Geisinger Health Plan members have no cost-sharing for the COVID-19 vaccine. Learn more about COVID-19 vaccination below.
Waived member cost-sharing for COVID-19 testing ends Thursday, May 11, 2023 (except for GHP Family and GHP Kids)
- Members currently do not pay for a diagnostic COVID-19 test. Members also do not pay a visit fee to a primary care provider, urgent care center or ER if they are tested for COVID-19. These cost waivers will remain in effect until Thursday, May 11 (applicable to most Geisinger Health Plan members, including self-insured/TPA groups). For GHP Family (Medicaid) and GHP Kids (CHIP) members, these waivers will remain in place through Monday, Sept. 30, 2024.
GHP does not cover population surveillance testing or other screening testing performed for non-diagnostic purposes or without suspicion of infection and individual clinical assessment.
- Cost-sharing for antibody tests is also waived through Thursday, May 11, for non-Medicaid/CHIP members. The waiver remains in place through Monday, Sept. 30, 2024, for GHP Family and GHP Kids members.
- During the pandemic, Geisinger Health Plan waived COVID-19-member cost-sharing — such as deductibles, copays and coinsurance — for in-network inpatient treatment of COVID-19. These waivers were benefit enhancements that were not mandated by the CARES Act or other guidance. Last September, these enhancements ended. Cost-sharing was reinstated for all in-network inpatient treatment for COVID-19 beginning on or after Sept. 1, 2022 (except monoclonal antibody treatment).
Members may call the number on their member ID card for more details.
PROMISe ID service location requirement
- PROMISe ID and related requirements were reinstated for GHP Family and GHP Kids claims with dates of service on or after Sept. 1, 2021. As of Feb. 27, DHS has reinstated all pre-pandemic requirements for enrollment (MA Bulletin 99-22-11). More information is below.
Prior authorization
Prior authorization will not be a barrier for any COVID-19 related testing or treatment. GHP will not subject COVID-19 related testing or treatment to prior authorization.
*Prior authorization for in-network SNF admissions reinstated April 1, 2022.
In 2021, we temporarily removed the prior authorization requirement for admissions to participating skilled nursing facilities (SNFs) for all plans and all diagnoses. As of April 1, 2022, prior authorizations for in-network SNF admissions for all members and all diagnoses should be obtained, as they were before the temporary waiver. SNF admissions are still required to meet medical necessity criteria outlined in medical policy MP332.
*Medicaid note: Prior authorization for Medicaid services was suspended in accordance with DHS guidance in 2020. All services that formerly required prior authorization again require prior authorization for dates of service as of July 1, 2021, and beyond. COVID-19-related testing and treatment are still exempt from prior authorization requirements until further notice.
Coverage for at-home COVID-19 test kits
Cost-sharing waivers for over-the-counter, at-home COVID-19 test kits, remain in place until Thursday, May 11, 2023. Learn more about coverage for at-home COVID tests.
Prescription refills
The early refill allowance for 30 or 90-day prescriptions at retail and mail-order pharmacies will end Thursday, May 11, 2023. Members are encouraged to ask about and use home delivery, when available, for their prescriptions. Early refills are available for controlled substances, but will not apply for prescriptions containing opioids outside of certain conditions.
Telehealth
Waived cost-sharing for telehealth services remains through May 11, 2023. Learn more on how GHP is addressing telehealth services below.
The Centers for Medicare and Medicaid Services (CMS) has changed the billing process for COVID-19 vaccination administration and monoclonal antibody therapy treatments. If you administer COVID-19 vaccinations and/or monoclonal antibody therapy treatments to Geisinger Gold members on or after Jan. 1, 2022, you’ll need to bill Geisinger Gold. Previously, providers were directed to bill Medicare for COVID-19 vaccination administration and monoclonal antibody therapy treatments.
Visit CMS for more information regarding billing for COVID-19 vaccine administration and monoclonal antibody infusion.
Visit our COVID-19 vaccine resource page to provide your patients with the latest information and updates.
Member cost-sharing
There will be no member cost-sharing for the COVID-19 vaccine for any line of business. TPAs cannot opt out of this waiver.
Vaccine cost
Currently, FDA-approved COVID-19 vaccine doses are being paid for with U.S. taxpayer dollars. There is no reimbursement for COVID-19 vaccine doses supplied to a provider at no cost.
Vaccine administration and reimbursement
GHP will reimburse CDC COVID-19 vaccination program providers for the administration of FDA-approved COVID-19 vaccine administration in accordance with appropriate state and federal agency guidance. Payment for administration is based on contracted rates or CMS published rates, as applicable.
Who to bill
|
Plan type |
Who to bill |
Vaccine administration reimbursement |
Member cost-sharing |
|
Medicare Advantage – Geisinger Gold |
Geisinger Health Plan (as of Jan. 1, 2022) |
None – no member cost-sharing for vaccine or administration whether received in or out of network |
|
|
Medicaid and CHIP –GHP Family and GHP Kids |
Geisinger Health Plan |
Based on your contracted rate and the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines. |
None – no member cost-sharing for vaccine or administration whether received in or out of network |
|
Commercial employer and individual plans – Geisinger Health Plan and Geisinger Marketplace |
Geisinger Health Plan |
In-network based on contracted rates
Out-of-network based on CMS rates |
None – no member cost-sharing for vaccine or administration whether received in or out of network |
|
Self-funded TPA plans |
Geisinger Health Plan |
In-network based on contracted rates
Out-of-network based on CMS rates |
None – no member cost-sharing for vaccine or administration whether received |
Members can receive telehealth services through their in-network provider or through our vendor, Teladoc. We have waived cost-sharing for telehealth services through Thursday, May 11, 2023.
GHP’s Teladoc service offerings
We’re encouraging members to get care through Teladoc in two convenient ways:
- Online: Visit teladoc.com to download the Teladoc smartphone app. Use the app to create an account, fill out a short medical history questionnaire and schedule an online doctor visit. This is the fastest way to get in touch with a doctor. Teladoc will provide an estimate of when a doctor will contact them.
- By phone: Call 800-TELADOC to request a call from a doctor. Teladoc will provide an estimate of when a doctor will contact them.
In-network provider telehealth services
GHP will cover in-network telehealth and virtual care services that allow members to avoid unnecessary trips to the office. This includes telehealth services for any physical or behavioral health diagnosis, virtual screenings for COVID-19, and other routine medical needs such as cold, flu, allergy, rash or sinus infection.
Our goal is to make sure members get the care they need — through telehealth or otherwise — and we’ll continue to work with providers to address concerns about coverage and reimbursement.
Telehealth billing advice
- To bill standard E&M codes or outpatient behavioral health therapy codes as telehealth services, providers must do both of the following:
- Bill the same location code that would be billed for an in-person visit.
- Add modifier 95 to indicate telehealth services.
- In accordance with CMS as of April 1, 2022, location code 02 has been redesignated and location code 10 has been introduced. Location code 02 now refers to telehealth provided other than in a patient's home, and location code 10 to telehealth provided in a patient's home. You can continue to bill telehealth services with location code 02 or 10 as appropriate. Services billed with location code 02 or 10 are generally paid at a lesser rate.
- For a brief virtual visit, bill code G20120.
- Medicare has approved the initial Annual Wellness Visit (AWV) code G0438 as a telehealth service. GHP will also accept subsequent AWV code G0439 as a telehealth service for Geisinger Gold members.
DHS revalidation and other enrollment requirements reinstated
In April 2020, to mitigate the effects of the COVID-19 crisis, the Centers for Medicare and Medicaid Services (CMS) approved the PA Department of Human Services' (DHS) request for provider enrollment flexibilities (Provider Quick Tip 240). These flexibilities waived the application fees and allowed some providers to enroll provisionally and temporarily.
Starting Feb. 27, 2023, DHS will reinstate all pre-pandemic requirements for enrollment (MA Bulletin 99-22-11).
Providers must revalidate enrollment for each service location every 5 years (MA Bulletin 99-16-10).
DHS has issued additional information on how to check the status of your enrollment (Provider Quick Tip 265).
GHP Family and GHP Kids reinstated PROMISe ID verification requirements as of Feb. 27
On March 15, 2020, GHP Family (Medical Assistance) and GHP Kids (CHIP) suspended PROMISe ID verification claim edits to offer providers maximum flexibility in fighting the COVID-19 pandemic.
In conjunction with DHS lifting COVID-19 emergency measures, GHP Family and GHP Kids put PROMISe ID verification claim edits back into place for dates of service on or after Feb. 27 of this year.
As of Feb. 27, all facilities, offices, individual providers and other practitioners who render, order, refer or prescribe items or services to GHP Family and GHP Kids members must be enrolled with DHS with a valid PROMISe ID specific to each practice location — for claims to pay.
ORP provider billing requirement reinstated
The PA Department of Human Services (DHS) has issued a notice reinstating the requirement to include the NPI of ordering, referring and prescribing (ORP) providers on Medical Assistance claims, including your claims for GHP Family members. The ORP requirement was previously relaxed in response to the COVID-19 pandemic.
Claims for encounters on or after Jan. 1, 2021, where the ORP provider is required but do not contain the NPI for the ORP provider, may be affected. A valid NPI is needed for the provider types and specialties listed in the PH and CH ORP Required PT-SP Chart.
The ORP requirement will be applied to GHP Family claims as of March 15, 2021. We will not reprocess GHP Family claims that have already been adjudicated.
- If your GHP patient has questions about their coverage, they should call the customer service phone number on the back of their member ID card.
- View the CMS COVID-19 vaccine toolkit for healthcare providers for details on vaccine administration and billing.
- If you have any questions or concerns about COVID-19, visit the CDC website at cdc.gov/coronavirus for current news, testing information and prevention guidelines.
- The Pennsylvania Department of Health website also offers a robust supply of printable and shareable fact sheets, covering just about every topic that COVID-19 may impact.
- Neighborly is a resource page that helps individuals and families find free or reduced-cost services in their communities. They can search for local resources to access food, housing, childcare, transportation, utility assistance, healthcare, financial assistance and other needs. Visit Neighborly.