Waived cost-sharing for telehealth services extended through September 30, 2020
Other existing cost share waivers put into place as a response to the coronavirus outbreak will remain in place until further notice.
Coronavirus Information for Providers
Updated August 4, 2020
Geisinger Health Plan (GHP) is always prepared to handle any public health concern, and that stands true with COVID-19. We continue to monitor the novel coronavirus situation and follow guidance from the Pennsylvania Department of Health and Centers for Disease Control and Prevention. Our goal is to work with healthcare providers to ensure GHP members receive the testing and treatment needed to combat the spread and effects of COVID-19. As we continue to work together in the face of this pandemic, we ask for your continued cooperation and patience.
GHP has taken action
- GHP has waived member cost-sharing for testing and treatment of COVID-19:
- Members will not pay for a diagnostic COVID-19 test. Members will also not pay a visit fee to a PCP, urgent care center, or ER if they are tested for COVID-19.
- If a member is hospitalized for COVID-19, all in-network, inpatient treatment costs will be waived.
- Cost-sharing is also temporarily waived on all telehealth visits with participating providers, for medical or behavioral health needs, whether or not the visit is COVID-19 related.
The cost waivers will be in effect until further notice. This is applicable to all Geisinger Health Plan members. Self-insured/TPA groups may opt-out.
Cost-sharing for antibody tests is also waived. See the diagnostic and antibody testing section below.
Members may call their Customer Care Team at the number on their member ID card for more details.
- PROMISe ID service location requirement: GHP has suspended the PROMISe ID service location requirement on GHP Family and GHP Kids claims for dates of service March 15, 2020 and after. More information 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.
- Prescription refills: We are allowing early refills for 30 or 90-day prescriptions at retail pharmacies. Members are encouraged to ask about and use home delivery when available for their prescriptions. We are also allowing early refills on 90-day prescriptions from our mail order pharmacy, which delivers directly to the member’s home at no extra cost. Early refills are available for controlled substances but will not apply for prescriptions that contain opioids outside of certain conditions.
- Home prescription delivery: We have relaxed restrictions on home prescription delivery. We’re also encouraging eligible members to use the CareSite mail order pharmacy.
- Telehealth: We have waived cost-sharing for telehealth services through September 30, 2020. Learn more on how GHP is addressing telehealth services below.
We understand the important role telehealth services play in keeping both patients and healthcare professionals safe amid the COVID-19 outbreak. GHP will cover telehealth services and member costs will be waived for telehealth visits through September 30, 2020. Members can receive telehealth services through their in-network provider or through Teladoc.
GHP’s Teladoc service offerings
We are 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.
Please note: As the coronavirus outbreak evolves, the need for telehealth care has never been greater. As a result, users may experience extended wait times. The fastest way to connect with a doctor is to use the app or web page.
Learn more about this service at GeisingerHealthPlan.com/Teladoc
In-network provider telehealth services
GHP will cover and waive member cost sharing for any in-network providers who offer 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, sinus infection, etc.
Our goal is to ensure members get the care they need—through telehealth or otherwise—and we will 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 should both:
- Bill the same location code that would be billed for an in-person visit, and
- Add modifier 95 to indicate telehealth services.
- Providers can also choose to continue billing telehealth services with location code 02. Services billed with location code 02 are generally paid at a lesser rate.
- For a brief virtual visit, bill code G2012.
- 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.
We are working closely with the PA Department of Human Services (DHS) to address the needs of GHP Family (Medicaid) and GHP Kids (CHIP) members amid the COVID-19 pandemic. To give healthcare providers maximum flexibility to test for and treat COVID-19, in addition to regular patient care, we are relaxing claim edits related to the PROMISe ID service location registration requirement. This requirement ensures providers are registered for each service location at which they see GHP Family and GHP Kids members. Under normal circumstances, GHP Family and GHP Kids claims submitted by a provider without a service location that can be matched to a location registered for that provider, would be denied.
- Code the reason for encounter and add ICD10 code B97.29: Providers should continue to code the reason for the encounter using current ICD10 diagnosis codes for illnesses such as Pneumonia, Lower Respiratory Infection, etc. and then code B97.29 (Other coronavirus as the cause of diseases classified elsewhere).
- If the provider documents “suspected”, “possible” or “probable” COVID-19, providers should not use B97.29. Instead, providers should assign a code explaining the reason for the encounter such as fever, etc.
- ICD10 diagnosis code U07.1: The World Health Organization has created a new ICD10 diagnosis (U07.1) for COVID-19. This code will be effective and acceptable for use as of April 1, 2020.
- Do not use ICD10 diagnosis code B34.2: Providers should not use diagnosis code B34.2, Coronavirus infection, unspecified. The cases have universally been respiratory in nature and the site would not be “unspecified”.
COVID-19 diagnostic testing
Choose the right diagnostic test for your patient
- Polymerase chain reaction (PCR) test — FDA authorized and the best method to confirm COVID-19 infection
- Antigen test — FDA authorized but inferior sensitivity to the PCR test
- Multi pathogen respiratory panels — not recommended for diagnosing COVID-19
Diagnostic testing codes
CMS released a ruling on April 14, 2020 regarding a payment increase for two new HCPCs codes to encourage COVID-19 testing. The increase in payment reflects the time, enhanced technician training and specialized equipment needed to conduct high-throughput testing. The two new codes created are:
- 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-R.
Providers should report U0003 for services that would normally be reported using CPT code 87635.
- 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.
Providers should report U0004 for services that would normally be reported using code U0002.
COVID-19 antibody testing
Serologic assays, or antibody tests, for COVID-19 — granted an emergency use authorization by the U.S. Food and Drug Administration (FDA) — have become widely available. Despite their availability, federal agencies and public health officials recognize the science around COVID-19 antibody testing is rapidly evolving. In late May, the CDC issued interim guidelines on antibody testing.
CDC guidelines acknowledge limitations of antibody testing
- The CDC does not recommend the use of antibody tests to diagnose a suspected COVID-19 infection. Antibody tests do not conclusively indicate current or previous infections and should not be used as a basis for decisions on grouping, PPE, or returning to work.
- Positive antibody test results do not indicate immunity. Currently, there is no correlation between the presence of antibodies and immunity to COVID-19.
- The reliability of some antibody tests on the market remains in question. Some tests exhibit cross reactivity with other coronaviruses leading to false positives. The FDA continues to review tests and assess current emergency use authorizations.
The CDC recommends these antibody testing strategies
- Choose high-specificity tests.
- Test those with a high likelihood of COVID-19 exposure or previous infection.
- Use 2 independent tests in sequence when the first test is positive but the positive predictive value is low.
- The CDC does not recommend the use of IgA.
What your patients should understand about antibody testing
Although the public interest in COVID-19 antibody testing has grown, it’s important to remember your patients may not fully understand the intent of these tests; or their limitations. When ordering an antibody test, be sure your patients know what their results really mean.
- What a positive COVID-19 antibody test result can tell you:
- At some point in time, you had COVID-19 — but it can’t tell you when you were or if you’re currently infected.
- You have antibodies against COVID-19 — but you’re not necessarily immune to COVID-19.
- You were exposed to someone with COVID-19 — but it can’t tell you who or when; or whether you’ve exposed others.
- What a negative result can tell you:
- No antibodies were found — but that does NOT mean you’ve never had a COVID-19 infection.
Codes to use for antibody testing
- COVID-19 specific codes:
- 86328 Single step method (e.g. reagent strip
- 86769 Multi step method (e.g. ELISA, etc.)
Coverage for COVID-19 antibody testing
Geisinger Health Plan covers COVID-19 antibody testing for members with the following indications:
- A member with symptoms consistent with COVID19 infection and multiple negative PCR tests to COVID-19; or
- A member who has recovered from a documented COVID19 infection and is now considering plasma donation; or
- A child with suspected Multisystem Inflammatory Syndrome in Children (MIS-C
Antibody tests for members must be ordered by a treating clinician. Member cost-sharing for antibody tests is also waived.
Therapeutic protocols for COVID-19 may include the use of albuterol and a combination of hydroxychloroquine and anti-viral therapy in some cases. We remind prescribers that these medications should be used judiciously. Supplies are limited and it is imperative that reserves are maintained for those patients already on these pharmaceuticals for chronic conditions or those who may benefit from its use.
By recommendation of the Pennsylvania Department of Human Services (DHS), new starts of hydroxychloroquine for GHP Family members will be limited to a quantity of 4 tablets per day for up to a 10-day supply. GHP has extended these limits to GHP Marketplace and commercial members as well. Existing prescriptions of hydroxychloroquine and albuterol are limited to a 30-day supply at this time. These limits do not apply to Geisinger Gold.
Providers should also be vigilant about potential fraud, waste and abuse related to these medications. If fraud, waste or abuse is suspected, you can call GHP’s Fraud and Abuse Hotline at 800-292-1627 (calls may be made anonymously).
- 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.
- Visit Geisinger's Coronavirus Resource Center
- If you have any questions or concerns about COVID-19, please 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.
- Geisinger has produced a podcast series featuring Stanley Martin, MD, director of Infectious Diseases at Geisinger, where he discusses coronavirus facts, symptoms, testing and home isolation. These short and informative videos are appropriate for providers, staff and patients. Watch the series.
- As we continue to respond to the COVID-19 crisis, we recognize the need extends well beyond the healthcare setting. 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.