COVID-19 Payer Information - Archives

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Past Updates (A-G)        Past Updates (H-N)         Past Updates (O-W)

Absolute Total Care

8/13/2021 - COVID-19 Public Health Emergency Extended by Federal Government. READ MORE

5/4/2020 - Effective immediately, Absolute Total Care will no longer require Medicaid LTC providers to submit a signed Form 181 or Phoenix documentation prior to claims submission for members enrolled in Absolute Total Care’s South Carolina Healthy Connections Prime Medicare-Medicaid Plan. READ MORE

4/20/2020 - Absolute Total Care is providing assistance to network providers in South Carolina who are seeking relief amid the COVID-19 pandemic through the Small Business Administration (SBA) and the CARES Act. READ MORE

3/16/2020 - Waiving cost-sharing for COVID-19 testing or telehealth services. Removing prior authorizations requirements. Expanding access to certain telehealth services. READ MORE

Aetna

1/26/2022 - Medical Clinical Policy Bulletins - Policy 0982 revised 1/26/22 "Remdesivir (Veklury)." READ MORE

Are there any out of pocket costs for Aetna members that receive a COVID-19 vaccine? READ MORE 

Are there any out of pocket costs for Aetna members who go to an in or out of network pharmacy or provider for their vaccine? READ MORE 

Which COVID-19 vaccinations will Aetna cover? READ MORE 

9/1/2021 - How long are Aetna's liberalized coverage of telemedicine services and cost share waivers in effect? READ MORE

9/1/2021 - What were the start and end dates for the telemedicine cost share waiver? READ MORE 

6/30/2021 - How should providers bill for the COVID-19 vaccine and it's administration? READ MORE

6/5/2021 - Will telehealth/telemedicine services pay as a bill above to capitation? READ MORE 

5/27/2021 - Twenty-one pharmacy chains, including CVS, are participating in the Federal Pharmacy Program. READ MORE 

5/27/2021 - Providers should bill for the COVID-19 swab collection using one of these codes. READ MORE 

5/27/2021 - To ensure access for COVID-19 testing and have consistent reimbursement, Aetna will reimburse contracted and non-contracted providers for COVID-19 testing as follows in accordance with the member’s benefit plan. The following rates are used for COVID-19 testing for commercial and Medicare plans, unless noted otherwise. READ MORE

5/12/2021 - Aetna will follow the guidance provided by the CDC and FDA regarding the age of eligibility to receive the vaccine. As of May 12, 2021, children over the age of 12 are eligible to receive the Pfizer BioNTech vaccine. READ MORE

4/23/2021 - Aetna generally does not reimburse doctors and dentists for Personal Protection Equipment. PPE, like other disposable infection control supplies, is part of the cost of the underlying procedure. READ MORE

4/21/2021 - Aetna suspended the 2% sequestration reduction in payments made to providers, to support them during the COVID-19 pandemic. READ MORE

4/14/2021 - Aetna members in Commercial and Medicaid plans will not have to pay any out-of-pocket costs for a COVID-19 vaccine, regardless of whether they go to an in-or out-of-network pharmacy or provider. READ MORE

4/14/2021 - E-Clinic visits are now covered by most Aetna Medicare Advantage plans. READ MORE 

3/16/20201 - Aetna is waiving member cost-sharing related to the COVID-19 vaccination for Commercial and Medicaid members. For Medicare, CMS has indicated it will cover the full cost of the vaccine for all Medicare beneficiaries, including those in a Medicare Advantage plan, in 2020 and 2021. READ MORE

1/21/2021 - What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19 ? (posted 1/21/21). READ MORE 

12/29/2020 - COVID-19 Update 12/29/20 - Medicare Advantage. READ MORE 

12/23/2020 - COVID-19 Vaccine FAQs 12/23/20.READ MORE 

12/14/2020 - Aetna, a CVS Health company, announced that it is waiving member cost-sharing related to the COVID-19 vaccination for Commercial and Medicaid members. READ MORE  

11/30/2020 - Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. READ MORE

11/9/2020 - COVID-19 Updates. READ MORE 

10/30/2020 - Telemedicine Update. READ MORE 

7/9/2020 - Aetna Medicare waives out-of-pocket costs for telehealth services. READ MORE 

6/5/2020 - Q: What are the start and end dates for the telemedicine cost share waiver?  READ MORE

6/5/2020 - Coverage of telemedicine service liberalization will continue through August 4, 2020. READ MORE

6/1/2020 - The use of telemedicine is encouraged as a first line of defense to limit potential COVID-19 exposure in physician offices. Commercial member telemedicine visits are covered with no cost-sharing to the member, until June 4, 2020. READ MORE

6/1/2020 - COVID-19 Telemedicine via telephone update. READ MORE

6/1/2020 - As states recommence elective services, Aetna is resuming standard prior authorization protocols for Post-Acute and Long-Term Care Hospital Admissions effective May 31, 2020, except in certain states with executive orders or DOI mandates in place. READ MORE

5/29/2020 - COVID-19 Testing Locations updated 6/1/2020. READ MORE

5/26/2020 - COVID-19 Provider Facts: READ MORE

5/26/2020 - For Commercial plans, Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until August 4, 2020.  READ MORE

5/18/2020 - Aetna will cover appropriate evaluation and management codes with a wellness diagnosis for those aspects of the visit done via telehealth.  READ MORE

5/14/2020 - Through September 30, 2020 Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient and mental health counseling services for the Commercial plans. READ MORE

5/11/2020 - Until June 4, 2020, Aetna will waive member cost sharing for any in-network covered telemedicine visit - regardless of diagnosis - for their Commercial plans.  

5/6/2020 - Aetna is resuming their standard prior authorization protocols for inpatient admission effective May 7, 2020.

5/4/2020 - Per guidance from the Centers of Medicare & Medicaid Services (CMS), the Department of Labor and the Department of the Treasury, all Commercial and Medicaid plans must cover serological (antibody) testing with no cost-sharing.

4/29/2020 - Until further notice Aetna will offer zero co-pay telemedicine visits for any reason to all Individual and Group Medicare Advantage members. 

4/27/2020 - Physicians can refer patients to Teladoc for convenient and quality alternative care to ER and Urgent Care visits for non-emergency medical care. 

4/21/2020 - Aetna will cover minor acute care services rendered via telephone through June 4, 2020.

4/16/2020 - Effective date 3/6/2020 – 6/4/2020, cost share waived for listed telemedicine services when billed with place of service 02 and modifier GT or 95.

4/6/2020 - Waiving Precertification/Prior Authorization for admission to Post-Acute care facilities, Acute Care Hospitals and Long-Term Acute Care Hospitals for Commercial and Medicare Advantage Part C plans. Facility still needs to notify Aetna of an admission within 48 hours.

3/25/2020 - Aetna, a CVS Health company, 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, 2020.

3/24/2020 - Aetna is waiving co-pays and applying no cost-sharing for all diagnostic testing related to COVID-19.

America's Health Insurance Plans (AHIP) 

5/6/2020 - America’s Health Insurance Plans (AHIP) and the Healthcare Financial Management Association (HFMA) have collaborated on providing information on billing and coding for COVID-19 services taking place in alternate inpatient settings. READ MORE

American Hospital Association
(AHA)

10/21/2020 - AHA, Others Urge Congress to Pass Legislation to Provide Relief from Medicare Sequestration in 2021.
READ MORE 

American Medical Association (AMA)

2/1/2022 - The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes new product and administration codes assigned to the Pfizer-BioNTech COVID-19 vaccine for children 6 months to under 5 years of age. READ MORE

1/12/2022 - AMA Announces CPT update for third dose of Pfizer’s pediatric COVID-19 vaccine. READ MORE 

9/29/2021 - AMA CPT Assistant - Special Edition/September 2021. New COVID-19 Vaccine Codes. READ MORE 

9/3/2021 - AMA Announces Update to COVID-19 Vaccine CPT Codes. READ MORE

7/30/2021 - COVID-19 CPT Coding & Guidance. READ MORE 

6/10/2021 - CPT Assistant/Special COVID-19 Edition May 2021. READ MORE

12/1/2020 - High-Level Overview of Select Provisions in the Consolidated 2020 Omnibus Legislation. READ MORE 

11/10/2020 - AMA Announces Vaccine-Specific CPT Codes for COVID-19 Immunizations. READ MORE 

8/10/2020 - COVID-19 Coding/Guidance. READ MORE 

7/31/2020 - Physicians have a role in the new COVID-19 lab reporting requirements. READ MORE

7/31/2020 - Reasons why COVID-19 Medical Liability Shield Critics Are Wrong. READ MORE 

7/27/2020 - UPDATE - ACLA Statement on Senate Republicans' Coronavirus Relief Package. READ MORE 

7/22/2020 - Patients, Employers, Labs and Health Insurance Providers Call on Congress to Dedicate Funding for COVID-19 Testing to Get America Back to Work and School. READ MORE 

7/22/2020 - Data Reporting for COVID-19 Testing. READ MORE

7/13/2020 - AMA Press Release: Cutting Medicare Pay During COVID-19 Pandemic Doesn't Make Sense. READ MORE

6/25/2020 - AMA Press Release: The American Medical Association (AMA) announced an update to Current Procedural Terminology (CPT®) that includes a new code for reporting antigen testing of patients suspected of being infected with the novel coronavirus (SARS-CoV-2).  READ MORE 

5/20/2020 - COVID-19 Coding and Guidance. New Current Procedural Terminology (CPT®) codes have been created that streamline the novel coronavirus testing currently available on the United States market. READ MORE

5/4/2020 - Special Coding Advice during the COVID-19 Public Health Emergency. READ MORE

3/13/2020 - CPT Editorial Panel fast-tracked a new CPT code to report lab services that diagnose the presence of novel coronavirus: 87635 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. READ MORE

Amerigroup

5/18/2022 - Reimbursement of COVID-19 Vaccine Counseling for All Ages. READ MORE 

3/16/2022 -Timeline for the Expiration of the Remaining COVID-19 Hospital Administrative Flexibilities. READ MORE 

3/9/2022 - Reimbursement of COVID-19 Vaccine Counseling for All Ages. READ MORE 

1/19/2022 - Provider Update: To help address care providers’ questions, we have developed the following updates and frequently asked questions. READ MORE 

10/13/2021 - October 2021 Provider Newsletter: Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new Clinical Criteria documents will require prior authorization. READ MORE

10/6/2021 - October 2021 Provider Newsletter: Prior authorization updates for specialty pharmacy. READ MORE 

9/15/2021 - 09/08/2021: State communication; A message from the Division of TennCare.  READ MORE 

9/15/2021 - Medicaid|Medicare Advantage Provider Update: Important COVID-19 update: prior authorization and other policy adjustments (updated September 3, 2021). READ MORE 

8/25/2021 - COVID-19 information (August 2021 update) - Please note that the following information applies to Medicare Advantage plans. Please review the specific sites noted below for details about these plans. READ MORE 

8/25/2021 - Amerigroup Tennessee Medicaid: Division Of TennCare - SUBJECT: Reinstatement of Covid-19 Post-Acute Placement Flexibility. READ MORE

8/4/2021 - August 2021 Provider Newsletter: COVID-19 Vaccine Communication & Outreach Strategies in Primary Care.
READ MORE

8/4/2021 -  Apple Health (Medicaid) COVID-19 vaccine clinical policy. READ MORE 

8/4/2021 - Extension of telehealth and telephonic visits. READ MORE 

6/30/2021 - Apple Health (Medicaid) COVID-19 vaccine clinical policy (June 23, 2021) READ MORE 

6/23/2021 - Apple Health (Medicaid) telemedicine & telehealth brief. READ MORE 

6/23/2021 - Medicare Advantage - COVID-19 information from Amerigroup (New Jersey). READ MORE 

6/23/2021 - COVID-19 information from Amerigroup Community Care (Maryland). READ MORE

5/6/2021 - Send swab tests to Amerigroup-contracted laboratories. READ MORE 

5/6/2021 - Quick reference guide, COVID-19 vaccine registration (Maryland). READ MORE 

4/30/2021 - COVID-19 information from Amerigroup Community Care (Maryland). READ MORE

12/24/2020 - COVID-19 Update 12/24/20 for Medicare Advantage. READ MORE 

6/5/2020 - Telehealth (video + audio): effective March 17, 2020 through September 30, 2020, Amerigroup will waive any normally required member cost shares for telehealth visits from in-network providers, including visits for mental health or substance use disorders, for our Medicaid, Medicare-Medicaid (MMP) and CHIP members, where permissible. READ MORE

6/5/2020 - Telephonic - only care: effective March 19, 2020 through September 30, 2020, Amerigroup will cover telephonic-only visits with in-network providers.  READ MORE

4/29/2020 - Drive-thru COVID-19 testing is covered for participating hospitals and is recognized with codes 87635 and U0002. No prior authorization is required for diagnostic services related to COVID-19 testing.  And telehealth visits should be billed with place of service 02 and modifier 95. READ MORE

4/6/2020 - Effective 3/17/2020, Telehealth visits - will waive normally required member costs for 90 days. Effective 3/19/2020, Telephonic visits - will waive normally required member costs for 90 days. READ MORE

3/30/2020 - Waiving normally required cost shares for – including copays, coinsurance and deductibles – for COVID 19. No prior authorization is required for diagnostic services related to COVID-19 testing.  READ MORE

Anthem BCBS Ohio

3/24/2020 - Waiving cost shares for fully insured employer, individual, MCR and MCD plans for COVID-19 test (and visits associated with the test). Effective 3/17/2020 for 90 days, waiving cost shares for Telehealth visits for the same product lines, where permissible.  READ MORE

Anthem California

6/1/2022 - Medicare News 6/1/22. Provider Notice for COVID-19 Testing. Evaluation and management services for COVID testing — professional. READ MORE 

2/18/2022 - Payment for COVID-19 testing services and vaccine administration on or after January 1, 2022. READ MORE 

1/12/2022 - COVID-19 Update 1/12/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities, acute rehabilitation, and long-term acute care. READ MORE 

1/24/2022 - COVID-19 Update 1/24/22. We recently updated information about COVID-19 covered testing – SB510.
READ MORE 

1/18/2022 - COVID-19 Update 1/18/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities, acute rehabilitation, and long-term acute care. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. 
READ MORE 

4/1/2021 - COVID-19 Screenings: Identifying the most appropriate COVID-19 testing codes, testing sites and type of test to use can be confusing. READ MORE 

2/22/2021 - Update on Vaccines. READ MORE 

2/12/2021 - We recently updated prior authorization requirements for the following: Patient transfers from acute inpatient hospitals to lower levels of care, COVID-19 DME, and respiratory services for the treatment of COVID-19. READ MORE 

12/30/2020 - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). READ MORE 

12/23/2020 - COVID-19 Update: We recently updated information regarding prior authorization requirements for patient transfers from acute inpatient hospitals to other levels of care. READ MORE 

10/16/2020 - We recently updated FAQs about telehealth and telephonic-only care. READ MORE 

9/25/2020 - Information from Anthem for Care Providers about COVID-19. READ MORE 

9/17/2020 - Information from Anthem for Care Providers about COVID-19. READ MORE 

7/16/2020 - Will Anthem waive member cost shares related to COVID-19 including screening, testing, and treatment?
READ MORE

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. The expansion covers the waiver of cost shares for COVID-19 treatment received through December 31, 2020. READ MORE

4/17/2020 - Effective March 17, 2020, and until further notice, Anthem and its delegated entities will waive member cost share for telehealth (video + audio) visits, including visits for behavioral health, for our fully-insured employer, individual, Medicare and Medicaid plans where permissible.  READ MORE

During the COVID-19 State of Emergency, when a provider delivers a service via telehealth that the provider would normally deliver in-person, the provider should document and bill the service(s) as follows. READ MORE

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce.  READ MORE

Inpatient and respiratory care - waiving Prior Authorizations for transfers from Acute to skilled nursing, rehab long term acute IP hospitals and behavioral health. READ MORE

5/1/2020 - The 4/30/2020 Webinar recording is now available. READ MORE

4/15/2020 - Overview on government funding specifically designated for care providers in the CARES Act. READ MORE

4/1/2020 - In addition to the proactive steps Anthem has already taken to support care providers and protect our members, associates and communities against COVID-19, Anthem announced, effective April 1, they will expand coverage for members undergoing treatment related to COVID-19 diagnosis.

3/30/2020 - Waive cost shares for fully insured employer, individual, MCR and MCD plans for COVID-19 test (and visits associated with the test). Effective 3/17/2020 for 90 days, waive cost shares for telehealth visits for the same product lines, where permissible. Refer to the CDC for CPT/HCPCS and ICD10 codes. Prior Auth not required on COVID-19 testing. 

3/26/2020 - Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed.

Anthem Colorado

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

4/1/2022 - COVID-19 Vaccine - Adverse Reactions. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies.
READ MORE 

9/10/2021 - COVID-19 Update 9/10/21 - Prior Authorization and Other Policy Adjustments. READ MORE 

8/2/2021 - COVID-19 Update 8/2/21. Telephonic-Only Care. READ MORE 

4/28/2021 - COVID-19 Update: We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/30/2020 - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). READ MORE 

12/2/2020 - COVID-19 Update - Prior Authorization and other policy adjustments. READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19 .READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care 6/9/2020: Telehealth (video + audio).

6/4/2020 - Telehealth (video and audio) and Telephonic-only care - effective 3/17/2020 through September 30, 2020.

6/3/2020 - COVID-19 Prior Authorization Updates for Commercial health plans. Inpatient and Respiratory Care. Prior authorization requirements suspended for patient transfers through May 30, 2020.

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment (updated 5/29/2020).

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce.

5/11/2020 - COVID-19 Update on Telehealth/Telephonic Care for Behavioral Health Services. 

5/4/2020 - Further Clarification on COVID-19 testing and visits associated with COVID-19 testing. READ MORE

5/1/2020 - The 4/30/2020 Webinar recording is now available. READ MORE

4/22/2020 - For telehealth services rendered by a professional provider, report the CPT/HCPCS code with Place of Service “02” and also append either modifier 95 or GT.

4/17/2020 - Beginning March 26th, will apply to members of all lines of business except as noted below, including self-insured plan members and in-network and out-of-network providers, where permissible. 

4/14/2020 - Providers do not need to notify Anthem of new, temporary addresses for providing health care services during the COVID-19 emergency.

4/10/2020 - Federal Funding Specifically Designated for Care Providers within the CARES Act. 

4/8/2020 - COVID-19/Administrative Updates (please note that the following information applies to Anthem’s Commercial health plans); Medicare plans are included where noted. 

4/1/2020 - In addition to the proactive steps Anthem has already taken to support care providers and protect our members, associates and communities against COVID-19, Anthem announced, effective April 1, they will expand coverage for members undergoing treatment related to COVID-19 diagnosis. 

3/26/2020 - Unless otherwise required under State and Federal mandates, Anthem health plans will suspend select prior authorization requirements, member cost sharing, claims review and handling protocols; applicable to members of all lines of business including self-insured plan members.  Prior authorization requirements are suspended for COVID-19 Durable Medical Equipment. Our timely filing requirements remain in place, but Anthem is aware of limitations and heightened demands that may hinder prompt claims submission. 

Anthem Connecticut

4/25/2022 - COVID-19 Update 4/25/22. We recently updated information about codes for telehealth and telemedicine care. READ MORE 

4/8/2022 - Rebounding from the Pandemic. Information about our efforts to assist and support our providers along with claims resources available. READ MORE 

1/18/2022 - COVID-19 Update 1/18/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing and acute rehabilitation facilities. READ MORE 

1/4/2022 - COVID-19 Update 1/4/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities, acute rehabilitation, and long-term acute care. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility).READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. 
READ MORE 

8/3/2021 - COVID-19 Update 8/3/21 regarding Telehealth coverage dates. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/30/2020 - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). READ MORE 

12/22/2020 -  COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Prior authorization requirements are suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective December 21, 2020 through January 15, 2021. READ MORE

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE 

6/4/2020 - Telehealth (video and audio) and Telephonic-only care - effective 3/17/2020 through September 30, 2020. 

6/3/2020 - COVID-19 Prior Authorization Updates for Commercial health plans. Inpatient and Respiratory Care. Prior authorization requirements suspended for patient transfers through May 30, 2020.

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce.

Anthem Georgia

5/1/2022 - COVID-19 News 5/1/22. Evaluation and management services for COVID testing: professional (MAC - Material adverse change). READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

2/1/2022 - COVID-19 News 2/1/22. Clarification to reimbursement policy update: Virtual Visits (professional and facility).
READ MORE

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 

9/23/2021 - COVID-19 Update 9/23/2021. Prior authorization and other policy adjustments. READ MORE 

8/23/2021 - COVID-19 Update 8/23/2021. Prior authorization and other policy adjustments. READ MORE 

8/2/2021 - COVID-19 Update 8/2/2021 regarding Telehealth coverage date. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

2/1/2021 - Important update: Prior authorization and other policy adjustments (Updated 2/1/21). READ MORE

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/14/2020 - COVID-19 Update 12/14/20. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to other settings. READ MORE 

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19. READ MORE 

9/18/2020 - COVID-19 Provider Facts Update. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care - Telehealth (video + audio). READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. E

5/26/2020- Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce. 

5/11/2020 - Guidance for telehealth/telephonic care for Behavioral Health Services. Health providers can utilize and be compensated for telehealth (audio + video). Telephonic-only care is now available for patients effective march 17, 2020 for 90 days. See website for details and CPT codes. 

Anthem IN, KY, OH, MO

5/1/2022 - COVID-19 News 5/1/22. Evaluation and management services for COVID testing-Professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

1/28/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. Inpatient and respiratory care. READ MORE

1/21/222 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing, acute rehabilitation, and long term acute care hospital facilities. READ MORE 

1/7/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing, acute rehabilitation, and long term acute care hospital facilities. READ MORE 

12/30/2021 - We recently updated information about coverage dates for telephonic-only care. READ MORE 

12/20/2021 - COVID-19 Update: Prior authorization and other policy adjustments (updated 12/20/21). READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility).READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. 
READ MORE 

10/20/2021 - COVID-19 Update 10/20/21. Prior authorization and other policy adjustments. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE 

10/1/2021 - COVID-19 Update 10/1/21. Prior authorization and other policy adjustments. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

9/15/2021 - COVID-19 update 9/15/21. Prior Authorization and other policy adjustments. READ MORE 

9/8/2021 - COVID-19 Update 9/8/21 - Prior Authorization and other policy adjustments. READ MORE

8/24/2021 - COVID-19 Update 8/23/2021. Prior authorization and other policy adjustments. READ MORE 

8/2/2021 - COVID-19 Update 8/2/21 regarding Telehealth coverage dates. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

11/25/2020 - Important COVID-19 update: Prior authorization and other policy adjustments (Updated November 25, 2020). READ MORE 

11/12/2020 - Information from Anthem IN for Care Providers about COVID-19 (updated 11/12/20). READ MORE 

10/12/2020 - From March 17 through Dec. 31, 2020, Anthem will waive member cost shares for telehealth visits from in-network providers, including visits for mental health and substance use disorders, for our Medicare Advantage and Medicaid plans, where permissible.

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19. READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio)READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce. READ MORE 

5/11/2020 - COVID-19 Update on Telehealth/Telephonic Care for Behavioral Health Services.  READ MORE

5/1/2020 - The 4/30/2020 Webinar recording is now available. READ MORE

4/22/2020 - For telehealth services rendered by a professional provider, report the CPT/HCPCS code with Place of Service “02” and also append either modifier 95 or GT.  READ MORE

4/17/2020 - Beginning March 26th, will apply to members of all lines of business except as noted below, including self-insured plan members and in-network and out-of-network providers, where permissible. READ MORE

4/14/2020 - Providers do not need to notify Anthem of new, temporary addresses for providing health care services during the COVID-19 emergency.

4/10/2020 - Federal Funding Specifically Designated for Care Providers within the CARES Act

4/8/2020 - COVID-19/Administrative Updates (please note that the following information applies to Anthem’s Commercial health plans); Medicare plans are included where noted. READ MORE

4/1/2020 - In addition to the proactive steps Anthem has already taken to support care providers and protect our members, associates and communities against COVID-19, Anthem announced, effective April 1, they will expand coverage for members undergoing treatment related to COVID-19 diagnosis. 

3/26/2020 - Will suspend select prior authorization requirements, member cost sharing, claims review and handling protocols; applicable to members of all lines of business including self-insured plan members. Prior authorization requirements are suspended for COVID-19 Durable Medical Equipment.  Anthem will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers; applicable for employer-sponsored, individual, Medicare and Medicaid plan members. 

Anthem Maine

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

12/30/2021 - COVID-19 Update 12/30/2021. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE 

12/30/2021 - We recently updated information about coverage dates for telephonic-only care. READ MORE 

12/20/2021 - COVID-19 Update 12/20/21. Prior Authorization and other policy adjustments. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility).READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 

9/8/2021 - COVID-19 Update 9/8/21. Prior Authorization and other policy adjustments. READ MORE 

8/2/2021 - COVID-19 Update 8/2/2021 regarding Telehealth coverage date. READ MORE 

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

11/23/2020 - Information from Anthem for Care Providers about COVID-19. READ MORE 

11/2/2020 - Anthem COVID-19 Provider Updates 11/2/2020. READ MORE 

10/23/2020 - Information from Anthem for Care Providers about COVID-19.  We recently updated FAQs about telehealth and telephonic-only care. READ MORE

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19. READ MORE 

9/18/2020 - COVID-19 Provider Facts Update. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio). READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

Anthem Nevada

5/1/2022 - COVID-19 News 5/1/22. Evaluation and management services for COVID testing: professional (MAC - Material adverse change). READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

1/28/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

1/18/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE 

12/30/2021 - COVID-19 Update. We recently updated information about coverage and cost shares for telephonic-only care. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies.
READ MORE 

8/2/2021 - COVID-19 Update 8/2/2021 regarding Telehealth coverage date. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

11/12/2020 - Information from Anthem for Care Providers about COVID-19 (updated 11/12/20). READ MORE 

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19.READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE 
We recently updated FAQs with information about the use of modifier CS on claims related to evaluation for COVID-19 testing. 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio)READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce. READ MORE

5/11/2020 - Guidance for telehealth/telephonic care for Behavioral Health Services. Health providers can utilize and be compensated for telehealth (audio + video). Telephonic-only care is now available for patients effective March 17, 2020 for 90 days. See website for details and CPT codes. READ MORE

Anthem New Hampshire

5/1/2022 - COVID-19 News 5/1/22. Evaluation and management services for COVID testing - professional. READ MORE 

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

2/1/2022 - COVID-19 News 2/1/22. Clarification to reimbursement policy update: Virtual Visits - Professional and Facility.
READ MORE

12/30/2021 - COVID-19 Update. We recently updated information about coverage dates for telephonic-only care. READ MORE 

12/15/2021 - COVID-19 Update 12/15/21. Prior authorization and other policy adjustments. READ MORE

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies.
READ MORE 

8/2/2021 - COVID-19 Update regarding Telehealth coverage dates. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

11/2/2020 - Information from Anthem for Care Providers about COVID-19. READ MORE 

11/2/2020 - We recently updated FAQs about telehealth and telephonic-only care. READ MORE

10/23/2020 - Information from Anthem for Care Providers about COVID-19. We recently updated FAQs about telehealth and telephonic-only care. READ MORE

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/21/2020 - Information from Anthem for Care Providers about COVID-19 (updated 9/21/2020). READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio). READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

Anthem New York

4/20/2022 - COVID-19 Update 4/20/22. We recently updated information about codes for telehealth and telemedicine care. READ MORE 

2/9/2022 - COVID-19 Update 2/9/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing and acute rehabilitation facilitiesREAD MORE 

2/1/2022 - COVID-19 News 2/1/22. Clarification to reimbursement policy update: Virtual Visits - Professional and Facility.
READ MORE

1/18/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing and acute rehabilitation facilities. READ MORE 

12/30/2021 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE 

12/27/2021 - COVID-19 Update 12/27/21. Prior authorization and other policy adjustments. READ MORE 

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility). READ MORE

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines?  READ MORE 

12/30/2020 - Information from Anthem for Care Providers About COVID-19 (Updated December 30, 2020). READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

11/13/2020 - Information from Empire for Care Providers about COVID-19. We recently updated FAQs about cost shares for COVID-19 testing; COVID-19 testing and visits associated with COVID-19 testing. READ MORE 

9/22/2020 - Information from Empire for Care Providers about COVID-19 (Updated September 22). READ MORE 

9/14/2020 - Information from Empire for Care Providers about COVID-19 (Updated September 14, 2020). READ MORE

8/26/2020 - The New York Department of Financial Services (“DFS”) recently issued a circular letter, “Charges for Personal Protective Equipment by Participating Providers”. READ MORE 

8/13/2020 - Mental Health Services for Fully Insured New York Members including Essential Workers. READ MORE 

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio).  READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

Anthem Virginia

4/20/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 -
COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

1/18/2022 - COVID-19 Update 1/18/22. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing and acute rehabilitation facilities. READ MORE 

12/30/2021 - COVID-19 Update 12/30/21. We recently updated information about coverage dates for telephonic-only care. READ MORE

10/20/2021 - COVID-19 Update 10/20/21. Prior authorization and other policy adjustments. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities.  READ MORE

10/1/2021 - COVID-19 Update 10/1/21. Prior authorization and other policy adjustments. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

8/2/2021 - COVID-19 Update 8/2/2021 regarding Telehealth coverage date. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/8/2021 - COVID-19 Update: We've updated information about coverage for telephonic-only care. READ MORE

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

12/22/2020 - COVID-19 Update: We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities. READ MORE

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19. READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE  

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio).  READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

5/29/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment (updated 5/29/2020).  READ MORE

Anthem Wisconsin

4/15/2022 - COVID-19 Update 4/15/22. We recently updated information about coverage dates for telephonic-only care. READ MORE 

2/14/2022 - COVID-19 Update 2/14/22. We recently updated information about coverage dates for telephonic-only care.
READ MORE 

1/21/2022 - COVID-19 update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing, acute rehabilitation, and long term acute care hospital facilities. READ MORE 

1/7/2022 - COVID-19 Update. We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing, acute rehabilitation, and long term acute care hospital facilities. READ MORE 

12/30/2021 - COVID-19 Update 12/30/21. We recently updated information about coverage dates for telephonic-only care. READ MORE  

12/20/2021 - COVID-19 Update 12/20/21. Prior authorization and other policy adjustments. READ MORE 

12/1/2021 - Reimbursement Policy Update: Virtual Visits (Professional and Facility).READ MORE

12/1/2021 - Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies. READ MORE 

10/1/2021 - COVID-19 Update 10/1/21. Prior Authorization and Other Policy Adjustments. Inpatient and respiratory care.
READ MORE 

8/4/2021 - COVID-19 Update 8/2/2021 regarding Telehealth coverage date. READ MORE 

4/28/2021 - COVID-19 Update 4/28/21. We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE

4/6/2021 - COVID-19 Update: We recently updated information about reimbursement for the COVID-19 vaccine. The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. READ MORE 

1/26/2021 - How is Anthem reimbursing U.S. Food and Drug Administration (FDA)-approved COVID-19 vaccines? READ MORE 

9/29/2020 - COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services. We are extending cost share waivers for telehealth and telephonic-only care. READ MORE 

9/18/2020 - Updated Information for Anthem Care Providers About COVID-19. READ MORE 

8/10/2020 - COVID-19 Provider Facts Update. READ MORE

6/25/2020 - Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond. READ MORE

6/9/2020 - COVID-19 Updates to Telehealth/Telephonic care: Telehealth (video + audio).  READ MORE

5/26/2020 - Anthem BC Waives Cost Share for COVID-19 Treatment. Anthem announced, effective April 1 that we will expand coverage for our members undergoing treatment related to COVID-19 diagnosis. READ MORE

5/26/2020 - Introducing lower cost Anthem plans in response to COVID-19. Anthem is working to help employers who are facing tough decisions on furloughing or reducing hours of their workforce. READ MORE

3/26/2020 - Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits associated with the COVID-19 test, including visits to determine if testing is needed. READ MORE

Blue Cross Blue Shield Association

3/6/2020 - Its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19. READ MORE

Blue Cross Blue Shield
Alabama

3/23/2022 - LTACH and SNF Streamlined Admission Process for COVID Patients Ending March 31, 2022. READ MORE 

2/24/2022 - The streamlined process for SNF and LTACH admissions extends through March 31, 2022. READ MORE

12/27/2021 - We are extending the process to streamline admissions for the following facilities: Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses and Skilled nursing facilities (SNF) specifically for Blue Advantage® members with one or more specified diagnoses who require an acute inpatient admission. This streamlined process for SNF and LTACH admissions extends through January 31, 2022. READ MORE 

12/6/2021 - Effective January 1, 2022, providers who give COVID-19 vaccinations or administer monoclonal antibody treatment to patients enrolled in a Medicare Advantage plan, including Blue Advantage®, should submit claims to the Medicare Advantage plan. READ MORE 

12/6/2021 - We have updated our COVID-19 Vaccines page with newly added codes related to vaccines authorized for use. Refer to this webpage for a list of current vaccine codes and other vaccination-related information. READ MORE 

11/26/2021 - BCBS Alabama is extending the process to streamline admissions for the following facilities: Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses. Skilled nursing facilities (SNF) specifically for Blue Advantage® members with one or more specified diagnoses who require an acute inpatient admission. This streamlined process for SNF and LTACH admissions extends through December 31, 2021. READ MORE 

10/28/2021 - Streamlined Admissions Process for COVID Patients Extended Through November 30. READ MORE 

9/24/2021 - We are extending the process to streamline admissions for the following facilities: Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses, and Skilled nursing facilities (SNF) specifically for Blue Advantage® members with one or more specified diagnoses who require an acute inpatient admission. This streamlined process for SNF and LTACH admissions extends through October 31, 2021. We will evaluate the need for additional extensions for the admissions process on a monthly basis. READ MORE 

8/24/2021 - We are extending the process to streamline admissions for the following facilities: Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses. READ MORE 

8/20/2021 - We have updated our COVID-19 Vaccines page with codes for third-dose administration of the Pfizer-BioNTech and Moderna vaccines effective August 13, 2021. READ MORE 

6/22/2021 - Effective July 1, 2021, we are returning to our standard process for admissions to long-term acute care hospitals (LTACHs) for all Blue Cross and Blue Shield of Alabama members. We are not extending the streamlined LTACH admission process for Blue Cross members with a specified COVID-19 diagnosis beyond June 30. READ MORE 

5/28/2021 - We are extending the process to streamline admissions to long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses. This process extends through June 30, 2021. We will evaluate additional extensions for the admissions process to LTACHs on a monthly basis. READ MORE

4/26/2021 - The U.S. Department of Health and Human Services’ Office of Inspector General has issued an announcement about COVID-19 vaccination administration that includes the following guidance: The vaccine must be administered at no cost to recipients. Providers may not charge an office visit or other fee if the COVID-19 vaccine is the sole medical service provided. Providers may not seek any reimbursement, including through balance billing, from the vaccine recipient. READ MORE 

4/26/2021 - We are extending the process to streamline admissions for the following facilities through May 31, 2021: Long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses. Note: the similar streamlined admissions process for skilled nursing facilities specifically for Blue Advantage® members will not extend beyond April 30, 2021. READ MORE 

3/31/2021 - Streamlined Admission Process for COVID Patients Extended Through April 30, 2021. READ MORE 

3/10/2021 - Our COVID-19 Vaccines page includes new information related to the Janssen vaccine that has received emergency use authorization from the U.S. Food and Drug Administration. READ MORE

2/26/2021 - We are extending the process to streamline admissions to long-term acute care hospitals (LTACH) for all Blue Cross and Blue Shield of Alabama members with one or more specified diagnoses.READ MORE 

2/10/2021 - Our new COVID-19 Vaccines page contains coding information and other resources for providers, including a link to frequently asked questions and answers. READ MORE 

2/1/2021 - As COVID-19 vaccines increasingly become available to the public in Alabama, we want to remind providers that testing for surveillance purposes is not covered, whether conducted separately or in conjunction with the vaccine administration. READ MORE

2/1/2021 - As hospitals across the state are caring for patients admitted with COVID-19, Blue Cross and Blue Shield of Alabama is continuing to improve needed access for patients. READ MORE 

12/16/2021 - As COVID-19 cases increase and many hospitals across the state approach peak admissions, Blue Cross and Blue Shield of Alabama is improving needed access for patients. READ MORE

12/15/2020 - We do not reimburse providers for CPT code 99072, which is defined as: “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.” READ MORE

12/15/2020 - Codes for COVID-19 vaccines and monoclonal antibodies as well as their administration have been published on our COVID-19 Treatment page. READ MORE

12/9/2020 - DME Update: Oxygen Therapy: In response to the ongoing COVID-19 public health emergency, the suspension of the oxygen saturation requirement for both certification and recertification has been extended through the end of the federal public health emergency. READ MORE 

12/4/2020 - In response to the ongoing COVID-19 pandemic, expanded telehealth services coverage for eligible Blue Cross members including Blue Advantage® will continue through the end of the federal public health emergency. READ MORE 

10/12/2020 - The U.S. Department of Health and Human Services has extended the Public Health Emergency in response to the COVID-19 pandemic for 90 days, effective October 23, 2020. This action includes extension of telehealth services for Blue Advantage. READ MORE 

9/17/2020 - CPT code 86413 has been added to the list of approved codes related to testing. READ MORE 

9/9/2020 - It is important that providers review medical record documentation and avoid the following common inappropriate billing scenarios. READ MORE 

9/2/2020 - In response to the ongoing COVID-19 Public Health Emergency, the suspension of the oxygen saturation requirement for both certification and recertification has been extended to December 1, 2020.

8/14/2020 - COVID-19 Testing: Clarification on Testing for Return to College/Work. READ MORE 

8/5/2020 - Federal law requires most employer-sponsored group health plans and private health insurance plans to pay for medically appropriate testing to detect or diagnose COVID-19 in an individual. READ MORE 

8/4/2020 - Codes Not Subject to EAPG Pricing: CPT codes 87426 and 0224U and HCPCS code G2024 have been added to the list of codes not subject to EAPG pricing on our COVID-19 Testing page. READ MORE 

7/24/2020 - Adding CPT code 87426 to the Preferred Medical Doctor (PMD) Agreement - Exhibit I (Physician In-Office Laboratory Procedures). READ MORE

7/20/2020 - COVID-19 Testing Code 0224U Added. CPT code 0224U has been added to the list of approved COVID-19 testing procedure codes. Refer to our COVID-19 Testing page for a full list of approved testing and specimen collection codes and fees. READ MORE

7/16/2020 - The fee for COVID-19 testing CPT code 87426 has been increased to $31.02. The payer will reprocess claims submitted with this code going back to the code's effective date of June 25, 2020. READ MORE

7/16/2020 - Telehealth services will be extended through December 31, 2020 while the payer determines whether a further extension is needed. READ MORE

7/9/202 - CPT code 87426 has been added to the Testing Procedure Codes section on our COVID-19 Testing page. READ MORE

7/2/2020 Made updates to Telehealth Billing Guide. READ MORE

6/19/2020 - Telehealth expansion extended through July 31, 2020. READ MORE 

6/9/2020 - Coronavirus Codes Added to List of Services Carved Out of EAPG Pricing. The Services Carved Out of EAPG Pricing document has been updated with three additional coronavirus-related codes and their corresponding fees. (Details available on the secured Provider Portal). READ MORE

6/8/2020 - FEP Coverage and Billing for the COVID-19. READ MORE

6/8/2020 - BCBS Alabama is not reimbursing for CDT code D1999 (unspecified preventive procedure, by report) when used to document and report the use and cost of additional personal protective equipment (PPE). 

5/28/2020 - COVID-19 Provider Updates: Patient-Specific COVID-19 and Telehealth Coverage and Cost-Share Information.
READ MORE

5/22/2020 - DME Update for Oxygen Therapy. In response to the COVID-19 Public Health Emergency, we are suspending the oxygen saturation requirement for both certification and re-certification for 60 days, effective April 1, 2020. This action will not extend beyond May 31, 2020. 

5/20/2020 - Updated the “Laboratory Testing” section of our COVID-19 Coding Guide to include the following codes: Specimen collection code added: C9803.

5/20/2020 - Telehealth expansion extended through June 30, 2020. READ MORE

5/11/2020 - Payer updated their Telehealth Billing Guide to include Preferred Chiropractors as eligible providers for E/M codes (excluding Blue Advantage members). This expanded Telehealth Coverage Guidelines is effective starting March 1, 2020, and will expire on June 1, 2020.

5/4/2020 - Payer updated their Telehealth Billing Guide to include the following: Facility Telehealth Billing section added. The Payer's expanded Telehealth Coverage Guidelines are effective starting March 1, 2020, and will expire on June 1, 2020.

4/27/2020 - Payer has decided to postpone medical record requests for the Blue Advantage Readmission Review Program. This action will remain in place until further notice.

4/20/2020 - Payer updated its Telehealth Billing Guide to include the following level 4 E&M codes: 99204 and 99214. These codes are eligible for telehealth services effective April 24, 2020. 

4/20/2020 - Blue Cross is following CMS’ home health modifications that allow nurse practitioners, clinical nurse specialists or physician assistants to perform the following for Blue Advantage patients: Order home health services, establish and periodically review a plan of care for home health services (e.g., sign the plan of care) and certify and recertify that the patient is eligible for Medicare home health services. 

4/17/2020 - Effective April 21, 2020, Blue Advantage telehealth services will require providers to use audio AND video capability for the visits for Blue Advantage claims. If possible, it is recommended to begin using video immediately.

4/14/2020 - Payer will extend Telehealth Coverage Guidelines through June 1, 2020. They will begin a monthly review process on May 1, 2020, for the duration of the telehealth extension to determine a continuance.

4/8/2020 - BCBS AL has updated their Telehealth Billing Guide to include the following: Eligible telehealth services for Preferred Optometry Network providers. As we continue to expand our telehealth coverage, we will update this billing guide to provide additional details. Payer's expanded Telehealth Coverage Guidelines are effective starting March 1, 2020, and expire on April 16, 2020. 

4/7/2020 - Payer is postponing medical record requests for the Blue Advantage Readmission Review Program. This decision is effective through April 30, 2020, and will be re-evaluated before the end date to determine whether to continue this action.

3/31/2020 - Some claims for telehealth services were filed with CPT codes 98966-98968 or 99441-99443. Although these are valid CPT codes, they are not included in BCBS AL COVID-19 expanded Telehealth Coverage Guidelines. If you notice a rejected claim that was originally submitted with one of the above codes, file a new claim with one of the approved codes from the Telehealth Billing Guide and place of service 02 (telehealth).

3/26/2020 - Updated Telehealth guidelines effective 3/1/20 to 4/16/20 including CPT/HCPCS codes, Requirements, Member Plans, and Eligible Providers.

3/24/2020 - Waiving up-front member cost-sharing (copayments, deductibles, co-insurance) for COVID-19 related services. Retroactive to 3/1/20 and in effect until 4/16/20 and may be extended as necessary.

Blue Cross Blue Shield
Arizona

3/11/2020 - BCBSAZ is taking the following steps: Waiving Prior Auths where medically necessary, no cost-share for medically necessary diagnostic tests related to COVID-19, waive the member cost share for telehealth sessions. READ MORE

Blue Cross Blue Shield
Arkansas

9/23/2021 - COVID-19 Update. Here is a rundown of the anticipated status of those COVID-19-related benefits and measures as of October 1, 2021. READ MORE

6/11/2020 - COVID-19 Telehealth Update. Arkansas Blue Cross and Blue Shield and Health Advantage described a temporary change to our policy in the March issue of Arkansas Blue Cross Providers’ News. We revised that temporary policy on March 24, 2020, making it retroactive to March 16, 2020. READ MORE

5/19/2020 - The temporary COVID-19 benefits put into place by Arkansas Blue Cross and Health Advantage will be extended to run through July 25, 2020. READ MORE

4/1/2020 - Payer will cover the testing by in-network providers to diagnose COVID-19. READ MORE

3/21/2020 - Fully insured members - no prior authorizations for COVID-19 diagnostic tests and for covered services per policy guidelines and CDC; current screen test is the RT-PCR Test. 

Blue Cross Blue Shield
Federal Employee Program

9/3/2021 - COVID-19 Vaccination Incentive Program: Deadline extended Sept. 3, 2021. READ MORE 

5/25/2021 - Vaccine Update published 5/5/2021. READ MORE 

1/21/2021 - FEP members have NO out-of-pocket costs when they receive any of the vaccines approved by the FDA with emergency use authorization. READ MORE 

1/14/2021 - FEP will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. FEP members have NO out-of-pocket costs when they receive any of the vaccines approved by the FDA with emergency use authorization. READ MORE 

12/15/2020 - No member cost share for vaccines. READ MORE 

3/31/2020 - FEP will waive prior authorizations for diagnostic tests and covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. Similarly, FEP will waive any cost-share for diagnostic tests or treatment that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. FEP will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications. FEP will waive copays for all telehealth services provided by Teladoc®. READ MORE

Blue Cross Blue Shield Florida

6/15/2022 - Telehealth Documentation and Coding - June 2022 Coding Tips & Best Practices. Guidelines cover: Types of Telehealth; Risk Adjustment Data Eligibility; Documentation and Coding Guidelines; and available coding webinars. READ MORE 

5/19/2022 - COVID-19 Provider Billing Guidelines as of May 2022. READ MORE 

3/29/2022 - The Federal Public Health Emergency has been extended through April 16, 2022. READ MORE

12/1/2021 - UPDATE - COVID-19 Vaccine and Monoclonal Antibody Treatment Billing Updates (December 2021). READ MORE

11/4/2021 - While vaccines remain our best protection against COVID -19, more of your patients may be eligible for COVID-19 monoclonal antibody treatment. READ MORE 

10/21/2021 - The Federal Public Health Emergency has been extended through Jan. 16, 2022. READ MORE 

8/25/2021 - COVID-19 Update 8/25/21. The State of Florida State of Emergency expired on June 26, 2021. The Federal Public Health Emergency has been extended through Oct. 18, 2021. READ MORE 

8/20/2021 - COVID-19 Update - Normal Member Cost Shares Resume September 1, 2021. READ MORE 

8/12/2021 - Johnson & Johnson Information Added - Updated Guidelines for COVID-19 Vaccine Billing. READ MORE 

8/3/2021 - COVID-19 Alert 8/3/21. Hotline Available to Answer Questions about the Vaccine. READ MORE 

8/3/2021 - Closing Gaps & Meeting Metrics/Coding Tips & Best Practices (August 2021). Telehealth Documentation/Best Practices for Risk Adjustment. READ MORE 

8/3/2021 - COVID-19 Update - Temporary Change to Oxygen Requests for COVID-19 Patients. READ MORE 

7/30/2021 - COVID-19 Update - Temporary Change to Admission Approval Process for Post-Acute Care. READ MORE 

6/16/2021 - Florida Blue COVID-19 Provider Billing Guidelines. READ MORE 

5/25/2021 - Florida Blue COVID-19 Provider Billing Guidelines. READ MORE 

5/13/2021 - BCBS Florida COVID-19 Provider Billing Guidelines-small update to the guidelines with respect to GatorCare Health Plans. READ MORE 

4/29/2021 - COVID-19 Update 4/29/21. The Florida State of Emergency has been extended through June 26, 2021. READ MORE 

3/12/2021 - Florida Blue Commercial/Affordable Care Act (ACA)/Medicare Advantage Update - Medical Test/Testing Related Services/And Related Services. READ MORE 

3/12/2021 - Federal Employee Program (FEP) Updates - Tests and Treatment. READ MORE 

3/1/2021 - Reminder: Refer your Florida Blue patients to an in-network lab for services according their contract benefit. Quest Diagnostics is our preferred lab provider. READ MORE 

2/1/2021 - COVID-19 Update (JAN 2021). During the COVID-19 pandemic, the processes created for the PHE remain in effect until further notice. READ MORE

1/22/2021 - The Federal Public Health Emergency Order currently expires April 21, 2021. The State of Florida Emergency Order currently expires February 27, 2021. READ MORE

12/31/2020 - COVID-19 Vaccine Billing Information. READ MORE 

12/14/2020 - Medicare Advantage Updates. Medical Test/Testing-Related Visits and Related Services cont'd. Additional visit information. READ MORE 

11/5/2020 - COVID-19 Update: Florida Blue Commercial, ACA, and Medicare Advantage Updates. READ MORE

11/5/2020 - Florida Blue "Bluemail" - New CPT Code Clarified. READ MORE

10/22/2020 - Florida Blue Commercial/ACA, and Medicare Advantage Updates - Medical Test, Testing-Related Visits and Related Services - Reminder: Refer your Florida Blue patients to an in-network lab for services according to their contract benefits. Quest Diagnostics is our preferred lab provider. READ MORE 

10/7/2020 - COVID-19 Provider Billing Guidelines - resources updated on 10/7/2020. READ MORE 

9/25/2020 - Florida Blue Email for Providers 9/25/20. COVID-19 Special Alerts. READ MORE 

9/22/2020 - Provider COVID-19 News Update. READ MORE

9/11/2020 - COVID-19 Update. READ MORE 

9/8/2020 - Ten page Billing Guideline has been updated. READ MORE 

8/27/2020 - Commercial, ACA (Affordable Care Act), and Medicare Advantage Updates for Medical Test/Testing-Related Visits/Related Services. READ MORE 

8/11/2020 - Medicare Advantage Update on COVID-19 Medical Treatment. READ MORE 

8/11/2020 - Florida Blue Commercial and Affordable Care Act (ACA) Update on COVID_19 Medical Treatment. READ MORE 

7/27/2020 - Bluemail News COVID-19: In response to the coronavirus disease (COVID-19), we have made additional process updates for our Commercial, Affordable Care Act (ACA), Medicare Advantage and Federal Employee Program® (FEP) lines of business. READ MORE

7/17/2020 - Added COVID-19 waiving members cost share through 10/31/2020. READ MORE 

7/13/2020 - Medicare Advantage Update on authorizations/prior approvals. Post-Acute Care: CareCentrix manages post-acute care for Florida Blue Medicare members. Through September 5, 2020. READ MORE

7/8/2020 - Commercial/Affordable Care Act (ACA) Update for Telemedicine. Audio-only virtual visits. READ MORE 

7/2/2020 - (1) Administrative Updates for all lines of business. READ MORE

(2) Commercial/ACA and Medicare Advantage Updates. READ MORE

6/18/2020 - MCR Advantage/ Commercial/ACA Updates/Medical Test, Testing-Related Visits and Related Services. READ MORE

6/18/2020 - Medicare Advantage Post Acute Care: The following guidelines are effective through June 30, 2020; beginning July 1, will return to normal business practices. READ MORE

6/18/2020 - Commercial/ACA Post Acute Care: The following guidelines are effective through June 30, 2020; beginning July 1, will return to normal business practices. READ MORE

6/18/2020 - The medical diagnostic test for COVID-19 is available at $0 cost share to our members. For Commercial/ACA and Medicare Advantage: Testing-related visits whether in a provider’s office, outpatient or telemedicine, and related services that result in an order for the COVID-19 test are at $0 cost share to our members. READ MORE

6/4/2020 - COVID-19 Provider Update 6/4/2020. Commercial/Affordable Care Act (ACA) Updates for Telemedicine. In-network primary care providers, behavioral health providers and specialists can bill for virtual visits if they have telemedicine capabilities and want to consult with their patients virtually. READ MORE

5/28/2020 - COVID-19 Update: Medicare Advantage. READ MORE

5/14/2020 - The COVID-19 Provider Billing Guidelines have been updated. They have also extended suspensions of some prepay edits through May 31,2020 as well as the requirements for some additional documentation. READ MORE

5/7/2020 - If a patient had an already-approved authorization for an elective procedure or a planned admission prior to March 20, the Payer is extending those authorizations 90 days from when the executive order was lifted on May 4. Providers and members will not need to do anything to receive this extension as our Payer's systems will automatically add the extended time. READ MORE

5/1/2020 - COVID-19 Provider Billing Guidelines have been updated. READ MORE

4/22/2020 - Per the announcement on March 26, 2020, the Payer is allowing more time for members and employer groups to pay their premiums.  READ MORE

4/17/2020 - Availity Transaction results may not reflect the temporary process and claim adjudication decisions related to COVID-19. READ MORE

4/9/2020 - In response to COVID-19, the payer has established billing code guidelines for Commercial, ACA, Medicare Advantage and Federal Employee Programs. 

3/31/2020 - FL Blue is temporarily suspending some medical record requests for their commercial fully insured and (ACA) LOB. 

3/20/2020 - From April 29 through May 17, BCBS FL will be unable to accept updates or make changes to Provider profiles in the Provider Data Management Capabilities in availity.com. READ MORE

Blue Cross Blue Shield
Illinois

1/25/2022 - Effective immediately, Blue Cross and Blue Shield of Illinois (BCBSIL) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until Feb. 28, 2022. READ MORE

11/22/2021 - Starting Jan. 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will cover the cost of COVID-19 vaccines and their administration for Blue Cross Medicare Advantage HMOSM (MA HMO), Blue Cross Medicare Advantage PPOSM (MA PPO) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members instead of the Original Medicare program (also known as fee-for-service Medicare). MA (HMO and PPO) and MMAI members will continue to have no cost-sharing during their 2022 benefit year for COVID-19 vaccines and their administration, including approved booster doses. READ MORE

9/27/2021 - 2022 Telehealth Services. In support of our members and employer groups, in 2022 Blue Cross and Blue Shield of Illinois (BCBSIL) will continue to cover the expanded telehealth services that we’ve covered in 2021.
READ MORE 

9/16/2021 - The federal government requires us to cover the COVID-19 vaccine at no cost share through the end of the public health emergency (PHE). READ MORE 

3/12/2021 - In the face of the COVID-19 pandemic, pharmaceutical companies have moved to produce vaccines.
READ MORE 

3/9/2021 - BCBSIL Providers: Free Vaccine Confidence and Process Improvement Webinars. READ MORE 

2/17/2021 - COVID-19 Lab Codes. READ MORE

1/28/2021 - Blue Cross and Blue Shield of Illinois (BCBSIL) supports telehealth as an emerging and valuable mode of health care delivery that can help improve the health of our members when appropriate. READ MORE 

1/4/2021 - From Nov. 12, 2020 to Feb. 28, 2021, Blue Cross and Blue Shield of Illinois (BCBSIL) will not require a post-acute care facility to wait for prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals, skilled nursing facilities, rehabilitation facilities and in-patient hospice. The receiving facility must call and inform us of the transfer by the next business day. READ MORE 

12/22/2020 - BCBS Illinois supports telehealth as an emerging and valuable mode of health care delivery that can help improve the health of our members when appropriate. READ MORE 

12/21/2020 - Guidelines for COVID-19 vaccines and how it will be covered by BCBS Illinois. READ MORE 

11/25/2020 - In March, we announced that, as of April 1, 2020, BCBS Illinois would start implementing new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions). READ MORE 

10/12/2020 - (Update from April 4): BCBSIL is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. READ MORE 

9/29/2020 - BCBSIL is working with Home Access Health Corporation to provide in-home test kits for some of our PPO members with diabetes. READ MORE 

9/11/2020 - This notice was updated to reflect the extension of the member cost-sharing waiver from Sept. 30, 2020 to Dec. 31, 2020. READ MORE 

8/21/2020 - BCBS Illinois has expanded access to telehealth at no cost-share for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) members through 12/31/20. READ MORE 

8/10/2020 - BCBS Illinois is continuing its expanded telehealth benefits program through Dec. 31, 2020, and waiving member cost-sharing through Sept. 30, 2020. READ MORE 

8/10/2020 - BCBS Illinois is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. READ MORE 

7/20/2020 - BCBS IL is continuing its expanded telehealth benefits program and waiving member cost-sharing through Dec. 31, 2020, for our Medicare (excluding Part D) and Medicare Supplement members, which includes Blue Cross Medicare Advantage (PPO) SM and Blue Cross Medicare Advantage (HMO) SM members. READ MORE 

7/2/2020 - BCBS Illinois continues to provide coverage for medically necessary care for the treatment of COVID-19. READ MORE

6/30/2020 - BCBSIL Extends Telehealth Benefits Through Dec. 31, 2020. READ MORE

6/30/2020 - Member Cost-Sharing Waiver for COVID-19 Treatment Extended Until August 30, 2020. READ MORE

6/4/2020 - Credentialing process simplified for COVID-19: We will accept practitioners practicing in the state of Illinois who hold a full unrestricted license granted by any state, subject to the state’s emergency provider licensure laws. READ MORE

5/29/2020 - COVID-19 FAQs updated. READ MORE

5/20/2020 - BCBS Illinois is continuing its expanded telehealth benefits program through Dec. 31, 2020, and waiving member cost-sharing through June 30, 2020. READ MORE

5/19/2020 - BCBS Illinois is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. READ MORE

5/15/2020 - Prior Authorizations to transfer members to post-acute care resumes May 16, 2020. This policy had been temporarily suspended. Providers should revert to processes in place before April 1, 2020. READ MORE

5/14/2020 - As previously announced on April 6, BCBS Illinois is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020.  READ MORE

4/28/2020 - Blue Cross and Blue Shield of Illinois (BCBSIL) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until May 15, 2020, not June 15, 2020 as previously listed. READ MORE

4/23/2020 - BCBS Illinois has extended the date where transfer of members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until June 15, 2020 (previously April 30, 2020). READ MORE

4/20/2020 - For services furnished on March 18, 2020, through the end of the Public Health Emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing-related services.
READ MORE

4/17/2020 - BCBS Illinois is temporarily simplifying access to chest computed tomography (CT). As of March 2, 2020 and until April 30, 2020, providers that request prior authorization through eviCore healthcare (eviCore) for chest CT scans with a COVID-19 diagnosis will receive an approval without the need for clinical documentation. Payer is also temporarily waiving the need for members to notify us when they are scheduled to have a chest CT scan. READ MORE

4/14/2020 - In response to COVID-19 the iExchange deactivation planned for April 15, 2020, has been temporarily suspended to offer Providers an extension to convert to the Availity® Authorizations tool during this pandemic. Given the iExchange extension is only temporary, Providers are still encouraged to transition and use the Availity Authorizations tool for electronic benefit preauthorization submissions for inpatient admissions and select outpatient services handled by BCBS Illinois. READ MORE

4/8/2020 - BCBS Illinois temporarily updating credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. READ MORE

4/6/2020 - BCBS Illinois temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020.
READ MORE

4/1/2020 - No copays, deductibles or coinsurance for medically necessary lab tests to diagnose COVID-19, for in-network provider visits related to COVID-19, whether at a provider's office, urgent care clinic, emergency room or by telehealth, or for treatment at in-network facilities and treatment for out-of-network emergencies. READ MORE

3/30/2020 - Launched expanded telehealth program on 3/11/2020 for all state-regulated, fully insured members. Effective March 19, 2020, BCBSIL began providing benefits to fully-insured members for health care services provided by in-network and out-of-network providers for all medically necessary covered services and treatments (consistent with the terms of the member’s benefit plan). READ MORE

Blue Cross Blue Shield
Kansas City MO

 

5/8/2020 - Payer is covering telehealth services with a $0 copay for sick and wellness visits. READ MORE

4/1/2020 - Effective April 1, Blue KC is waiving all member cost sharing and co-payments for inpatient hospital admissions due to the diagnosis of COVID-19 for individuals fully insured by Blue KC. This policy will remain in place through June 30, 2020 and applies to insured Blue KC plans. READ MORE

3/18/2020 - Effective through May 15, 2020, the COVID-19 diagnostic test will be covered consistent with CDC guidance related to COVID-19, with no cost share to the member (the office visit is subject to member cost sharing). Prior auth waived for diagnostic tests and for covered services medically necessary and consistent with CDC. Blue KC waiving fees for urgent/sick virtual care for members. In addition, Blue KC has facilitated remote work spaces for employees. READ MORE

Blue Cross Blue Shield
Massachusetts

5/6/2022 - Authorization Requirements Previously Relaxed to Resume on May 17th. In March, we told you that prior authorization requirements for certain services were relaxed through May 16, 2022 as required by the Division of Insurance (Bulletin 2022-03). READ MORE 

2/17/2021 - U0005 - Reimbursable for dates of service on or after January 1, 2021 when billed with U0003 or U0004. READ MORE 

4/29/2020 - Modifiers (GT, 95, GO, GQ) are required on all video/telehealth claims. READ MORE

4/8/2020 - COVID-19 expedited credentialing process and provider audits on hold. READ MORE

4/7/2020 - Temporary fee schedules posted. READ MORE

3/24/2020 - Effective with dates of service February 4, 2020, claims for COVID-19 tests for commercial, and Medicare Advantage members use CPT codes U0001, U0002 and 87635. Use ICD-10 codes (for patients presenting for evaluation of possible COVID-19) Z20.828, Z03.818 and Z11.59 and ICD-10 codes (if your patient has a previously confirmed COVID-19 illness or tested positive for COVID-19) B97.29, B97.21, U07.1 and B34.2.  READ MORE

3/23/2020 - Waived member cost share for medically necessary COVID-19 testing/treatment at doctor's offices/urgent care center/ERs (excluding inpatient care)/telehealth for in-network providers, in accordance w CDC & MA Dept of Public Health. Removed prior auth/referrals for medically appropriate care for COVID-19. Still requiring providers to notify us when a member is admitted. READ MORE

Blue Cross Blue Shield
Michigan

6/15/2022 - 2022 COVID-19 HCPCS Update: New Code Added. The Centers for Medicare & Medicaid Services has added a new code as part of its quarterly Health Care Procedure Coding System updates. READ MORE 

6/15/2022 - BCBS MI Changes to Basic Benefit and Medical Policy/Policy Clarifications. J0248 - Basic benefit and medical policy - - Veklury (remdesivir). READ MORE 

2/6/2022 - BCBS of Michigan will waive all copays, deductibles, and coinsurance for the administration of COVID-19 vaccines to commercial members. READ MORE

2/9/2021 - BCBS of Michigan and Blue Care Network members will pay zero out-of-pocket costs for COVID-19 diagnosis and treatment through September 30, 2021. READ MORE 

8/10/2020 - BCBS of Michigan Sees Volume of Health Care Claims Returning to Pre-Pandemic Levels. READ MORE 

5/6/2020 - Expanded laboratory testing for COVID-19 to any laboratory provider in Michigan, regardless of network status.
READ MORE

4/1/2020 - Blue Cross Michigan will waive member cost sharing for all COVID-19 treatment through June 30, 2020. Blue Cross will cover, with no member cost share, all COVID-19 treatment provided to members on an inpatient or outpatient basis, from both in-network and out-of-network providers. This includes Covering telehealth medical services at no cost through June 30 for members with existing telehealth medical benefits, waiving prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19. READ MORE

3/23/2020 - BCBS MI & Blue Care Network of MI will fully cover the cost of medically-necessary COVID-19 tests for members in fully-insured health plans; and will work with employer group customers that are self-insured to make decisions regarding their own benefits. READ MORE

Blue Cross Blue Shield
Nebraska

2/14/2022 - Blue Cross and Blue Shield of Nebraska will be reinstating precertification’s and prior authorization’s beginning March 15, 2022. Please be sure to use the preauthorization tool via NaviNet. If you have questions, please contact our nurse care manager team at 844-201-9644. READ MORE 

12/28/2021 - COVID-19 extensions are being extended through March 31, 2022. READ MORE

10/29/2021 - Claims with procedure codes not medically appropriate to be performed via telehealth will begin denying. Today, these claims are being returned with an Action Needed letter to please resubmit for proper billingREAD MORE 

8/24/2021 - BCBSNE will commit to extending the approval dates for an already approved Pre-Authorization (PA) due to the continued precautions. READ MORE

8/20/2021 - For both our commercial and Medicare members we are modifying prior authorization requirements for acute inpatient hospital admissions or skilled admissions. READ MORE 

3/31/2021 - July 1, 2020, BCBSNE updated its telehealth services policy to a limited number of providers, including: Medical doctors, Doctors of osteopathy, Physician assistants, Nurse practitioners, Behavioral health providers, and Occupational, physical and speech therapists. BCBSNE will continue to pay eligible providers at the assigned office fee schedule rates and prefers providers use a HIPPA-secure platform. The video component is not required. READ MORE 

3/3/2021 - BCBS of Nebraska will be reinstating precertification’s for Home Health, SNF and Acute Rehab admissions beginning March 15, 2021. READ MORE 

2/23/2021 - Effective March 15, 2021, we will once again require prior authorization for acute inpatient hospital admissions. READ MORE

1/1/2021 - BCBSNE will continue to pay eligible providers at the assigned office fee schedule rates and prefers that providers use a HIPAA-secure platform. READ MORE 

12/11/2020 - COVID-19 Treatment and Vaccine: You can find an updated COVID-19 FAQ on NaviNet. All updated information is highlighted in yellow. This includes information on how to bill for COVID treatment and vaccines. READ MORE 

11/13/2020 - Effective Nov. 16, 2020, BCBSNE will not require prior authorization for acute inpatient hospital admissions. This includes acute mental health inpatient admissions but does not include residential treatment center admissions. READ MORE 

11/13/2020 - BCBSNE will commit to extending the approval dates for an already approved preauthorization due to the continued precautions with coronavirus. READ MORE 

11/5/2020 - For admissions Nov. 6, 2020 and forward, BCBSNE has made the decision to administratively approve days 1-5 of a Skilled Nursing Facility (SNF) or Acute Rehab (AR) admission. READ MORE 

11/5/2020 - BCBSNE will continue to pay eligible providers at the assigned office fee schedule rates and prefers that providers use a HIPAA-secure platform. READ MORE 

10/7/2020 - In response to the COVID-19, BCBSNE extended the timely filing deadline for providers to December 31, 2020 or your current contract’s filing deadline, whichever is later. READ MORE

8/26/2020 - BCBSNE continues to support its customers and has made the decision to extend its member cost-share waiver for in-network treatment of COVID-19 through Dec. 31, 2020. READ MORE 

7/19/2020 - COVID-19 Provider Support: BCBSNE will extend the approval dates for already-approved preauthorizations affected by COVID-19. READ MORE

6/19/2020 - For Medicare Advantage members, we will continue to cover telehealth services for non-COVID-19 related services after July 1 for the remainder of the year, however, the applicable cost-shares/copays will apply. READ MORE 

5/29/2020 - COVID-19 and Telehealth Updates. READ MORE

5/29/2020 - Waiving Member Cost Share for COVID-19 Treatment. READ MORE

5/29/2020 - COVID-19 Antibody Testing. READ MORE

4/10/2020 - Pre-authorizations Affected by COVID-19. READ MORE

4/9/2020 - Due to the ever-changing status of COVID-19, BCBSNE will research and make retroactive changes to claims on the Provider's behalf as they adjust their policies.

4/8/2020 - Effective April 9, 2020, BCBSNE is extending the timely filing deadline for providers to Dec. 31, 2020 or to providers’ current contract filing deadline, whichever is later.

4/6/2020 - BCBSNE has made the decision to waive member cost-sharing for in-network treatment of COVID-19 from March 1, 2020, through June 30, 2020. This applies to office, urgent care, emergency room and inpatient hospital stays for the following BCBSNE plan members: fully insured, individual, Medicare Supplement, and Medicare Advantage. Also, 100% of allowable amounts for in-network covered benefits will be paid.

3/31/2020 - Effective 3/30/20, payer will not require prior authorization for acute inpatient hospital admissions. This does not include residential treatment center admissions.

3/26/2020 - Covering without copayment  – all telehealth services from qualified health care providers, including dentists, within the BCBSNE network at 100% of the assigned fee schedule from 3/13/20 through 6/30/20.  A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95 and POS 02 for reimbursement. All codes will be covered at 100% of the provider’s existing fee schedule.

3/24/2020 - The COVID-19 testing kit/swab/interpretation of the test and related office/urgent care/ER visit will all be paid without member cost share.  Starting 3/16/2020, all telehealth visits from providers will be paid with no member cost share for all members covered under a BCBSNE medical plan until further notice.

3/23/2020 - Extending the approval dates for an already approved Pre-Authorization for an additional 3 months when this is requested by the ordering provider.

Blue Cross Blue Shield
New York Empire

3/23/2021 - Updated Federal Guidance Related to COVID-19 Viral and Antibody Testing. READ MORE

11/4/2020 - Information from Empire for Care Providers on COVID-19 (updated 11/4/20). We recently updated FAQs about COVID-19 diagnostic testing. COVID-19 testing and visits associated with COVID-19 testing.  READ MORE 

IMPORTANT: In-network providers are reminded that they may not collect any deductible, copayment, or coinsurance for COVID-19 testing or visits to get the test.

Blue Cross Blue Shield
New Mexico

3/7/2020 - Effective immediately, payer won’t require prior authorization and won’t apply member co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control guidance. This applies to all members payer insures. With regard to treatment for COVID-19, Blue Cross and Blue Shield of New Mexico plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of your benefits. READ MORE

Blue Cross Blue Shield
North Carolina

6/7/2022 - In response to the COVID-19 pandemic that began in 2020, Blue Cross NC allowed certain services to be billed as telehealth. We have discovered through our claims review process that some services have been billed as telehealth that would not have been possible to be performed via telehealth such as surgery, anesthesia, laboratory testing and radiology.  We will deny or request refunds for any services that were billed and paid as telehealth incorrectly. READ MORE 

5/23/2022 - In April of 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a policy to ensure that out-of-network providers would not balance bill members for COVID-19 related services. READ MORE 

3/10/2022 - BCBS NC is extending its expanded reimbursement telehealth policy. It will remain in place through September 30, 2022. READ MORE 

12/7/2021 - For Medicare Advantage plans offered or administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC), the COVID-19 treatment cost-sharing waiver will remain in place through December 31, 2021. READ MORE 

11/9/2021 - BCBS NC and Teladoc Health announced the rollout of Teladoc Health's comprehensive virtual care platform to select Blue Cross NC employers and members. READ MORE 

11/3/2021 - BCBS NC announced its expanded telehealth policy will remain in place through March 31, 2022.
READ MORE 

10/21/2021 - Beginning January 1, 2022, Medicare Advantage Organizations (MAOs) and Medicare Medicaid Plans (MMPs) are responsible for adjudicating claims for COVID-19 vaccines and their administration and for COVID-19 monoclonal antibodies and their administration. READ MORE 

10/1/2021 - The Food and Drug Administration has issued an Emergency Use Authorization to allow the use of monoclonal antibody therapies for the treatment of mild to moderate COVID-19 in certain high-risk patients.
READ MORE 

9/13/2021 - This notice is a clarification of the appropriate coding for provider reimbursement for COVID-19 vaccine counseling (CPT 99401) for vaccine-hesitant commercial members. READ MORE 

8/27/2021 - This notice is a clarification of the appropriate coding for provider reimbursement for COVID-19 vaccine counseling (CPT 99401) for vaccine-hesitant commercial members. READ MORE 

6/15/2021 - Our cost-sharing waiver for COVID-19-related treatment will expire on June 30, 2021 for customers on the following plans: Fully-insured commercial plans (individual and group plans), State health plan, Balance funded Administrative Services Only (ASO) plans, other ASO plans, unless the employer has opted to extend this waiver. READ MORE 

6/1/2021 - Our cost-sharing waiver for COVID-19-related treatment will expire on June 30, 2021 for customers on the following plans: Fully-insured commercial plans (individual and group plans), Blue Medicare Supplemental plans, Balance funded Administrative Services Only (ASO) plans, and Other ASO plans, unless the employer has opted to extend this waiver. For Medicare Advantage plans offered or administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC), the COVID-19 treatment cost-sharing waiver will remain in place through the duration of the federal public health emergency (PHE). The PHE is set to expire on June 30, 2021 but may be extended by the federal government. READ MORE

5/28/2021 - Effective June 1, 2021, providers and facilities submitting COVID-19 claim inquiries to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will no longer be able to submit any inquiries via the online Microsoft Form or via the COVID19questions@bcbsnc.com or COVID19claimsfallout@bcbsnc.com mailboxes. READ MORE 

5/24/2021 - Effective June 30, 2021, there will be a change in coverage related to temporary language found in several policies as a result of COVID-19. READ MORE

5/24/2021 - The temporary language in the following policies will be extended to September 30, 2021: "Allergy Immunotherapy (Desensitization)," and "Advanced Illness/Advance Directives." READ MORE 

4/15/2021 - On March 15, 2021, the Centers for Medicare & Medicaid Services (CMS) announced it will increase the Medicare payment amount for administrating each dose of the COVID-19 vaccine to approximately $40 per administration (exact rate will depend on type of entity and geographic location). Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is reviewing CMS’s announcement and will communicate any impacts to commercial lines of business once determined. READ MORE 

4/13/2021 - Blue Cross and Blue Shield of North Carolina's (Blue Cross NC) current telehealth policy will remain in place through the end of 2021 to best serve its members throughout the course of the pandemic. READ MORE 

4/12/2021 - Effective June 1, 2021, providers and facilities submitting COVID-19 claim inquiries to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will no longer be able to submit any inquiries via the online Microsoft Form or via the COVID19questions@bcbsnc.com or COVID19claimsfallout@bcbsnc.com mailboxes. Providers will need to direct all future claim inquiries to Provider Service by calling 1-800-214-4844​. READ MORE

4/1/2021 - Blue Cross NC has extended waiving member cost-sharing (copays, deductibles and coinsurance) through June 30, 2021, for COVID-19-related treatment that is medically necessary and consistent with guidance from the Centers for Disease Control and Prevention (CDC). READ MORE 

3/30/2021 - Effective February 15, 2021 through August 15, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will participate in a Special Enrollment Period in response to the challenges of COVID-19. This Special Enrollment Period will allow individuals to apply for health insurance coverage. READ MORE 

3/16/2021 - BCBS of North Carolina will provide members with cost-free access to the COVID-19 vaccine. READ MORE 

3/2/2021 - The waiver of prior authorization requirements for emergent non-elective inpatient admissions, durable medical equipment and post-acute care services that are medically necessary for COVID-19 related services will expire on March 31, 2021. READ MORE 

2/22/2021 - The following is specific to Inter-Plan Program Host (IPP Host) members. These are members of another state’s Blues plan but receive care in North Carolina. READ MORE 

2/15/2021 - Effective February 15, 2021 through May 15, 2021, BCBS NC will participate in a Special Enrollment Period in response to the challenges of COVID-19. READ MORE 

1/14/2021 - BCBS NC is asking our Blue Cross NC network of behavioral health providers to participate in a short online survey about their current capacity. READ MORE 

12/21/2021 - BCBS NC will waive prior authorization requirements for all conditions, including non-COVID-19 conditions, and require notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs). READ MORE 

12/21/2020 - BCBS NC will cover COVID-19 vaccines that are FDA approved for emergency use authorization (EUA) at no cost for all members, both during the public health emergency and after. READ MORE 

12/10/2020 - As we anticipate an emergency use approval from the FDA for a COVID-19 vaccine soon, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is preparing so the vaccine will be available at no cost to all Blue Cross NC members. READ MORE 

11/17/2020 - Virtual Care - The following measure is extended through June 30, 2021 (previous date was Dec. 31, 2020).READ MORE 

11/17/2020 - Prior Authorization Waiver for COVID-19 Related Services - The following measure has been extended through March 31, 2021 (previous date was Dec. 31, 2020). READ MORE 

11/17/2020 - COVID-19 Treatment Cost-Share Waivers - The following measure has been extended through March 31, 2021 (previous date was Dec. 31, 2020). READ MORE 

11/17/2020 - From Nov. 13 through Dec. 31, 2020, no doctor’s order is needed for member cost sharing to be waived for COVID-19 testing for eligible members. READ MORE

10/20/2020 - The Centers for Medicare and Medicaid Services (CMS) will be reinstating the Medicare 2 percent sequestration payment reduction on Jan. 1, 2021.READ MORE 

10/8/2020 - Effective October 1, members and providers could experience changes in what services may require prior authorization. READ MORE 

9/29/20020 - CMS implemented 12 new procedure codes in response to COVID-19 to describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). READ MORE

9/29/2020 - The American Medical Association (AMA) released new CPT code 99072, which became effective on Sept. 8, 2020. The code is designed for practices to report expenses incurred during a Public Health Emergency (PHE), including supplies and additional clinical staff time. READ MORE 

9/25/2020 - The following measure has been extended through December 31, 2020 (previous expiration date was October 31): Prior Authorization Waiver for COVID-19 Related Services. READ MORE 

9/25/2020 - The following measure has been extended through December 31, 2020 (previous expiration date was October 31): COVID-19 Treatment Cost-Share Waivers. READ MORE 

8/28/2020 - Blue Cross NC is continuing to waive member cost-sharing (copays, deductibles and coinsurance) for COVID-19 related clinical visits and testing that is ordered by a provider, medically necessary and FDA cleared, approved or authorized for members with a suspected or confirmed COVID-19 diagnosis. READ MORE 

8/19/2020 - Claims Submission Guidance for COVID-19 Testing for Preadmission Services. READ MORE

7/16/2020 - Due to an error in the Payer's systems, behavioral health providers who submitted claims under our COVID-19 expanded telehealth measure (service dates on or after March 6, 2020) may not have been paid at parity with their face-to-face reimbursement rate. READ MORE

7/10/2020 - Through 12/31/20, BCBS NC will continue its expanded virtual care policy. READ MORE

7/10/2020 - Through 10/31/20, BCBS NC will continue waiving member cost-sharing (copays, deductibles and coinsurance) for COVID-19 related treatment that is medically necessary and consistent with CDC guidance if a member is diagnosed with COVID-19. READ MORE

6/24/2020 - BCBS NC has launched a program called Accelerate to Value to support independent primary care practices.
READ MORE

6/24/2020 - BCBS NC has updated its coding guidance for our coverage of and cost-share waiver for a doctor visit or call to determine if COVID-19 testing is necessary. READ MORE   

6/18/2020 - BCBS NC is extending its policy to pay providers at parity for telehealth services through Dec. 31, 2020.
READ MORE

6/18/2020 - Measures extended through July 31, 2020: COVID-19 Treatment Cost-Share Waivers, Prior Authorization Waiver for COVID-19 Related Services, and Prior Authorization Required for Hydroxychloroquine and Chloroquine. 

6/8/2020 - Blue Cross NC will continue waiving prior authorization requirements for emergent non-elective inpatient admissions, durable medical equipment and post-acute care services that are medically necessary for COVID-19 related services. This measure applies to all Blue Cross NC commercial plans and Medicare Advantage plans offered and administered by Blue Cross NC, including Experience Health. This measure previously was set to expire on June 30, 2020, but has been extended through July 31, 2020. READ MORE

6/8/2020 - Blue Cross NC is requiring prior authorization for hydroxychloroquine and chloroquine. READ MORE

6/4/2020 - Virtual Rounds COVID-19 webinar on June 15th. READ MORE

6/2/2020 - UPDATE BC NC to waive co-pays for primary care and behavioral health for Medicare Advantage members through the end of 2020. READ MORE

6/2/2020 - BCBS NC is waiving all copays for in-network primary care and outpatient behavioral health visits for Medicare Advantage members from June 1 through the end of 2020. Visits do not have to be related to COVID-19 and can be done in person or virtually through telehealth. READ MORE

5/27/2020 - Expiring June 4, 2020: For non-COVID-19 vendor-based telehealth services (MDLIVE or Teladoc), the member cost-share waiver expires on June 4, 2020. This means that cost-sharing (copays, deductibles, coinsurance) will apply for members who have access to these services through their Blue Cross NC plans, starting on June 5, 2020. READ MORE

5/27/2020 - Extended through July 31, 2020: BCBS NC will continue its expanded virtual care policy. BCBS NC will continue waiving member cost-sharing (copays, deductibles and coinsurance) for COVID-19 related treatment that is medically necessary and consistent with CDC guidance if a member is diagnosed with COVID-19. This measure applies to all fully insured, State Health Plan, Federal Employee Program, Blue Cross NC Medicare Advantage members, and Experience Health members. READ MORE

5/27/2020 - Extended through June 30, 2020: BCBS NC will continue waiving prior authorization requirements for emergent non-elective inpatient admissions, durable medical equipment and post-acute care services that are medically necessary for COVID-19 related services. This measure applies to all BCBS NC members and Experience Health members. READ MORE

5/21/2020 - Webinar held on May 18 about COVID-19 updates. Some key points include the extension of expanded telehealth measures through July 31, 2020, and the waiving of member cost-sharing (copays, deductibles, and coinsurance) for COVID-19 related treatment that is medically necessary until June. Slides from the presentation available online. READ MORE

5/20/2020 - In response to provider questions, Blue Cross NC is clarifying that telehealth claims are risk-adjustable for Medicare and Affordable Care Act patients if they meet all other criteria for risk adjustment eligibility. The Centers for Medicare and Medicaid Services (CMS) has issued guidance that audio-visual telehealth claims are risk-adjustable under the COVID-19 emergency waiver. READ MORE

5/15/2020 - FAQs updated including no change in timely filing deadline, out-of-network rates, no reimbursement for PPE, telehealth guideline, and waiving of Prior Authorization guideline. Slide decks from recent webinars are also available. Modifier-CR is needed only if it is an audio-only or telephone telehealth consult. Condition code DR should be used when reporting COVID-19-related services on both inpatient and outpatient claims. READ MORE

5/11/2020 - BCBS NC continues to experience a higher volume of telehealth claims that require adjustment than anticipated.  READ MORE

5/8/2020 - BCBS NC is extending its expanded telehealth measure through July 31, 2020. READ MORE

5/4/2020 - COVID-19 measures extended to June 4. READ MORE

4/28/2020 - Elective inpatient admissions: No additional medical necessity review will be required for in-network providers that were previously approved with service dates on or after March 1, 2020. READ MORE

4/15/2020 - To help providers with cash flow concerns during the COVID-19 pandemic, BCBS NC is temporarily suspending the 2% reduction in Medicare payments for dates of service May 1, 2020 and after. READ MORE

4/15/2020 - CMS announced a temporary rule change allowing providers to establish alternate places of service for inpatient care. As such, BCBS NC is advising in-network providers to bill using their existing Proprietary Provider Number (PPN) to ensure payment. READ MORE

4/14/2020 - BCBS NC is covering the cost of telemedicine for members, including for tele-dentistry services covered under BCBS NC dental plans. READ MORE

4/9/2020 - Blue Cross NC is enhancing their claims payment processes to speed payments to providers. READ MORE

4/9/2020 - Our COVID-19 measures are in effect as of March 6, 2020. They were extended for an additional 30-day period starting on April 5, 2020, and will be re-evaluated for further extension. READ MORE

4/5/2020 - COVID-19 testing will not need prior approval and payer will provide coverage and waive cost-sharing (including deductibles, co-payments, and coinsurance) for COVID-19 testing or for a doctor visit or call to determine if testing is necessary. READ MORE

3/17/2020 - Federal Employee Program (FEP) has lifted the requirement that members must use the TeleDoc service for virtual care. They may now see their physicians through a virtual visit.

3/17/2020 - No Prior Authorization and No Member Cost Share for COVID-19 Testing - Effective March 6, 2020. (This may not apply to self-insured groups.) Do not file telehealth claims with Blue Cross NC until March 21, 2020 and use Telehealth as Place of Service (02). Use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits. 

Blue Cross Blue Shield
South Carolina

3/31/2020 - "Blue Care On Demand" is for video or health provider visits for members inside or outside SC without COVID-19 symptoms.  READ MORE

3/31/2020 - Effective immediately, will waive all out-of-pocket costs related to in-network COVID-19 medical treatment for members through June 1, 2020. READ MORE

Blue Cross Blue Shield
Tennessee

12/30/2020 - BlueCross Tennessee Shares Plan to Cover Costs for COVID-19 Vaccination. READ MORE 

9/24/2020 - BlueCross Extends Cost Waiver for Medicare Advantage Members Seeking Primary, Behavioral Care Through Dec. 31. READ MORE 

Blue Cross Blue Shield
Texas

6/21/2022 - COVID-19 Vaccine Administration Codes 0094A Benefit for Medicaid. READ MORE 

6/21/2022 - COVID-19 Vaccine Administration Codes 0074A Benefit for Medicaid. READ MORE 

5/31/2022 - COVID-19: Office Visit Co-Payments. Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE 

5/31/2022 - COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

5/20/2022 - COVID-19 Vaccine Informational Code Q0221 Benefit for Medicaid. READ MORE 

5/6/2022 - COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

5/6/2022 - COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid. READ MORE 

5/6/2022 - COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE 

4/13/2022 - COVID-19: New ICD-10 Diagnosis Codes Updates for Texas Medicaid Effective 04/01/2022. READ MORE

4/1/2022 - COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid.
READ MORE 

4/1/2022 - COVID-19: Rural Health Clinics (RHC) and Telehealth/Telemedicine – Texas Medicaid. READ MORE

4/1/2022 - COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid.
READ MORE

4/1/2022 - COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE

3/24/2022 - What is New: For dates of service on or after January 3, 2022, the Texas Medicaid and Healthcare Partnership (TMHP) issued usage of the vaccine administration procedure codes 0051A, 0052A, 0053A, and 0054A to administer the first, second, third (additional), and booster doses for Pfizer-BioNTech COVID-19 vaccine as benefits of Medicaid and CHIP for individuals 12 years of age and older. READ MORE 

3/14/2022 - Member Over-the-Counter COVID-19 Tests. READ MORE 

2/25/2022 - COVID-19 Vaccine Administration Codes M0220 and M0221 Benefits for Medicaid. READ MORE 

2/21/2022 - COVID-19 Effective Jan. 21, 2022: Veklury (Remdesivir) is a Texas Medicaid Benefit. READ MORE 

2/1/2022 - COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid Revised February 1, 2022.
READ MORE

1/18/22 - We are covering COVID-19 tests that are FDA-authorized, including rapid and antibody tests. READ MORE 

11/15/2021 - Update to COVID-19 lab testing section below related to tests as a condition of employment. READ MORE 

10/28/2021 - Following update(s) have been made: Waiver of prior authorizations related to medically appropriate interfacility transfers expires 10/31/2021; Referral waiver put in place for Monoclonal Antibody IV Therapy as approved under Emergency Use Authorization. READ MORE

10/1/2021 - BCBSTX Making It Easier to Transfer Members to Post-Acute Care. READ MORE 

9/16/2021 - 2022 Telemedicine and Telehealth Services: In support of our members and employer groups, in 2022 Blue Cross and Blue Shield of Texas (BCBSTX) will continue to cover the expanded telemedicine and telehealth services that we've covered in 2021. READ MORE 

9/15/2021 - COVID-19 Vaccines and Coverage: Booster Shots and Additional Doses. READ MORE

8/25/2021 - Are telemedicine/telehealth consultations covered? Is there an end date? Our Medicare members have access through the end of the HHS public health emergency. READ MORE 

8/23/2021 - BCBSTX Making It Easier to Transfer Members to Post-Acute Care. READ MORE 

6/24/2021 - Update to Telemedicine Code List. Review the codes we've updated in the Telemedicine Code List; these codes were effective January 1, 2021. READ MORE

5/19/2021 - What You Need to Know About COVID-19 Vaccine Protocols. READ MORE 

5/13/2021 - Coronavirus (COVID-19) Provider Information for ERS Participants. READ MORE 

3/20/2021 - Changes effective April 1, 2021 are outlined below. READ MORE 
Drug List Coverage Additions – As of April 1, 2021
Drug1: PFIZER-BIONTECH COVID-19 VACCINE (covid-19 (sars-cov-2) mrna vacc-pfizer im susp 30 mcg/0.3 ml)
Drug Class/Condition Used For: COVID-19 Vaccine

3/11/2021 - COVID-19 Vaccines and Coverage: Updated March 11, 2021. READ MORE 

3/5/2021 - We updated this notice to reflect that the Interfacility Transfer without Prior Authorization accommodation expired. This accommodation expired on Feb. 28, 2021. READ MORE 

3/1/2021 - Telemedicine Expansion for 2021. READ MORE 

2/23/2021 - COVID-19 Collection Codes Existing codes updated. READ MORE 

2/5/2021 - COVID FAQs. READ MORE 

1/29/2021 - Telehealth Claim Place of Service. READ MORE 

1/19/2021 - For treatment of COVID-19, we temporarily waived member cost-sharing through Dec. 31, 2020. Copays, deductibles and coinsurance now apply. READ MORE 

1/15/2021 - Telehealth 2021. We updated this notice to include information on Intensive Outpatient Program (IOP) telehealth coverage. READ MORE 

1/8/2021 - This article relates only to telemedicine/telehealth services rendered between March 10, 2020 and Dec. 31, 2020. READ MORE 

1/5/2021 - Telehealth: Member cost share. READ MORE 

12/30/2020 - Members will have access to the expanded telemedicine services through Dec. 31, 2020. READ MORE 

12/30/2020 - Blue Cross and Blue Shield of Texas (BCBSTX) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities through Feb. 28, 2021. READ MORE 

11/30/2020 - (Originally Posted 04/15/2020) COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

11/30/2020 - COVID-19: RURAL HEALTH CLINICS (RHC) and TELEHEALTH/TELEMEDICINE. READ MORE

11/23/2020 - COVID-19 Initiatives Extended.

11/18/2020 - How Providers can Become a COVID-19 Vaccinator/What’s New. READ MORE

11/13/2020 - COVID-19: Existing Prior Authorizations 90-day Extension for Texas Medicaid End Dates Extended

11/9/2020 - Modifier CS: Use the CS modifier only on the codes specified by the Centers for Medicare & Medicaid Services. 

10/20/2020 - Durable Medical Equipment (DME) Client Signature Waived During COVID-19.

10/6/2020 - For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance.

9/25/2020 - We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

8/25/2020 - Blue Cross and Blue Shield of Texas (BCBSTX) has expanded access to telehealth at no cost-share for our Medicare Advantage members through Dec. 31, 2020. 

8/14/2020 - For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance. 

8/14/2020 - COVID-19 Diagnosis Codes: To indicate services performed in conjunction with the testing for COVID-19 or COVID-19 antibodies. 

8/3/2020 - COVID-19: Texas Provider FAQs Updated 8/3/2020 

7/29/2020 - COVID-19 Initiatives Extended: Updated July 29, 2020. 

7/22/2020 - Extended End Dates: We extended the end dates for the treatment and telehealth/telemedicine cost-share waiver. Our state-regulated fully insured HMO and PPO members have access through Aug. 31, 2020. Our Medicare members have access through Dec. 31, 2020.

7/1/2020 - Medicare (excluding Part D) and Medicare Supplement members won’t pay copays, deductibles or coinsurance for COVID-19 treatment with providers or at facilities. 

7/1/2020 - The cost-share waiver for telemedicine services applies to claims beginning March 1, 2020, and is scheduled to end Dec. 31, 2020. 

7/1/2020 - BCBSTX expanded the telemedicine/telehealth program in response to the COVID19 crisis to provide greater access to medical and behavioral health services for members.

6/16/2020 - Donated Remdesivir Ineligible for Separate Reimbursement. 

6/16/2020 - COVID-19 Initiatives Extended into June. We updated this notice to reflect the extended end date of July 31, 2020 for Interfacility Transfer without Prior Authorization. 

6/2/2020 - BCBS TX further expands Telemedicine to In-Network Providers.

5/29/2020 - Expanded access to telehealth at no cost-share. 

5/26/2020 - BCBS Texas Further Expands Telemedicine to In-Network Providers. 

5/21/2020 - COVID-19 Webinar: Join the BCBSTX Network Management team for a review of our COVID-19 policies.

5/19/2020 - For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance.

5/18/2020 - BCBSTX expanded telemedicine/telehealth program in response to the COVID-19 crisis to provide greater access to medical and behavioral health services for our members through June 30, 2020 (previously May 31, 2020).

5/12/2020 - Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures, and Therapies. 

5/4/2020 - The Employees Retirement System of Texas (ERS) is the administrator of the HealthSelect of Texas® and Consumer Directed HealthSelectSM self-funded plans.  

4/28/2020 - Updated April 28, 2020 from 4-20-20 Chest CT Scans. This communication was updated to remove the April 30, 2020 end date. 

4/23/2020 - Telehealth-specific services are not in the electronic eligibility and benefits response. 

4/23/2020 - Expanded our telemedicine/telehealth program in response to the COVID-19 crisis to provide greater access to medical and behavioral health services for our members through May 31, 2020. 

4/20/2020 - As of March 2, 2020, providers that request prior authorization through eviCore for chest CT scans with a COVID-19 diagnosis will receive an approval without the need for clinical documentation. 

4/18/2020 - Modifier CS: For services furnished on March 18, 2020, through the end of the Public Health Emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing-related services. 

4/18/2020 - At this time BCBSTX will not be extending the timely claims filing requirements.

4/1/2020 - Credentialing Process Simplified for COVID-19. 

4/1/2020 - Wait Time: While this unprecedented situation is ever-changing, please be advised, during this time the payer is experiencing higher than usual call volumes. You may experience longer than usual wait times. 

3/27/2020 - Telehealth: Temporarily expanding coverage for medical and behavioral health telehealth visits. 

Blue Cross Blue Shield
Vermont

6/18/2020 - Update on Billing of U0001. READ MORE 

3/17/2020 - For BCBSVT members to receive a zero-cost share for the coronavirus testing, services must be provided in an office (place of service 11), or Urgent Care (place of service 20) or Emergency Room (place of service 23) setting. CPT codes U0001, U0002, 87635 and 87631; refer to complete billing details. READ MORE

Blue Cross of Idaho

3/20/2020 - BCI will cover the COVID-19 testing performed by in-network provider with no member cost share; we will also cover the test performed by an out-of-network provider at the same rate and the OON provider is prohibited from balance billing the member under the Family First ActREAD MORE

Blue Shield of California

5/7/2021 - COVID-19 Update. READ MORE 

3/16/2021 - Blue Shield of California has signed a contract with the state of California to be its Third Party Administrator to help optimize and accelerate the allocation and distribution of COVID-19 vaccines equitably, efficiently, and safely throughout the state. The nonprofit health plan is not charging the state for its staff time devoted to this effort. It will only bill the state actual expenses to support the vaccine network up to the limit of the contract. READ MORE 

2/26/2021 - March 1 marked the start of California’s transition to an enhanced provider vaccination Network that’s designed to make COVID-19 vaccines available to all Californians equitably, safely and as quickly as possible. READ MORE 

2/16/2021 - Blue Shield of California Answers Call to Assist California in COVID-19 Vaccine Effort. READ MORE 

1/19/2021 - COVID-19 Update. Who can get tested? READ MORE 

12/17/2020 - COVID-19 Vaccines: Here's What You Need to Know About Coverage. READ MORE 

10/14/2020 - Blue Shield of California Provides Over $50 Million in Premium Relief for Customers to Help Ease Financial Burden During COVID-19 Pandemic.

9/11/2020 - Blue Shield of California (Blue Shield) and Blue Shield of California Promise Health Plan (Blue Shield Promise) will waive out-of-pocket costs for copays, coinsurance, and deductibles for: Virtually using telehealth (including Teladoc), in a doctor's office, at an urgent care, in a hospital (including ER), and COVID-19 testing that’s ordered by a healthcare provider who is licensed to order these tests

9/1/2020 - Through December 31, 2020, out-of-pocket benefit costs for COVID-19 treatment will be waived. There are no prior approvals needed for COVID-19 treatment. Blue Shield will waive copays, coinsurance, and deductibles for COVID-19 treatments received between March 1 – December 31, 2020. 

8/4/2020 - Blue Shield of California will continue waiving copayments, coinsurance and deductible requirements for COVID-19 treatment for members who are covered under fully insured commercial HMO and PPO plans, Medicare Advantage plans, and Medicare Supplemental plans, through December 31, 2020. 

7/16/2020 - When Blue Shield of California launched the BlueSky initiative last year, the goal was to figure out ways to boost mental health support for middle- and high-school students in California. 

6/8/2020 - There are no prior approvals needed for COVID-19 treatment. Blue Shield and Blue Shield Promise will waive copays, coinsurance, and deductibles for COVID-19 treatments received between March 1 - September 30, 2020. 

6/3/2020 - BS CA extends member cost-sharing waivers for COVID-19 treatment and Teladoc service through 9/30/2020. 

5/28/2020 - COVID-19 Update.

5/13/2020 - Blue Shield of California and Bank of America Collaborate to Make $50 Million in Financial Support Available to Providers in Response to COVID-19 Crisis.

5/7/2020 - Blue Shield of California is carefully considering returning their employees to work.

5/4/2020 - In a notice, Blue Shield of California feels the State needs an innovative approach to help battle the Pandemic.

4/28/2020 - Blue Shield of California’s network of home-visit specialists has shifted much of their work to telemedicine to continue providing care, while keeping members safe. 

4/20/2020 - New details on Blue Shield's $200 million effort to support providers - Blue Shield of California has announced additional details on four programs available to qualifying network providers.

4/15/2020 - In the News: Blue Shield of California Foundation Commits $6.8 million to Communities Hit by COVID-19. 

4/6/2020 - Dr. Seth Glickman, Blue Shield of California's chief health officer: There are promising treatments for Coronavirus (COVID-19), but in the meantime, wear a mask. There is no curative treatment for the virus. 

4/6/2020 - Blue Shield of California is working with financial service partners to provide up to $200 million in direct support to healthcare providers and hospitals through financing guarantees, advance payments and restructuring of contracts.

4/4/2020 - California To Dramatically Ramp Up Testing for COVID-19: California Governor Gavin Newsom announced a new task force involving leading health experts to dramatically increase capacity and improve turnaround times for COVID-19 testing in the state. The task force’s immediate goal is to achieve a five-fold increase in daily testing for Californians per day by the end of April 2020. 

4/1/2020 - Blue Shield of California Will Help Reduce Costs for Members During the COVID-19 Crisis: Cover members’ coinsurance, co-payments and deductibles for COVID-19 medical treatments through May 31, 2020.

3/31/2020 - Telehealth during the COVID-19 public health emergency: Effective March 17, 2020, Telehealth services provided during the COVID-19 public health emergency do not have to be related to a patient’s diagnosis or treatment for COVID-19. This exception applies to all telehealth services, including medical-related and behavioral health services. 

3/17/2020 - Waiving all cost-sharing and any prior approval requirements for COVID-19 testing when prescribed by a physician for all members enrolled in Blue Shield’s fully insured commercial and Medi-Cal plans. Also, instituted a company-wide work-from-home policy. 

Buckeye Community Health Plan

9/13/2021 - Prior authorization requirements for long term acute care facilities (LTAC), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF hospital) are being waived in accordance with the August 27, 2021 Ohio Department of Medicaid Memo - Effective Immediately-COVID 19 Surge-Removing Administrative Barriers. READ MORE 

12/17/2020 - Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. READ MORE 

7/20/2020 - Effective July 1, 2020, all medical & behavioral health prior authorizations requirements have resumed. READ MORE 

7/20/2020 - Allwell from Buckeye Health Plan EXTENDS $0 MEMBER LIABILITY FOR Primary Care, Behavioral Health, and Telehealth SERVICES for Remainder of 2020. 

3/31/2020 - Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth. Any services that can be delivered virtually will be eligible for telehealth coverage. All prior authorization requirements for telehealth services will be lifted for dates of service from March 9, 2020 through June 30, 2020. Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state. 

CareFirst BCBS

1/14/2022 - COVID-19 News 1/14/22. Outpatient Coverage of Remdesivir for COVID-19 for all CareFirst Members. 
READ MORE 

1/6/2022 - COVID-19 News 1/6/22. Utilization Management Flexibilities. READ MORE 

12/30/2021 - COVID-19 Billing Update. COVID-19 Vaccine Administration Fees for Medicare Advantage. READ MORE

12/1/2021 - COVID-19 Update - Billing and Submitting Commercial Claims for Coronavirus Treatment. READ MORE 

9/13/2021 - COVID-19 Update. Billing and Submitting Commercial Claims for Coronavirus Treatment. READ MORE 

3/16/2021 - CareFirst BCBS will fully cover all member costs associated with all FDA-approved COVID-19 vaccines, including for members in self-insured plans. READ MORE

12/15/2020 - CareFirst BCBS to Cover All Costs for COVID-19 Vaccines. READ MORE 

12/4/2020 - CareFirst BlueCross BlueShield Extends COVID-19 Benefits into 2021, Encourages Flu and Childhood Vaccinations. READ MORE 

9/24/2020 - CareFirst BCBS Extends COVID-19 Member Benefits Through 2020 and Encourages Vaccinations. 

3/16/2020 - Eliminating prior authorization requirements for medically necessary diagnostic tests and covered services related to COVID-19 diagnosis. Waiving cost sharing (copays, coinsurance and deductibles) for in-network or out-of-network visits to a provider’s office, lab fees or treatments related to COVID-19. Though CareFirst is waiving out-of-pocket costs, members may experience balance billing from out-of-network providers. Rapidly expanded the scope of contracted lab partners to support access to testing as it becomes available. 

CareSource Ohio

6/16/2022 - Ohio Medicaid Provider News 6/16/22. COVID-19: Vaccination Program Updates. Ohio Department of Medicaid (ODM) has added new Pfizer codes for COVID-19 vaccination billing. READ MORE 

5/31/2022 - Ohio Medicare Advantage and D-SNP Provider News 5/31/22. Introducing Teladoc, CareSource’s New Telehealth Partner. Effective July 1, 2022, CareSource will partner with Teladoc® to offer the convenience of telehealth services to our Medicare Advantage members and D-SNP members. READ MORE 

5/12/2022 - Ohio Medicaid & MyCare Providers. Effective 6/1/22 - Post-Acute Care Prior Authorization Resumption.
READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/22. Effective 4/1/22 - COVID-19: Vaccination Program with Booster.
READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/2022. COVID-19: Temporary Payment Policy for Immunizations Update. READ MORE 

5/4/2022 - Ohio Medicaid Provider News 5/4/22. COVID-19: Vaccination Pediatric Counseling Visit Coding Guidance.
READ MORE 

4/25/2022 - COVID-19 Update 4/25/22 for Ohio Marketplace Providers, RE: COVID-19 OTC At-Home Testing Billing Guidance. READ MORE 

3/30/2022 - CareSource Ohio Medicaid and MyCare Provider News 3/30/22. RE: Teladoc, CareSource's New Telehealth Partner. READ MORE 

2/28/2022 - COVID-19 News 2/28/22 for Ohio Marketplace Providers. COVID-19 - Oral Therapies effective January 2022. READ MORE 

2/25/2022 - COVID-19 News 2/25/22 for Ohio Medicaid Providers. READ MORE 

1/18/2022 - COVID-19 News 1/18/22 for Ohio Medicaid Providers. 2022 Vaccination Program Update. The administration fee will continue to be paid at $100 as part of the provider enhanced reimbursement program for vaccinations for dates of service through June 30, 2022. READ MORE 

12/15/2021 - COVID-19 News for Ohio Medicaid Providers. CareSource has received an update from the Ohio Department of Medicaid (ODM) regarding the billing guidelines for COVID-19 vaccine administration. READ MORE 

12/2/2021 - COVID-19 News 11/4/21 for Ohio Medicare Providers. Medicare Billing Vaccination Billing Guidance. READ MORE 

11/5/2021 - COVID-19 Update 11/5/21 for Ohio Medicaid & MyCare Providers. Temporary Change to Prior Authorization for Transition to Post-Acute Care. READ MORE 

11/1/2021 - COVID-19 News 11/1/21 for Ohio Medicaid Providers: Vaccine Administration Rate Increase. READ MORE 

8/27/2021 - COVID-19 - Temporary Change to Prior Authorization for Transition to Post-Acute Care. Effective Aug. 27, 2021, prior authorization requirements for long term acute care facilities (LTACH), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF/hospitals) have been lifted. 

8/24/2021 - COVID-19 Vaccination Update. CareSource and other Ohio Managed Care Plans (MCPs) have updated the $100 COVID-19 member vaccine incentive to now allow members 12 years and older to receive the incentive.
READ MORE 

6/25/2021 - Ohio Medicaid Providers: COVID-19 Vaccine Administration Fee Bonus Payment effective 6/10/2021.
READ MORE 

6/25/2021 - Ohio Medicaid Providers: COVID-19 Vaccine Administration Rate Increase effective 6/10/2021. READ MORE 

6/23/2021 - OH MCD Providers 6/23/21. Bulletin regarding COVID-19: Vaccine Administration Fee Bonus Payment; effective 6/10/21. READ MORE 

6/18/2021 - Ohio Medicaid Providers: COVID-19 Vaccination Temporary Payment Policy Update. READ MORE 

6/10/2021 - OH MCD Providers 6/10/21. Bulletin regarding COVID-19 Vaccine Administration Fee Increases. READ MORE 

4/29/2021 - COVID-19: Temporary Change to PA's for Transition to Post-Acute Care Update/Effective 4/1/21. READ MORE 

4/26/2021 - We're committed to streamlining operations for providers and recognize the impact COVID-19 has on many practices and facilities.  READ MORE 

3/3/2021 - CareSource is continuing to keep you updated on the latest information and guidance related to COVID-19, specifically regarding vaccine updates. READ MORE 

12/8/2020 - COVID-19: Temporary Change to PAs for Transition to Post-Acute Care. READ MORE

12/8/2020 - To: Ohio Long-Term Acute Care Hospitals, Skilled Nursing Facilities, and Inpatient Rehabilitation Facilities. RE: COVID-19 Temporary Changes to PA's for Transition to Post-Acute Care. READ MORE 

11/9/2020 - COVID-19 SNF Prior Authorization Process Temporary Update, Effective 11/16/20. READ MORE 

7/21/2020 - COVID-19 Emergency Provisions Update Effective 7/1/2020 for Ohio Providers. 

Ohio Medicaid COVID-19 Prior Authorization Guidance updated from 4/13/2020. CareSource will immediately follow the Ohio Department of Medicaid (ODM) direction as it relates to relaxing prior authorization requirements. 

Drug Testing: CareSource will temporarily no longer require a prior authorization for drug testing services rendered by qualified participating laboratories, even after the 30 presumptive/12 confirmatory annual member limit is reached. 

4/13/2020 - OH Medicaid Providers and COVID-19 Prior Auth: CareSource will immediately follow the Ohio Department of Medicaid (ODM) direction as it relates to relaxing prior authorization requirements.

4/3/2020 - OH Medicaid: The March 27, 2020 notice has been updated on Telehealth Services to now include Claim Billing Guidelines for behavioral health claims. Expanded behavioral health services that are rendered via telehealth with dates of service on or after March 9, 2020, will be processed when billed with Modifier GT and the appropriate Place of Service for the code based on the ODM Behavioral Health Provider Manual. 

3/27/2020 - Effective March 6, 2020, CareSource will expand the telehealth benefit for OH MCR, D-SNAP and Marketplace Providers. All par providers are eligible to render telehealth services and claims will be processed in accordance to the CMS billing guidelines. CareSource will follow all published regulatory guidance on non-par providers who render telehealth services. 

3/27/2020 - After April 1, 2020 accepting U0001 for the CDC test or U0002 COVID-19 tests by any other technique for dates of service 3/4/2020 and after. Some Telehealth service cost-shares may be waived. Log on to the portal or call to verify the patient's plan is included. Documentation for billing CareSource may be available on the Portal Log-in. 866-286-9949, Call ref#032720001587 

6/30/2020 - OH Medicaid and MyCare Providers. COVID-19 Prior Authorization Changes Effective 7/1/2020

5/21/2020 - Ohio Medicaid COVID-19 Prior Authorization Guidance updated from 4/13/2020. CareSource will immediately follow the Ohio Department of Medicaid (ODM) direction as it relates to relaxing prior authorization requirements. 

5/6/2020 - Effective 5/6/2020, Providers may begin submitting claims for all additional services that are now eligible to be rendered via telehealth due to the temporary emergency expansion, including therapy services, with dates of services on or after March 9, 2020, based on the guidance provided in the Telehealth Billing Guidelines During COVID-19 State of Emergency resource published by ODM. 

4/28/2020 - CareSource has developed the " Provider Stimulus Package Program Tool" reference for providers to use to navigate the COVID-19 stimulus package programs offered by the federal government. 

4/28/2020 - COVID-19 Prior Authorizations - Ohio MyCare Providers: Providers are still required to maintain medical necessity records of all services rendered to CareSource members and to provide medical records to CareSource upon request. 

3/27/2020 - OH Medicaid & MyCare providers: effective 3/9/2020, all participating providers (per the ODM emergency rule 5160-1-21) are eligible to render telehealth services to members. And CareSource will follow all published regulator guidance in regards to non-par providers. 

3/13/2020 - CareSource statement to ensure that testing and prevention are in alignment with the OH Department of Health and the CDC guidelines. 

Centene

10/6/2020 - Centene will expand its Medicare Advantage offerings for 2021. READ MORE 

7/17/2020 - Centene and Quartet Health announced a nationwide expansion of their existing partnership to help members quickly and easily have access to critical behavioral health care during COVID-19 pandemic and beyond.

3/12/2020 - Company to waive member cost-sharing, cover screening costs for Medicaid, Medicare and Marketplace members as it relates to COVID-19  and tests, office visits, ER visits, telehealth visits. Removing Prior Auth requirements. 

Centers for Disease Control & Prevention (CDC)

1/21/2022 - New ICD-10 Code for Post-COVID Conditions, following the 2019 Novel Coronavirus (COVID_19). Effective 10/1/2021. READ MORE 

10/23/2020 - Quarterly MUE Update Changes/Revisions made 10/1/2020. READ MORE

10/16/2020 - On Wednesday October 14, 2020, CDC published a new web page on COVID-19 point-of-care (POC) testing and who can provide these tests along with applications to apply and where to send the application. READ MORE

9/18/2020 - CDC Overview of Testing for SARS-CoV-2 (COVID-19). READ MORE  

9/3/2020 - CMS recently released new surveyor guidance for SARS-CoV-2 Laboratory Test Results Reporting for CLIA-certified laboratories. READ MORE

7/21/2020 ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 (10/1/2020 - 9/30/2021). Please refer to the complete document, as there are updates applicable to the COVID-19 PHE. READ MORE 

3/27/2020 - The CDC updated the COVID-19 transmission web page to clarify information about types of spread.  READ MORE

Centers for Medicare & Medicaid Services (CMS)

6/30/2022 - Events: CMS cancelled the August 16 and 17 provider enrollment conference due to the ongoing COVID-19 public health emergency. READ MORE 

2/3/2022 - CMS News. Biden-Harris Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare. READ MORE 

1/27/2022 - COVID-19 Vaccine Codes: Pfizer Pre-Diluted Vaccine for Patients Ages 12+ & Third Dose for Immunocompromised Patients Ages 5–11. READ MORE 

1/26/2022 - Litigation Update for CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule. READ MORE 

1/19/2022 - Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination. READ MORE 

1/19/2022 - CMS Omnibus COVID-19 Health Care Staff Vaccination Rule – Implementation Timeline. Refer to the chart for the itemization by state, with Phase 1 and Phase 2 Deadline dates. READ MORE 

1/19/2022 - COVID-19 Vaccination Requirements for Health Care Providers and Suppliers - Requirement Infographic. READ MORE 

1/10/2022 - CMS Frequently Asked Questions "How to get your At-Home Over-the-Counter COVID-19 Test for Free."  READ MORE 

1/10/2022 - CMS News. Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance.
READ MORE 

12/29/2021 - Litigation Update for CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule. READ MORE 

12/16/2021 - COVID-19 Vaccine & Monoclonal Antibody Products: Changes for MA Plan Claims Starting January 1, 2022. READ MORE

12/1/2021 - COVID-19 Facts on Medicare FFS Billing (Updated 11/16/21). READ MORE 

11/16/2021 - CMS Transmittal R11115CP Issued 11/16/21, CR# 12519, Implementation Date 1/3/2022. Subject "Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List." READ MORE

10/22/2021 - Biden-Harris Administration Issues Guidance to States on Required Medicaid and CHIP Coverage for COVID-19-Related Treatment. READ MORE 

10/6/2021 - COVID-19 Facts on Medicare FFS Billing (Updated 10/6/21). READ MORE 

9/24/2021 - CMS News 9/24/21. CMS Will Pay for COVID-19 Booster Shots, Eligible Consumers Can Receive at No Cost. READ MORE 

9/16/2021 - Independent Diagnostic Testing Facility (IDTF) - Revised. Read new information (PDF) in this Medicare Learning Network fact sheet. READ MORE 

8/19/2021 - CMS News Release 8/19/21. Immunocompromised Enrollees in Medicaid, CHIP, and Most Group health Plans and Health Insurance Coverage May be Able to Receive an Additional COVID-19 Dose at No Cost. READ MORE 

7/24/2021 - Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; etc. READ MORE 

7/8/2021 - COVID-19 Snapshot: Impact on the Medicare Population. READ MORE 

6/24/2021 - CMS COVID-19 Frequently Asked Questions on Medicare FFS Billing (updated 7/2/2021). READ MORE

6/24/2021 - COVID-19 Accelerated and Advance Payment (CAAP) Repayment & Recovery Frequently Asked Questions (Updated 6/24/21). READ MORE 

6/21/2021 - CMS Press Release 6/21/21. New Medicaid and CHIP Enrollment Snapshot Shows Almost 10M Americans Enrolled in Coverage During the COVID-19 Public Health Emergency. READ MORE

5/26/2021 - CMS News 5/26/21. CMS Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers. READ MORE 

4/16/2021 - COVID-19 Vaccine: Check Medicare Eligibility Starting April 16. READ MORE 

4/16/2021 - MLN Connects 4/16/21. Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through December. READ MORE 

4/16/2021 - Medicare Telehealth Services: Updated List. READ MORE 

3/24/2021 - COVID-19 Stakeholder Calls: Tuesday, April 6th at 5:00 – 6:00 PM Eastern. READ MORE 

3/23/2021 - CMS Press Release. READ MORE 

3/12/2021 - CMS Transmittal R10597OTN Issued 3/12/21, CR# 12086, Implementation Date 7/6/21 "Submission of Condition Codes to the Inpatient Prospective Payment System (IPPS) Pricer to Report Services Provided as Part of an Expanded Access Approval or Emergency Use Authorization." READ MORE 

3/5/2021 - CMS COVID-19 FAQs on MCR FFS Billing (updated 3/5/21). READ MORE 

3/3/2021 - COVID-19 Vaccines and Monoclonal Antibodies. Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency. READ MORE

2/26/2021 - CMS Press Release 2/26/21: In accordance with the Executive Order President Biden signed on January 21, 2021, the Centers for Medicare & Medicaid Services (CMS), together with the Department of Labor and the Department of the Treasury, (collectively, the Departments) issued new guidance today removing barriers to COVID-19 diagnostic testing and vaccinations and strengthening requirements that plans and issuers cover diagnostic testing without cost sharing. READ MORE 

2/23/2021 - COVID-19 FAQs on MCR FFS Billing (update 2/19/2021). READ MORE 

2/18/2021 - Claims/Pricers/Codes. FQHC & RHC Claims: Retroactive Rate Adjustment for Code G2025. READ MORE 

2/17/2021 - Medicare - Customer Cost-share is waived for the COVID-19 listed services when the applicable codes are used. READ MORE 

2/16/2021 - Medicare Monoclonal Antibody COVID-19 Infusion Program Instructions - for coding/billing and Medicare payment. READ MORE 

2/11/2021 - CMS National Training Program Medicare update and Education Webinar | February 11, 2021. READ MORE

2/10/2021 - COVID-19 Test Pricing updated 1/25/2021. READ MORE 

1/28/2021 - 2021 Special Enrollment Period in response to the COVID-19 Emergency. READ MORE

1/26/2021 - Events: COVID-19 Listening Sessions with CMS Office of Minority Health —January 26 & 28. READ MORE

1/11/2021 - CMS Newsroom. CMS Launches Automated Web Tool for 1135 Waiver Requests and Public Health Emergency-Related Inquiries During Crises Like COVID-19. READ MORE 

1/7/2021 - CMS COVID-19 Frequently Asked Questions on MCR FFS Billing (updated 1/7/2021). Hospital Inpatient Prospective Payment Systems (IPPS) Payments. READ MORE 

1/7/2021 - CMS COVID-19 Frequently Asked Questions on MCR FFS Billing (updated 1/5/2021). READ MORE

1/6/2021 - COVID-19 Update - 2021 ICD-10-CM. READ MORE 

12/16/2020 - UPDATE - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/16/20).  Pages 17 - 18 High Throughput COVID-19 Testing. READ MORE

12/14/2020 - COVID-19 Vaccine Administration. CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once it is available. READ MORE 

12/3/2020 - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/3/20). Pages 120 - 128 Drugs and Vaccines under Part B, Questions 5 - 16 regarding monoclonal antibody products to treat COVID-19 and what Medicare will pay.
READ MORE 

12/1/2020 - COVID-19 Frequently Asked Questions on MCR FFS Billing (Revised 12/1/20). READ MORE

12/1/2020 - Press Release: Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients. 

11/25/2020 - Press Release: CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge

11/13/2020 - Press Release from 11/10/20 Updated on 11/13/20. CMS Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment. READ MORE 

11/12/2020 - CMS COVID-19 Frequently Asked Questions on MCR FFS Billing. Medicare Telehealth/Page 79. READ MORE

11/6/2020 - Transmittal R10438BP, Issued 11/6/2020, CR# 12023, Implementation Date 1/11/2021. This Change Request (CR) updates the Medicare Benefit Policy Manual, Publication 100-02, Chapter 7. 

11/3/2020 - CMS Press Release 10/28/20. 4th COVID-19 Interim Final Rule with Comment Period. In regards to the Price Transparency for COVID-19

10/30/2020 - CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine once it is available. 

10/29/2020 - Press Release 10/29/20. CMS-9915-F. The Transparency in Coverage final rule released today by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (the Departments) delivers on President Trump’s executive order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. 

10/28/2020 - CMS COVID-19 Facts on MCR FFS Billing/page 119. READ MORE 

10/28/2020 - CMS COVID-19 Facts on MCR FFS Billing/page 121. READ MORE 

10/16/2020 - CMS - COVID-19 Frequently Asked Questions FFS Guide updated 10/16/20. On October 15, 2020, CMS released an amended Ruling (CMS 2020-1-R2) that created an add-on payment for COVID-19 CDLTs performed using high throughput technology (as described by HCPCS codes U0003 and U0004). READ MORE 

10/16/2020 - CMS List of Telehealth Services. List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth

10/15/2020 - Telehealth Services in Medicaid and Medicare Increase. 

10/9/2020 - Covid-10 Accelerated/Advance Payment Revised Payment Terms. The repayment period has been extended and the automatic recoupment will begin one year after the date the accelerated or advance payment was issued. 

9/24/2020 - COVID-19 Provider Facts on Billing MCR FFS Claims (updated 9/24/20).  

9/8/2020 - Includes mandatory testing requirements for Staff and residents in Nursing home. Staff with symptoms or signs of COVID-19 must be tested and are restricted from the facility pending the results of the testing. 

8/27/2020 - On 8/25/20, CMS began implementing an unprecedented national nursing home training program for frontline nursing home staff and nursing home management.

8/6/2020 - COVID-19: Telemedicine, Clinical Experiences, Resources for Hospitals and Urgent Care Centers. 

8/6/2020 - Counseling and COVID-19 Testing. Update to SE20011. 

8/4/2020 - CMS Updates MCR Payment Policies for IRFs. 

7/17/2020 - SE20011 Revised. In a Multi-MAC Collaboration for Medicare Parts A and B, CMS has approved a useful tool displaying COVID-19 modifier use in table form.  The table can be reached from the link under Sources.  The following MACs are part of this group along with CMS: CGS, First Coast, NGS, Novitas, Noridian and WPS. 

7/16/2020 - CMS is directing additional resources to Nursing Homes in COVID-19 Hotspot area by sending Quality Improvement Organizations (QIOs) for immediate assistance to facilities with known infections control issues.  This is to improve the quality, safety, and protection of the vulnerable in nursing homes around the country and to help bring all available resources to these Hotspots. 

7/10/2020 - CMS Directs Additional Resources to Nursing Homes in COVID-19 Hotspot Areas

7/8/2020 - Updates to CMS SE20011- "During the COVID-19 PHE, hospitals may furnish clinical staff services in the patient’s home as a provider-based outpatient department and bill and be paid for these services as Hospital Outpatient Department (HOPD) services when the patient is registered as a hospital outpatient.  

7/2/2020 - Transmittal R10207CP issued 7/2/2020 and implemented 7/6/2020 - "July 2020 Update of the Hospital Outpatient Prospective Payment System/OPPS."

7/1/2020 - CMS Transmittal 10178, dated 6/12/2020, is being rescinded and replaced by Transmittal 10205 dated 7/1/2020. "New Point of Origin Code for transfer from a Designated Disaster Alternative Care Site."  This Change Request implements a new Point of Origin (PoO) Code "G" to indicate a "Transfer from a Designated Disaster Alternative Care Site (ACS)," due to changes relative to the Coronavirus disease 2019 Public Health Emergency.  Implementation Date is 8/3/2020. 

6/12/2020 - Transmittal R10178OTN issued 6/12/2020 and effective 7/6/2020 - New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site. 

6/11/2020 - Prior Authorization Process and Requirements for Certain Hospital OPD Services: Payment for Related Services.

6/9/2020 - Trump Administration Encourages Reopening of Healthcare Facilities. Today, under the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS) released a guide for patients and beneficiaries as they consider their in-person care options. 

6/4/2020 - Ordering COVID-19 Diagnostic Laboratory Tests.  

6/1/2020 - CMS News Release: CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes.  

5/11/2020 - CMS recently provided additional blanket waivers for the duration of the PHE. 

4/23/2020 - NEWS UPDATE: Freestanding Emergency Departments to Provide Care to Medicare and Medicaid Beneficiaries during the COVID-19 Public Health Emergency. 

4/19/2020 - CMS announced new regulatory requirements that will require nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities. In addition, CMS now requires nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC). 

4/11/2020 - Expanded Coverage for Essential Diagnostic Services Amid COVID-19. Requires group health plans and group and individual health insurance to cover both diagnostic testing and certain related items and services provided during a medical visit with no cost sharing. 

4/9/2020 - Multi-Factor Authentication Requirement Delayed for PECOS, I&A, and NPPES until further notice. 

4/8/2020 -  Replacement Files (2nd Q 2020) - CMS updated procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs) for Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, retroactive to January 1, 2020.  

3/30/2020 - CMS issued new rules and waivers of federal requirements: increase hospital capacity (CMS hospitals w/out walls); rapidly expand the healthcare workforce; put patients over paperwork; further promote telehealth in Medicare. 

3/30/2020 - CMS Flexibilities to Fight COVID-19. Provider Enrollment: CMS has established toll-free hotlines for physicians, non-physician practitioners and Part A certified providers and suppliers establishing isolation facilities to enroll and receive temporary Medicare billing privileges. 

3/23/2020 - CMS Providers can apply for advanced payment. They will get a 120 day advance payment, but still also get paid for their claims they are submitting. 

3/22/2020 - CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs (QPP) (MIPS) with respect to upcoming measure reporting and data submission for those programs. 

3/20/2020 - CMS has released a Virtual Toolkit to help you stay up-to-date on CMS materials available on COVID-19. 

3/20/2020 - SE20011 has been revised. Telehealth claims don’t require the “DR” condition code or “CR” modifier. CMS is not requiring additional or different modifiers associated with telehealth services furnished under these waivers. 

3/18/2020 - Medicare Fee-For-Service Providers-Section 1135 and 1812(f) Waivers. 

MLN Connects Weekly Newsletters and Webinars/Phone Sessions - COVID-19 including Telehealth, Lab Tests, Pricing and Codes (Past Issues) 

    • 4/3/2020 - MLN Connects Special Edition.  READ MORE
    • 4/7/2020 - MLN Connects Special Edition. READ MORE
    • 4/9/2020- MLN Connect.. READ MORE
    • 4/10/2020 - MLN Connects Special Edition: CMS recently repurposed the CS modifier for COVID-19 purposes. READ MORE

    • 4/10/2020 - MLN Matters Special Edition. READ MORE

    • 4/17/2020 - MLN Connects Special Edition. READ MORE

    • 4/22/2020 - MLN Connects 4/23/2020.  READ MORE

    • 4/22/2020 - MLN Telehealth Booklet. READ MORE

    • 4/24/2020 - MLN Matters MM11765 . READ MORE

    • 4/24/2020 - MLN Matters MM11764. READ MORE

    • 4/30/2020 - MLN Connects Special Edition includes a 4/30/2020 revised MLN Matters SE20016. READ MORE

    • 5/7/2020 - MLN Connects 5/7/2020. READ MORE
    • 5/8/2020 - MLN Connects 5/8/2020  READ MORE

    • 5/8/2020 - MLN Connects Special Edition  READ MORE

    • 5/7/2020 - CMS announced a one week extension of the Qualified Health Plan (QHP) certification and rate review timelines.  READ MORE

    • 5/14/2020 - MLN Connect 5/14/2020. COVID-19: Office Hours Call - Friday, May 15 from 12:30 to 2 pm ET. READ MORE
    • 5/14/2020 - MLN Connects 5/14 - MLN Matters MM11784 released 5/8/2020, effective 10/1/2020. Extension of payment for section 3712 of the CARES Act. READ MORE
    • 5/15/2020 - CMS Outlines Medicaid Managed Care Options in Responding to COVID-19. READ MORE
    • 5/15/2020 - MLNConnects SE 5-15. CMS announced a call for nominations for the new contractor-led Coronavirus Commission on Safety and Quality in Nursing Homes. READ MORE
    • 5/15/2020. COVID-19 Nursing Home Call Wednesday, May 20th, 4:30 to 5pm ET.  READ MORE
    • 5/15/2020 - MLN Matters MM11778, Effective/Implementation Date 6/16/2020.  READ MORE
    • 5/15/2020 - The deadline for the Notification Requirements of Confirmed and Suspected COVID-19 Cases Among Nursing Home Residents and Staff are required to report the first week of data to the CDC beginning May 8 but no later than May 17. READ MORE
    • 5/21/2020 - COVID-19 Office Hours Call on Thursday, May 21st from 5 to 6 pm ET. READ MORE

    • 5/21/2020 - MLN Connects: CMS Releases Additional Waivers for Hospitals and Ground Ambulance Organizations. READ MORE
    • 5/21/2020 - MLN Connects: Hospitals - Submit Medicare GME Affiliation Agreements by October 1 During the COVID-19 PHE. READ MORE
    • 5/21/2020 - MLN Connects: COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals. READ MORE
    • 5/22/2020 - COVID-19 Lessons from the Front Lines - Call Friday, May 22nd from 12:30 to 2 pm ET.  READ MORE

    • 5/26/2020 - COVID-19: Office Hours Call — May 26. Tuesdays from 5 to 6 pm ET.

    • 5/26/2020 - COVID-19: Lessons from the Front Lines Call — May 29, 12:30 to 2 pm ET. READ MORE

    • MLN Connects 5/28/2020. COVID-19: Adjusting Operations to Manage Patient Surge. The Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) collaborated with the COVID-19 Healthcare Resilience Task Force on resources

    • 5/29/2020 - MLN Connects 5/29/2020 Special Edition. New COVID-19 Facts on Medicare Fee-for-Service Billing. CREAD MORE

    • 5/26/2020 - MLN Matters MM11791 revised 5/26/2020, Implementation Date MAC's 6/16/2020 and FISS 7/6/2020.
      READ MORE
    • 6/1/2020 - MLN Connects Special Edition. COVID-19 - Using the CR Modifier and DR Condition Code.  READ MORE

      MLN Matters MM11805 Effective 6/12/2020 - Ordering COVID-19 Diagnostic Laboratory Tests.  READ MORE

    •  6/4/2020 - COVID-19 Lessons from the Front Lines Call - June 5 from 12:30 to 2 pm ET.  READ MORE

    • 6/4/2020 - MLN Matters MM11791 Revised - Implementation Date for MACs is now June 16, 2020, and FISS is now July 6, 2020.  READ MORE

    • 6/12/2020 - MLN Matters MM11805 effective 6/12/2020. Summary of policies in the calendar year CY 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules.  READ MORE

    • 6/11/2020 - MLN Connects 6/11/2020 READ MORE
    • 6/18/2020 - MLN Connects 6/18/2020. Hospitals: Submit Medicare GME Affiliation Agreements by October 1, 2020. READ MORE 

      6/19/2020 - COVID-19: Lessons from the Front Lines Call 

    • 6/19/2020 - MLN Matters MM11742 revised 6/19/2020, implementation date 7/6/2020: "Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer. 

      6/25/2020 - MLN Connects 6/25/2020. Trump Administration Issues Call to Action Based on New Data Detailing COVID-19 Impacts on Medicare Beneficiaries. Data Underscores Need for Payment Models that Produce Better Health Outcomes. 

    • 6/26/2020 MLN Connects Special Edition. (A) COVID-19 SNF Benefit Period Waiver.  

    • MLN Connects Special Edition 6/26/2020. (B) CMS Announces Plans to End the Blanket Waiver Requiring Nursing Homes to Submit Staffing Data.    

    • MLN Connects 7/2/2020. (1) ABN Form Renewal | (2) SNF Benefit Waiver Period - Billing Update | Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer - revised. 
    • MLN Connects/Special Edition 7/6/2020. (1) COVID-19: New and Expanded Flexibilities for RHCs & FQHCs during the Public Health Emergency | (2) ESRD PPS CY 2021 Proposed Rule. 
    • MLN Connects 7/9/2020. Open Payments Program Year 2019 Data. 
    • MLN Matters SE20011 revised 7/8/2020. Medicare FFS Response to the PHE on the COVID-19 | Teaching Physicians and Residents: Expansion of CPT Codes that May Be Billed with the GE Modifier
    • MLN Connects 7/23/2020. Events - Telemedicine Hack. 
    • MLN Matters SE20011 Revised 7/24/2020. Note: We revised the article on July 24, 2020, to add clarifying language to the Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services section to show it applies to lab tests regardless of the HCPCS codes used to report those tests. 
    • MLN Matters SE20011 Revised 7/30/2020. Note: revised the article on July 30, 2020, to add the section “Counseling and COVID19 Testing." All other information remains the same.  
    • MLN Connects Special Edition. CMS and CDC Announce Provider Reimbursement Available for Counseling Patients to Self-Isolate at Time of COVID-19 Testing. 
    • MLN Connects Special Edition 7/31/2020. Inpatient Psychiatric Facilities | Skilled Nursing Facilities | Hospices 
    • MLN Connects Special Edition 8/28/20. CMS Offers Comprehensive Support for Louisiana and Texas with Hurricane Laura. 

    • MLN Matters SE20011 revised 8/26/2020 - Medicare FFS Response to the PHE on the COVID-19. READ MORE 

      MLN Connects 8/27/2020. COVID-19 - Waive Cost-Sharing for These HCPCS Codes. 

    • MLN Matters 8/21 R10317OTN "Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19)." 

    • MLN Connects 8/20/2020. CMS Announces Resumption of Routine Inspections of All Provider and Suppliers, Issues Updated Enforcement Guidance to States, and Posts Toolkit Assist Nursing Homes. READ MORE 

    • MLN Matters SE20015 Revised 8/17/2020. 
      Note: We revised this article on August 17, 2020, to add an update regarding the implementation of Section 3710 of the CARES Act for IPPS hospitals to address potential Medicare program integrity risks. All other information is unchanged.

    • MLN Matters MM11939 released 8/7/20, effective 1/1/20, and implementation date 10/5/20. READ MORE 

    • MLN Connects 8/6/20. Renewed ABN: Deadline Extended to January 1. READ MORE 

    • MLN Connects Special Edition 8/4/20. Expanding Telehealth Beyond the PHE. READ MORE

    • MLN-Matters MM11937 revised 8/21/20 to update CR11937 to include COVID-19 codes 86408, 86409, 0225U, 0226U. Effective 8/10/20. Codes Effective August 10, 2020. READ MORE 
    • MLN Connects 9/3/20 includes MLN Matters MM11623 revised 8/21/20. 
      Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) — Revised.
    • MLN Matters SE20015 revised 9/11/20.  READ MORE

    • MLN Connects 9/17/20.  COVID-19 Lessons Learned & Infectious Disease Surge Annex Template. READ MORE
    • MLN Matters R10361OTN issued 9/17/20 "Update to the Implementation of the Increased Payments for COVID-19 Discharges Under the Inpatient Prospective Payment System (IPPS) Under Section 3710 of the CARES Act." READ MORE 
    • MLN Connects Special Edition 9/18/20. New COVID-19 Nursing Home Visitation Guidance. READ MORE 
    • MLN Connects Special Edition 9/18/20 - CMS Offers Comprehensive Support for Oregon due to Wildfires. READ MORE 
    • MLN Matters 9/24/2020. October 2020 Update of the Hospital Outpatient Prospective Payment Systems (OPPS). READ MORE 
    • MLN Connections Special Edition 9/24/20. COVID-19: Maintaining Safety, Critical Care Load-Balancing, and Behavioral Health. READ MORE 
    • MLN Matters Spec Edition 9/24. CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management Phone Call. READ MORE 
    • MLN-Connects 9/24/20. Publications for Providers - Checking Medicare Eligibility. READ MORE
    • MLN Matters MM11960 revised 9/24/20 (CR# R10373CP), Effective 10/1/20 and Implementation Date 10/5/20. "October 2020 Update of the OPPS (Hospital Outpatient Prospective Payment System." READ MORE 
    • MLN Connects 10/1 includes notice of MLN Matters MM11937 revised 9/24/20 (CR# R10367CP), Effective 10/1/20 and Implementation Date 10/5/20. "Quarterly Update of Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment." READ MORE
    • 10/1/2020 - MLN Connects 10/1/20. COVID-19: Optimizing Health Care PPE and Supplies.
      READ MORE
    • 10/2/2020 - MLN Matters MM11944 Revised 10/2/20. R10382CP - October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3. READ MORE 
    • 10/8/2020 - MLN Connects - SNF and LTCH Quality Reporting Programs: COVID-19 Public Reporting — Revised.
      READ MORE 
    • 10/8/2020 - MLN Connects 10/8 - COVID-19: Optimizing PPE and Child Health and Wellness.
      READ MORE
    • 10/8/2020 - MLN Connects 10/8/20 - Submit Medicare GME Affiliation Agreements during COVID-19 PHE by January 1. READ MORE 
    • 10/8/2020 - MLN Connects Special Edition 10/8/2020. CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19. READ MORE 
    • 10/16/2020 - MLN Connects 10/16/20. Special Edition - Enforcement Discretion Relating to Certain Pharmacy Billing. READ MORE 
    • 10/16/2020 - MLN Matters SE20011 Revised 10/16/20. Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the COVID-19. READ MORE   
    • 10/27/2020 - MLN Matters R10408CP. CR# 11939 issued 10/27/20, Implementation Date 10/5/20. CMS Medicare Claims Processing Manual update. READ MORE 
    • 10/28/2020 - MLN Connects Special Edition 10/28/20. Coverage of Life-Saving COVID-19 Vaccines & Therapeutics. READ MORE 
    • 11/3/2020 - MLN Connects Special Edition 11/3/20 - MS New One-Stop Nursing Home Resource Center Assists Providers, Caregivers, Residents. READ MORE 
    • 11/3/2020 - MLN Connects Special Edition 11/3/20 - ESRD PPS: CY 2021 Payment Policies and Rates. READ MORE 
    • 11/3/2020 - MLN 11939 Revised Again. Quarterly Update to the Medicare Physician Fee Schedule Database/October 2020 Update. READ MORE 
    • 11/5/2020 - MLN Connects 11/5/20. COVID-19 Vaccine: Find Out How to Prepare. Get ready to administer the COVID-19 vaccine when it’s available. READ MORE 
    • 11/9/2020 - MLN Matters MM12011 released 11/6/20, CR 12011. Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury in ESRD Facilities for Calendar Year 2021. READ MORE 
    • 11/9/2020 - MLN Matters SE20011 Revised 11/9/20. Medicare Fee-For-service (FFS) Response to the Public Health Emergency on the COVID-19.  READ MORE 

    • 11/11/2020 - MLN Connects 11/12/20. COVID-19: Non-Physician Practitioner Billing for CPT Codes 98966-98968. READ  MORE 
    • MLN Connects 11/12/20 Special Edition - COVID-19 Vaccine Codes and PC-ACE Software Update. READ MORE 
    • 11/13/2020 - MLN Matters 11/13/20. Update to Vaccine Services Editing. Transmittal R10456CP, Implementation 4/5/21, CR# 11975. READ MORE
    • 11/19/2020 - MLN Connects 11/19/20. ** CMS Releases Nursing Home COVID-19 Training Data with Urgent Call to Action. READ MORE  
    • 11/19/2020 - MLN Matters R10470OTN issued 11/20/20 "Implementation of Two (2) New NUBC Condition Codes. READ MORE
    • 11/23/2020 - MLN Matters MM12011 Revised 11/23/20. "Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021." READ MORE 
    • 11/25/2020 - MLNConnects 11/25 - Hospital Price Transparency Webcast on Tuesday, December 8 from 2 to 3 pm ET. Register for this Medicare Learning Network event. READ MORE
    • 12/1/2020 - MLN Connects 12/1/20 Special Edition. Professional Scope of Practice and Supervision. READ MORE
    • 12/2/2020 - MLN Connects 12/2/20 - On December 2, CMS finalized policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. READ MORE
    • 12/3/2020 - MLN Connects 12/3/20. Events for Providers. Physician Fee Schedule Final Rule: Understanding 4 Key Topics Call (Thursday, December 10, 1:30 to 3 pm ET). Register for this Medicare Learning Network event.
      READ MORE
    • 12/4/2020 - MLN Matters R10505CP dated 12/4/20 "Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List." CR# 12071, Implementation Date 1/4/2021. READ MORE
    • 12/4/2020 - MLN Matters R105404CP dated 12/4/20 "CY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule." CR# 12063, Implementation Date 1/4/2021. READ MORE 
    • 12/9/2020 - MLN Connects 12/9/20 Special Edition. In Case You Missed It: CMS Announces Guidance for Medicare Coverage of COVID-19 Antibody Treatment. READ MORE 
    • 12/10/2020 - MLN Connects 12/10/20. 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application: Deadline February 1. READ MORE 
    • 12/10/2020 - MLN Connects 12/10/20. COVID-19: Hospital Operations Toolkit. READ MORE 
    • 12/10/2020 - MLN Connects 12/10/20.Telehealth Services: Bill Correctly. READ MORE 
    • 12/10/2020 - MLN Connects 12/10/20. ICD-10 MS-DRG Grouper V38.1 & 2021 ICD-10-PCS Code Files. READ MORE 
    • 12/10/2020 - MLN Connects Special Edition 12/10. CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and Providers. READ MORE 
    • 12/14/2020 - UPDATE - MLN Connects 12/14/20 Special Edition. COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech. READ MORE 
    • 12/17/2020 - UPDATE - MLN Connects  12/17/20. Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List. READ MORE
    • 12/18/2020 UPDATED - MLN Matters MM12080. We update the fees for clinical laboratory travel codes P9603 and P9604 on an annual basis. READ MORE
    • 12/18/2020 UPDATE - MLN Matters MM12080 12/18/20.  "Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment." Effective 1/1/2021, Implementation 1/4/2021, CR Transmittal R10523CP. COVID-19 Policy Updates - Payment for High Throughput Technologies. READ MORE
    • 12/18/2020 - MLN Connects 12/18/20 Special Edition. COVID-19: Add-on Payment for New Treatments. READ MORE
    • 12/22/2020 - MLN Connects 12/22/20 Special Edition. COVID-19 Vaccine Codes: Updated Effective Date for Moderna. READ MORE  
    • 12/22/2020 - MLN Matters R10533DEMO 12/22/2020 Telehealth Expansion Benefit Enhancement under the Pennsylvania Rural Health Model (PARHM) - Implementation. READ MORE 
    • 12/23/2020 - MLN Connects 12/23/20. ICD-10 Code Files for FY 2021. READ MORE 
    • 12/23/2020 - MLN Matters R10530OTN 12/23/20 Instructions to Medicare Administration Contractor (MAC) on COVID-19 Emergency Declaration Blanket Waivers for Medicare-Dependent, Small Rural Hospitals and Sole Community Hospitals. READ MORE 
    • 12/23/2020 - MLN Matters MM12093 12/23/20 "Addition of the QW Modifier to HCPCS Codes 87811 and 87428."
      READ MORE 
    • 12/28/2020 - MLN Connects 12/28/20 Special Edition. Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March. READ MORE 
    • 12/31/2020 - MLN Matters MM12126 12/31/20 "2021 Annual Update to the Therapy Code List." CR # R10542CP, Effective Date 1/1/2021, Implementation Date 1/4/2021. READ MORE 
    • 1/7/2021 - MLN Connects 1/7/2021. COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit. READ MORE 
    • 1/7/2021 - MLN Connects 1/7/21 Special Edition - Physician Fee Schedule Updates. READ MORE 
    • 1/20/2021 - MLN Matters MM12080 Revised 1/20/21. READ MORE 
    • 1/21/2021 - CMS MLN Connects 1/21/21. READ MORE 
    • 2/11/2021 - MLN Connects 2/11/21. COVID-19 Revised Clinician Codes Accepted w CS Modifier. READ MORE 

    • 2/18/2021 - MLN Connects 2/18/21. CMS Takes Further Steps to Ensure Medicare Beneficiaries have Wide Access to COVID-19 Antibody Treatment. READ MORE 

    • 2/25/21 - MLN Connects 2/25/21 - Compliance/Post-acute Transfer "Bill correctly." READ MORE

    • 3/4/2021 - MLN Connects 3/4. COVID-19 Vaccine Administration: Insurance Coverage, MBI, & MSP. READ MORE 

    • 3/4/2021 - MLN Connects 3/4/21. COVID-19 Vaccine Codes. READ MORE 

    • 3/4/2021 - MLN Connects 3/4/21. COVID-19 FAQs on Medicare FFS Billing to Administer Vaccines. READ MORE 

    • 3/8/2021 - MLN Matters 3/8/21 MM12175 effective 3/8/21, implementation 4/5/21. April 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS). READ MORE 
    • 3/9/2021 - MLN Matters 3/9/2021 MM12062 effective 4/1/21, implementation 4/5/21. April 2021 Update to the Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS). READ MORE
    • MLN Matters MM12131 released 1/20/21, effective 4/1/21, and implementation 4/5/21. HCPCS Codes Subject to and Excluded from CLIA Edits. READ MORE
    • 3/15/2021 - MLN Connects 3/15/21. Special Edition - Medicare Payment Increase for COVID-19 Vaccine. READ MORE 
    • 3/16/2021 - MLN Matters MM12068 3/16/2021, CR Transmittal R10168CP, Effective 1/1/2021, and Implementation Date 7/6/2021.Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update. READ MORE 
    • 3/30/2021 - MLN Connects/Special Edition 3/30/21. Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension. READ MORE
    • 4/1/2021 - MLN Connects 4/1/21. Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021. READ MORE 
    • 4/6/2021 - MLN Matters MM12068 Revised 4/6/2021, CR Transmittal R10716CP, Effective 1/1/2021, and Implementation Date 7/6/2021. Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update. READ MORE 
    • 4/8/2021 - MLN Connects 4/8/21. Preparedness Resources: Cybersecurity & Post-Acute Sequelae of SARS-CoV-2. READ MORE 
    • 4/14/2021 - MLN Connects 4/14/21, Special Edition. J&J COVID-19 Vaccine: Health Alert. READ MORE 
    • 4/20/2021 - MLN Connects 4/20/21, Special Edition. COVID-19 Update: FDA Revoked the EUA for Bamlanivimab When Administered Alone. READ MORE 
    • 4/22/2021 - MLN Connects 4/22/21. Dialysis Facilities: Partnership to Vaccinate Dialysis Patients and Health Care Personnel. READ MORE 
    • 4/26/2021 - MLN Matters MM12269 released 4/26/21. Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636. Effective 7/1/21, Implementation 7/6/21. READ MORE 
    • 4/27/2021 - MLN Connects Special Edition 4/27/21. CMS Proposes to Enhance the Medical Workforce in Rural and Underserved Communities to Support COVID-19 Recovery and Beyond. READ MORE 
    • 5/6/2021 - MLN Connects 5/6/21. Special Edition - CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions. READ MORE 
    • 5/6/2021 - MLN Connects 5/6/2021. (1) New Program: HRSA COVID-19 Coverage Assistance Fund. READ MORE 

    • 5/6/2021 - MLN Connects 5/6/2021.(2) Ground Ambulance Services: Waiver for Treatment in Place. READ MORE 
    • 5/11/2021 - MLN Connects 5/11/21. Special Edition - CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable. READ MORE 
    • 5/13/2021 - MLN Connects 5/13/21. Multimedia - Community Champions Video Launch. READ MORE
    • 5/20/2021 - MLN Matters MM12294. Addition of the Shared System CWF to the Business Requirements for the Healthcare Common Procedure Coding System (HCPCS) Codes U0002QW and 87635QW Mentioned in Change Request 11765.
      READ MORE 
    • 5/27/2021 - MLN Connects 5/27 - Submit Medicare GME Affiliation Agreements during COVID-19 PHE by January 1, 2022. READ MORE
    • 5/27/2021 - MLN Connects 5/27. Publications - Medicare Diabetes Prevention & Diabetes Self-Management Training — Revised. READ MORE 
    • 6/3/2021 - MLN Connect 6/3/21. MACs Resume Medical Review on a Post-payment Basis. READ MORE 

    • 6/9/2021 - MLN Connects 6/9/21. READ MORE 

    • 6/11/2021 - MLN Matters MM12318 - Addition of the QW Modifier to HCPCS Codes 0240U, 0241U and 87637. READ MORE 

    • 6/17/2021 - MLN Connects 6/17/21. COVID-19: EUA for Sotrovimab Monoclonal Antibody Product and EUA for Regeneron Monoclonal Antibody Product Casirivimab & Imdevimab. READ MORE 

    • 6/24/2021 - MLN Connects 6/24/21. Compliance - SNF 3-Day Rule: Bill Correctly. READ MORE 

    • 7/8/2021 - MLN Connects 7/8/21. COVID-19 Accelerated and Advance Payments: Updated FAQs. READ MORE 

    • 7/13/2021 - MLN Connects Special Edition 7/13/21. CMS Proposes Physician Payment Rule to Improve Health Equity, Patient Access. READ MORE
    • 7/19/2021 - MLN Connects 7/19/21 - Special Edition: COVID-19 Lessons. READ MORE
    • 7/22/2021 - MLN Connect 7/22/21. Publications - Critical Access Hospital (revised). READ MORE
    • 7/22/2021 - MLN Connects 7/22/21. COVID-19: EUA for Tocilizumab Monoclonal Antibody Product. READ MORE 

    • 8/2/2021 - MLN Connects 8/2/21 Special Edition: Hospital Inpatient Prospective Payment System Final Rule Increases Payments to Treat COVID-19 and Improves Quality of Data Collection. READ MORE 
    • 8/2/2021 - MLN Connects 8/2/21: Improving Health Equity - CMS is also adopting a measure that requires hospitals and LTCHs to report COVID-19 vaccination rates of workers in their facilities. READ MORE
    • 8/2/2021 - MLN Connects 8/2/21: Ensuring Access to Life-Saving Diagnostics and Therapeutics. READ MORE 
    • 8/2/2021 - MLN Connects 8/2/21: Sustaining Hospital Readiness to Respond to Future Public Health Threats.
      READ MORE 
    • 8/12/2021 - MLN Connects 8/12/21. COVID-19: Vaccinate Your Patients. READ MORE
    • 8/13/2021 - MLN Connects 8/13/21 Special Edition. COVID-19 Vaccine Additional Dose. READ MORE 

    • 8/16/2021 - MLN Connects 8/16/21 Special Edition. COVID-19 Vaccines Additional Doses: Codes & Payment.
      READ MORE

    • 8/24/2021 - MLN Connects 8/24/21 - Special Edition. CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations. READ MORE 

    • 8/26/2021 - MLN Connects 8/26/21. Impact of the PHE on Telehealth: Comparative Billing Report in August.
      READ MORE 

    • 9/2/2021 - MLN Connects 9/2/21. Provider Enrollment Activities Resume in October. READ MORE 

    • 9/8/2021 - MLN Matters SE20011 Revised 9/8/21 - Medicare FFS Response to the PHE on COVID-19. READ MORE
    • 9/9/2021 - MLN Connects 9/9/21 Special Edition. READ MORE 
    • 9/9/2021 - MLN Connects 9/9/2021. Medicare FFS Response to the PHE on the COVID-19 - Revised. READ MORE 
    • 9/16/2021 - MLN Connects 9/16/21. COVID-19 Vaccines: Act Now. READ MORE
    • 9/27/2021 - MLN Connects 9/27/21 - Special Edition. Flu & Pneumococcal Vaccines: Expanded SNF Enforcement Discretion for Certain Pharmacy Billing. READ MORE
    • 9/27/2021 - MLN Connects 9/30/21. Flu Season and COVID-19. READ MORE 
    • 10/7/2021 - MLN Connects 10/7/21. Medicare-Dependent Hospital COVID-19 Waiver: Modification. READ MORE 
    • 10/13/2021 - MLN Matters MM12427 - New/Modifications to the Place of Service (POS) Codes for Telehealth. READ MORE 
    • 10/22/2021 - MLN Matters 10/22/21 - Special Edition "COVID-19 Moderna & Jansen (J&J) Booster Shots." Effective October 20, 2021, FDA amended the emergency use authorizations for the Moderna (PDF) and Jansen (Johnson & Johnson) COVID-19 vaccines to allow for use of a single booster dose for certain populations. READ MORE 

    • 10/28/2021 - MLN Matters 10/28/21. Make a Strong Flu Shot Recommendation — it’s Critical. READ MORE

    • 11/2/2021 - MLN Connects 11/2/21 Special Edition. CMS Physician Payment Rule Promotes Greater Access to Telehealth Services, Diabetes Prevention Programs. Final Rule Advances Health Equity, Person-Centered Care. READ MORE 

    • 11/2/2021 - MLN Connect 11/2/21. Encouraging Proven Vaccines to Protect Against Preventable Illness. READ MORE 
    • 11/4/2021 - MLN Connects 11/4/2021. COVID-19 Vaccines for Children. READ MORE 
    • 11/4/2021 - MLN Connects 11/4/21. COVID-19 Vaccine Webinar for Rural Communities. Monday, November 15 from 1 – 2:30 pm ET. READ MORE 
    • 11/4/2021 - MLN Connects Special Edition 11/4/2021. Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers. READ MORE 

      11/18/2021 - MLN Connects 11/18/21. Changes to Nursing Home Visitation COVID-19 (Revised) & COVID-19 Survey Activities. READ MORE 
    • 11/24/2021 - MLN Connects 11/24/21. Provider Relief Fund Reporting Deadline: November 30, 2021. READ MORE 
    • 12/2/2021 - MLN Connects 12/2/21. Special Edition - CMS Encourages People with Medicare to get COVID-19 Vaccine Booster Shot. READ MORE 
    • 12/10/2021 - MLN Matters MM12557 12/10/21, CR Transmittal R11156OTN "Addition of the QW Modifier to HCPCS Code 86328." Effective 9/23/2020 and Implementation Date 1/3/2022. READ MORE 
    • 12/16/2021 - MLN Connects 12/16/21. Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes. 
      READ MORE  
    • 12/23/2021 - MLM Connects 12/23/21. COVID-19 Vaccine Access in Long-Term Care Settings. READ MORE 
  • 1/6/2022 - MLN Connects 1/6/22. News - COVID-19 Vaccine Access in Long-term Care Settings. READ MORE 
  • 1/7/2022 - MLN Connects 1/7/2022. Special Edition COVID-19: New HCPCS Code for Remdesivir Antiviral Medication. READ MORE 
  • MLN Connect 1/13/2022. OVID-19: Pfizer Booster Doses for Ages 12+ & Immunocompromised Ages 5–11. READ MORE 
  • 1/13/2022 - MLN Connects 1/13/22. COVID-19: Updated Materials for Visiting Nursing Homes During Omicron Surge. CMS updated our Nursing Home Resource Center with 2 new informational products. READ MORE
  • 1/13/2022 - MLN Matters 1/13/22. SE20016 Revised. New & Expanded Flexibilities for RHCs & FQHCs during the COVID-19 PHE. READ MORE 
  • 1/14/2022 - MLN Matters 1/14/22. For hospitals, providers, and home health agencies billing Medicare patients. MM12549/CR Transmittal R111750TN. CY2022 Telehealth Update Medicare Physician Fee Schedule. Effective Date 1/1/2022; Implementation Date 4/1/2022. READ MORE 
  • 1/13/2022 - MLN Connects 1/20/22. COVID-19: Vaccine Access in Long-term Care Settings. READ MORE 
  • 1/20/2022 - MLN Matters MM12573. Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits. CR Date 1/20/22, CR Transmittal R11208CP, CR Number 12573, Effective Date 4/1/22, and Implementation Date 4/4/22. READ MORE 
  • 1/27/2022 - MLN Connects 1/27/22. COVID-19: Tools to Determine if Vaccine Requirements Apply READ MORE
  • 2/3/2022 - MLN Connects 2/3/22. ** COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule. Read the Health Care Worker Vaccination Rule letter that CMS issued to health care facility administrators (PDF).
  • 2/4/2022 - MLN Matters MM12578 Revised 2/4/22, Transmittal R11255CP, Effective 4/1/22, and Implementation Date 4/4/22. READ MORE  
  • 2/10/2022 - MLN Connects 2/10/22. COVID-19: New HCPCS Code for Convalescent Plasma in Outpatient Setting.
    READ MORE
  • 2/16/2022 - COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing - Updated 2/16/22. BB) Drugs & Vaccines under Part B. READ MORE 
  • 2/18/2022 - MLN Connects 2/18/22 - Special Edition. COVID-19 Monoclonal Antibodies: FDA Authorized Bebtelovimab. READ MORE 
  • 3/10/2022 - MLN Connects 3/10/22. COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD. READ MORE
  • 3/17/2022 - MLN Connects 3/17/22. April 2022 Update to the Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) - Learn about coding for Pfizer's PAXLOVID and Merck's Molnupiravir. MLN Matters MM12631 released 2/17/22, CR Transmittal R11269CP, effective 4/1/22, and implementation date 4/4/22. READ MORE 
  • 3/24/2022 - MLN Matters MM12666 "April 2022 Update of Hospital Outpatient Prospective Payment System (OPPS)." CR Transmittal R11305CP, Release 3/24/22, Effective 4/1/22, and Implementation Date 4/4/22. READ MORE 
  • 3/24/2022 - MLN Matters MM12615 "Update to Chapter 7 Home Health Services of the Medicare Benefit Policy Manual (Pub 100-02)." CR Transmittal R11296BP, Release Date 3/25/22, Effective Date 1/1/22, and Implementation Date 5/26/22.  READ MORE
  • 4/4/2022 - MLN Connects/Special Edition 4/4/22. Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests.
    READ MORE 

  • 4/6/2022 - MLN Connects/Special Edition 4/6/22. Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost. READ MORE 

  • 4/7/2022 - MLN Matters 4/7/2022 R11343OTN - System Limitation Update for Centralized Flu Billers (CFB), Pneumococcal and Covid-19 Vaccinations. READ MORE 

  • 4/7/2022 - MLN Connects 4/7/22. Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers. Regulatory changes for mental health visits in RHCs and FQHCs; and billing information for mental health visits done via telecommunications. READ MORE 

  • 4/7/2022 - MLN Connects 4/7/22 Special Edition. CMS Returning to Certain Pre-COVID-19 Policies in Long-term Care and Other Facilities. READ MORE

  •  4/14/2022 - MLN Connects 4/14/22. COVID-19: New Codes for Moderna Vaccine Booster Doses. READ MORE 

  • 5/5/2022 - MLN Connects 5/5/22. COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers. READ MORE 

  • 5/5/2022 - MLN Matters MM12634 4/14/22 "Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General Updates." READ MORE

  •  5/12/2022 - MLN Connects 5/12/22. Clinical Laboratory Fee Schedule 2023 Preliminary Gapfill Rates: Submit Comments by July 11. READ MORE

  • 5/26/2022 - MLN Connects 5/26/22. COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose. READ MORE  

  • 5/26/2022 - MLN Matters MM12761 Issued 5/26/22 - July 2022 Update of the Outpatient Prospective Payment System (OPPS). READ MORE
  • 5/27/2022 - MLN Matters MM12427 Revised 5/27/22 - New/Modifications to the Place of Service (POS) Codes for Telehealth. READ MORE 
  • 6/15/2022 - MLN Matters MM12761 Issued 5/26/22 - July 2022 Update of the Outpatient Prospective Payment System (OPPS). READ MORE  

  • 6/16/2022 - MLN Connects 6/16/22. Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised. Learn about delayed in-person visit requirements (PDF) after the end of the COVID-19 public health emergency. READ MORE

  •  

    6/30/2022 - MLN Connects 6/30/22. COVID-19: Pfizer-BioNTech Vaccines for Children as Young as 6 Months — New Codes. On June 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization (PDF) to authorize use for all patients 6 months – 4 years old. READ MORE 

CGS Administrators - J15 A/B

4/6/2022 - COVID-19 News 4/6/22. On April 4, The Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. READ MORE 

2/2/2022 - CGS Medicare Claims Processing Issue Log. Issue - Claims containing these two COVID-19 codes were incorrectly routed to the Medical Review Department for further review. READ MORE

1/18/2022 - Billing VEKLURY™ (Remdesivir) Antiviral Medication in Outpatient Settings. READ MORE 

1/7/2022 - COVID-19: New HCPCS Code for Remdesivir Antiviral Medication. READ MORE 

12/2/2021 - CGS Medicare Claims Processing Issue Log. READ MORE 

5/11/2021 - CGS MCR Claims Processing Issues Log. 05/11/2021 Resolved. READ MORE

5/6/2021 - CGS Medicare Claims Processing Issues Log. 05/06/2021 Resolved. READ MORE 

5/1/2021 - COVID-19 News: Sequestration. READ MORE 

4/8/2021 - COVID-19 Vaccine Administration - No Out-of-Pocket Cost to Patients. READ MORE 

4/6/2021 - Accelerated and Advance Payments – Repayment Process Reminders. READ MORE 

4/2/2021 - COVID-19 News: Sequestration. READ MORE 

3/30/2021 - Part B News 3/30/21. Revised MLN Matters MM12131 - HCPCS Codes Subject to and Excluded from CLIA Edits. Effective 4/1/2021, Implementation 4/5/2021. Note: We revised this article to reflect a revised CR 12131. READ MORE 

3/9/2021 - CGS MCR Claims Processing Issues Log. READ MORE 

3/3/2021 - CGS MCR Claims Processing Issues Log. READ MORE 

02/5/2021 - CGS MCR Claims Processing Issues Log. Claims submitted for COVID-19 vaccine administration for patients enrolled in a Medicare Advantage (MA) plan were denied in error

1/21/2021 - CGS MCR Claims Processing Issues Log. READ MORE

12/10/2020 - Provider Enrollment for Mass Immunizers. READ MORE 

12/3/2020 - CGS News/ COVID-19. READ MORE 

11/5/2020 - CGS News/COVID-19. As a result of the COVID-19 PHE, CMS has issued waivers and flexibilities to assist Medicare beneficiaries in obtaining the services they need and allowing practitioners to utilize home oxygen therapy when they determine it is warranted. 

9/25/2020 - COVID-19 Provider Enrollment and Accelerated Payment Telephone Hotline: 1.855.769.9920 has been created for providers and suppliers to initiate provisional temporary Medicare billing privileges and address questions regarding provider enrollment flexibilities and accelerated payments, afforded by the COVID-19 waiver. The hotline is available Monday–Friday 7:00 am–4:00 p.m Central Time (CT). For additional information, refer to the COVID-19 web page

3/27/2020 - COVID-19 Provider Enrollment and Accelerated Payment Telephone Hotline: 1-855-769-9920 has been created for providers and suppliers to initiate provisional temporary Medicare billing privileges and address questions regarding provider enrollment flexibilities and accelerated payments, afforded by the COVID-19 waiver. The hotline is available Monday–Friday 7:00 am–4:00 p.m Central Time (CT). 

3/18/2020 - Open for calls, processing claims, paying claims. 

Cigna

4/18/2022 - Consistent with the new end of the PHE period, Cigna has extended cost-share waivers for COVID-19 diagnostic testing and related office visits through July 14, 2022. Customer cost-share will be waived for COVID-19 related virtual care services through July 14, 2022. READ MORE 

4/11/2022 - Cigna Policy Updates March 2022. READ MORE 

3/25/2022 - The facility-to-facility transfer authorization waiver will end on March 31, 2022.  READ MORE 

3/10/2022 - Cigna Policy Updates February 2022 - Pharmacy (Drugs & Biologics) Policies.
READ MORE 

2/25/2022 - Virtual care offered by Urgent Care Centers will no longer be reimbursed as of March 13, 2022. READ MORE 

2/25/2022 - On February 3, 2022, CMS announced a new initiative for free over-the-counter COVID-19 tests for individuals with Medicare plans. READ MORE 

12/29/2021 - Cigna is extending cost-share waivers for COVID-19 diagnostic testing and related office visits through January 15, 2022. We continue to make additional key  accommodations related to credentialing, virtual care, and facility transfers as outlined on this page. Interim accommodations for credentialing are extended until March 31, 2022.  READ MORE 

12/29/2021 - COVID-19 Updates 12/29/2021. READ MORE 

11/11/2021 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period, currently through January 15, 2022. READ MORE 

10/18/2021 - On October 15, 2021, the Secretary of Health and Human Services (HHS) renewed the national public health emergency (PHE) period for COVID-19 through January 15, 2022. Consistent with the new end of the PHE period, Cigna is extending cost-share waivers for COVID-19 diagnostic testing and related office visits through January 15, 2022. READ MORE 

9/8/2021 - Key COVID-19 Updates for September 2021. READ MORE 

8/23/2021 - Code 0003A now being used for third doses of Pfizer and Moderna vaccines. READ MORE 

8/23/2021 - To help facilitate freeing up bed space for facilities at or near capacity because of the current surge in COVID-19 admissions, Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH) without prior authorization until October 17, 2021 for both commercial and Medicare businesses. READ MORE

7/29/2021 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period, currently through October 17, 2021. READ MORE 

4/26/2021 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period, currently through July 20, 2021. READ MORE

4/6/2021 - Interim accommodations for authorizations ended on March 31, 2021. READ MORE  

3/16/2021 - Cigna is covering the cost of approved vaccines without any cost share. READ MORE 

3/4/2021 - The administration code for the Janssen (Johnson & Johnson) COVID-19 vaccine administration is 0031A. Pfizer uses codes 0001A and 0002A. Moderna uses 0011A and 0012A. AstraZeneca uses 0021A and 0022A. READ MORE 

2/22/2021 - As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. READ MORE 

2/17/2021 - Medicare - Customer Cost-share is waived for the COVID-19 listed services when the applicable codes are used. READ MORE 

1/20/2021 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until the end of Public Health Emergency (PHE) period, currently through April 20, 2021. We also continue to make several additional accommodations related to virtual care through the PHE period. Please review the “Virtual care services” frequently asked questions section on this page for more information. READ MORE

12/29/2020 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until January 21, 2021. The cost-share waiver for COVID-19 related treatment is in place until February 15, 2021. Other interim accommodations (e.g., for credentialing and authorizations) are extended through March 31, 2021, as outlined on this page. READ MORE 

12/21/2020 - As the first COVID-19 vaccines are being distributed across the country, we are committed to ensuring that Cigna commercial and Medicare customers receive the COVID-19 vaccine with no out-of-pocket costs and according to the federal and state priority grouping. Providers receive timely information and reasonable reimbursement consistent with CMS rates for administering EUA-approved COVID-19 vaccines and treatments. READ MORE 

12/7/2020 - Cigna Medical Coverage Policy 0557 effective 11/18/2020. COVID-19: In Vitro Diagnostic Testing. READ MORE 

11/1/2020 - Coverage Policy Updates for NOV 2020/Pharmacy. COVID-19 Drug/Biologic Therapeutics (2016) modified. 

10/30/2020 - The cost-share waiver for COVID-19 diagnostic testing and related office visits is extended until January 21, 2021. 

8/27/2020 - Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection through October 31, 2020 only when billed without any other codes.

7/1/2020 - Coverage Policy Updates/Reimbursement Policy. 

7/1/2020 - As federal guidelines continue to evolve in support of the COVID-19 pandemic, we are proactively extending customer cost-share waivers and other administrative benefits through at least October 31, 2020. We are also extending our interim virtual care and eConsult guidelines through at least December 31, 2020

6/23/2020 - Cigna will reimburse COVID-19 serology tests consistent with the recently announced CMS rates for COVID-19 serology testing as follows: 86769: $42.13 and 86328: $45.23

6/1/2020 - Effective immediately, global health service company Cigna (NYSE: CI) is expanding its support for customers during this unprecedented COVID-19 pandemic by eliminating cost-sharing for all primary care, specialty care and behavioral health care in-office or telehealth visits for COVID-19 and non-COVID-19 care. 

5/22/2020 - As federal guidelines continue to evolve in support of the COVID-19 pandemic, Cigna is adopting a position consistent with the federal public health emergency period, which ends on July 24, 2020.

5/11/2020 - Payer hosted a webinar on May 14 from 11 AM to 12 PM CST to discuss behavioral health challenges created by COVID-19 and possible solutions.

5/6/2020 - Cigna launched its new COVID-19 Customer Protection Program to further safeguard its customers from unexpected costs for COVID-19 care through "surprise" or "balance" bills from out-of-network health care providers. 

4/14/2020 - Cigna is launching Dental Virtual Care for customers to access an emergency dental consult during the COVID-19 pandemic. Dental virtual care will be available through Cigna's network of dental providers who offer teledentistry. 

3/30/2020 - General billing guidance for COVID-19 related services through at least 5/31/20.

3/25/2020 - Waive cost-sharing through May 31, 2020 for COVID-19 related office visit screening, testing and telehealth.  Free home delivery of prescriptions through Express Scripts.  Interim Billing Guidelines and FAQs available. 

3/23/2020 - Cigna is making it easier for hospitals to transfer patients to long term acute care hospitals (LTACHs) and other sub-acute facilities to help manage the demands of increasingly high volumes of COVID-19 patients. 

3/17/2020 - HCPCS code G2012 (brief communication technology-based service) will be reimbursed without customer copay or cost-share. [This code will pass Quadax XP edits after 4-7-2020}

Excellus
Blue Cross
Blue Shield

6/16/2022 - Preauthorization Requirements for Select Cardiology Services. Excellus BlueCross BlueShield is keeping a close eye on New York state COVID-19 emergency regulations and executive orders, which continue to be extended. READ MORE 

6/16/2022 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. READ MORE 

6/1/2022 - Connections Provider Newsletter: June 2022. NYS Executive Order #4 Extended. New York state Executive Order #4 has been extended until May 30, 2022. For more information related to the executive order, please refer to our provider bulletin issued October 7, 2021. READ MORE 

4/27/2022 - Provider News 4/27/22. Preauthorization Updates Effective August 1, 2022, for All Lines of Business Requiring Preauthorization. We would like to share updates regarding preauthorization under our Utilization Management (UM) Program. READ MORE 

4/18/2022 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. Please check back regularly. READ MORE 

4/13/2022 - COVID-19 Update 4/13/22. Vaccine Update/Vaccine Counseling Billing Information. READ MORE 

4/1/2022 - Connections Newsletter April 2022. New Telehealth Indicator Available. READ MORE 

3/18/2022 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. READ MORE 

3/10/2022 - Telehealth Claims - Place of Service (POS) 10. READ MORE 

3/2/2022 - COVID-19 News/Treatment Therapies updated 3/2/22. Post-exposure treatment therapy options. READ MORE 

2/1/2022 - Connections Newsletter February 2022. 2022 Telehealth Updates - The Health Plan will accept the following based on their purpose and descriptions. READ MORE

1/26/2022 - Authorization Updates. ** We are following the requirements of NYS DFS Insurance Circular Letter No. 1 (2022) for dates of service January 6, 2022 – February 5, 2022, related to in-network hospital transfers and inpatient rehabilitation services following a hospital stay for commercial and Safety Net lines of business. READ MORE 

1/18/2022 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. Please check back regularly. READ MORE  

1/10/2022 - COVID-19 Update 1/10/22. Monoclonal Antibodies. We have received notification that Medicare Advantage plans are required to cover monoclonal antibody products effective January 1, 2022. For dates of service on or after January 1, 2022, please bill Excellus BlueCross BlueShield (not Original Medicare) for the monoclonal antibody product and administration fee provided to MA members if the product was not received free of charge from the federal governmentREAD MORE 

12/27/2021 - Provider Connections newsletter: January 2022. COVID-19 Cost Share Update - Excellus BlueCross BlueShield will resume the collection of the member cost-share responsibility for COVID-19-related inpatient stays and monoclonal antibody treatment as of January 1, 2022 for fully insured members. READ MORE 

12/23/2021 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. READ MORE 

12/1/2021 - COVID-19 News/Vaccine Updates 12/1/21. READ MORE 

11/8/2021 - COVID-19 News/Vaccine Updates 11/8/21.  READ MORE 

10/21/2021 - Cost-Share for COVID-19 Treatment Resumes on January 1, 2022 (Audience: Hospitals). READ MORE 

10/18/2021 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. READ MORE 

10/7/2021 - Information Related to NYS Executive Order #4: Excellus BlueCross BlueShield (BCBS) has implemented the requirements included in Governor Hochul’s Executive Order #4, issued September 27, 2021 for its fully insured members. In addition, Excellus BCBS has extended these requirements to its Medicare line of business. READ MORE 

10/1/2021 - COVID-19 News/Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. Please check back regularly. READ MORE 

9/1/2021 - COVID-19 News: Testing Claim Reminder. READ MORE 

9/1/2021 - COVID-19 Coding Corner - Documentation Requirements for Telehealth Visits. READ MORE 

8/26/2021 - COVID-19 Update: Regulatory Time Frames - The time frames below are subject to change, dependent on decisions made at the state and federal levels. READ MORE 

8/6/2021 - COVID-19 Update 8/6/21 - Regulatory Time Frames. As we receive updates from New York state or the federal government, we will refresh this information. READ MORE 

7/21/2021 - Facility Claim Recovery Audit Appeal Time Frame Returns to 30 Days. Audience: Participating Hospitals. READ MORE 

7/9/2021 - Continued Waiver of Member Cost Share for Telehealth Services and COVID-19 Treatment for Fully Insured Members. READ MORE 

6/11/2021 - Expiration of Cost-Share Waiver for In-Network Outpatient Behavioral Health Services Provided In-Person to Essential Workers. READ MORE 

6/7/2021 - Telehealth Payment Parity Through March 31, 2022. READ MORE 

5/26/2021 - The initial supply of COVID-19 monoclonal antibodies will be provided free of charge by the federal government. The Health Plan will provide reimbursement for infusion of the antibody treatments only. Please do not bill for the monoclonal antibody products you receive for free. READ MORE 

5/4/2021 - The NYS Emergency Regulation on Telehealth has been extended to 6/4/2021. This extends specifically to COVID-19 and non-COVID-19-related telehealth services. READ MORE 

4/28/2021 - The U.S. FDA issued an emergency use authorization for the following investigational monoclonal antibody therapies for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adult and pediatric patients. We encourage you to review the FDA fact sheets on these drugs for additional details, including authorized use, limitations, administration guidelines, contraindications and more. READ MORE

3/16/2021 - Excellus BCBS will provide the COVID-19 vaccine at no cost to members, and members may access the vaccine from any service provider that offers it, regardless of whether the provider is in the Excellus network. READ MORE 

2/3/2021 - Excellus BCBS COVID-19 Updates. READ MORE 

1/21/2021 - Utilization Management Program-Preauthorization Update Effective May 1, 2021 for All Lines of Business that Require Preauthorization. READ MORE 

1/15/2021 - COVID-19 Treatment with Monoclonal Antibodies. READ MORE

12/30/2020 - Update to Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies – Diagnosis Code B97.29. READ MORE

12/23/2020 - Excellus BCBS Updates on COVID-19 (Coronavirus). READ MORE 

12/11/2020 - COVID-19 Reinstating Reimbursement of Preventive Visits via Telehealth. READ MORE 

12/4/2020 - Extension of In-Network Outpatient Behavioral Health Services for Essential Workers During the COVID-19 State of Emergency. Audience: Behavioral Health Providers and Outpatient Facilities. READ MORE 

12/1/2020 - Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing and Supplies; Reimbursement Update Effective March 1, 2021. Audience: Physicians and Facilities. READ MORE 

11/16/2020 - Extension of Member Cost-Share Waiver for COVID-19, non-COVID Telehealth Services. Audience - Professional Providers and Certified Home Healthcare Agencies. 

10/30/2020 - Telehealth Claims Billed with Modifier 95 - Processing Error. Audience: Behavioral Health Providers and Outpatient Facilities. 

10/29/2020 - No Coverage for CPT Code 99072, Personal Protective Equipment. 

10/22/2020 - Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing; Reimbursement Update Effective 1/21/2021. 

9/23/2020 - Member Cost-Share Waiver Update for COVID, and non-COVID Telehealth Services. 

8/17/2020 - Update Regarding Reimbursement for Telehealth Services. 

8/17/2020 - COVID-19 and Non-COVID-19 Related Telehealth Services.

8/14/2020 - Billing clarification for HCPCS Codes G2023 & G2024 for COVID-19 Specimen Collection. 

8/14/2020 - Updated Billing Requirements for Administrative Policy AP-26 COVID-19 Viral & Antibody Testing. 

8/14/2020 - Updated claim billing requirements for COVID-19 testing effective November 16, 2020.

7/17/2020 - Excellus BlueCross BlueShield implemented Administrative Policy AP-26 COVID-19 Viral and Antibody Testing effective March 13, 2020, to define the coverage, reimbursement and billing guidelines for this testing when it is determined to be medically appropriate. 

7/6/2020 - De-Implementing Temporary COVID-19 Hospital Contingencies.           

7/2/2020 - Medicare MS-DRG Payment Add-On for COVID-19 Hospitalizations. 

7/2/2020 - COVID-19 Reimbursement of Preventive Health Visits via Telehealth extended to September 7th. 

6/30/2020 - Updates on COVID-19.  Viral testing to rule out an active COVID-19 infection in patients prior to elective procedures is considered a component of pre-admission testing and is not reimbursed separately. 

6/4/2020 - Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual member, is not covered. 

6/4/2020 - For its commercial members, the Health Plan provides coverage with no member cost-share for COVID-19 diagnostic/viral testing as well as antibody testing that is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending provider as evidenced by an order from the attending provider. 

5/27/2020 - On May 2, 2020, the New York State Department of Financial Services issued an emergency regulation and circular letter that waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of emergency. 

5/21/2020 - COVID-19 Diagnostic and Antibody Testing Information. For its commercial members, the Health Plan provides coverage with no member cost-share for COVID-19 diagnostic/viral testing as well as antibody testing that is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending provider as evidenced by an order from the attending provider. 

5/20/2020 - COVID-19 Telehealth Billing Information for NYS OMH Licensed & Designated Facilities. Telehealth visits are covered for all medically necessary diagnoses (not just those related to COVID-19). There is no member cost-share (i.e., copay, coinsurance, deductible) for any telehealth services during the State of Emergency. 

5/5/2020 - Excellus BlueCross BlueShield would like to remind you that field 53 (dental provider signature) and field 54 (NPI) are required for a claim to process successfully. Please note that a claim submitted with “Signature on file” for field 53 will be returned as a billing error. 

5/4/2020 - COVID-19 Telehealth Information for Hospital Outpatient Services: For all lines of business (commercial, Medicare Advantage, New York State Government Programs and Special Programs) during the COVID-19 state of emergency, audio-only (telephonic) and video modalities, including technology commonly available on smartphones and other devices (e.g., Skype, FaceTime, Zoom) are acceptable and may be used when medically appropriate, with no risk of imposed penalties for noncompliance with HIPAA rules. 

4/17/2020 - Providers should not collect a copay or coinsurance and members will be covered, at no out-of-pocket expense, for in-network provider office visits, in-network urgent care visits, emergency room visits, and medically necessary diagnostic tests consistent with CDC guidelines related to COVID-19. 

4/16/2020 - Psychologists, Licensed Clinical Social Workers, Licensed Mental Health Counselors and Licensed Marriage and Family Therapists: For all lines of business (commercial, Medicare Advantage, New York State Government Programs and Special Programs) during the COVID-19 State of Emergency, electronic information and communication technologies for telehealth include audio only (telephonic) and video modalities, including technology commonly available on smart phones and other devices (e.g., Skype, FaceTime, Zoom). 

4/13/2020 - Info Updated April 10, 2020. Telehealth Information for Evaluation and Management Visits During the COVID-19 State of Emergency: Audience: Physicians, Nurse Practitioners and Physician Assistants. To assist our participating providers in delivering care to our members during the COVID-19 State of Emergency, we will provide reimbursement for evaluation and management (E/M) visit codes when they are provided via telehealth through audio (telephone) only. 

4/7/2020 - Some of the self-funded accounts have agreed that Excellus can apply the administrative assistance contingencies to services provided to their employees and covered family members. Please check member benefits on the following website- Provider.ExcellusBCBS.com or contact Customer Care.

3/26/2020 - No cost to members for medically necessary office, urgent care, or ER visits related to COVID-19. No cost to members for telehealth services (not just those related to COVID-19). Will reimburse all telehealth visits billed with place of service code 02 at the same rate as in-person visits for the same CPT code, and they will use the higher non-facility (office) relative value units for dates of service from March 13, 2020 until the State of Emergency has been lifted. 

3/26/2020 - All Excellus BCBS Resource Centers and walk-in customer service locations are closed until further notice. All Medicare informational seminars and mobile office hours are cancelled

Fidelis Care

3/26/2020 - Provider Access Online (Fidelis Care’s provider portal) will be unavailable starting on Thursday, March 26 at 8PM through Friday, March 27, 2AM.

3/24/2020 - Effective March 01, 2020, providers are responsible to ensure any copays, coinsurance, or deductible charges are waived for Fidelis Care members at the time of an office visit, urgent care visit, clinic, or emergency room visit when the purpose of that visit is testing for COVID-19.  Claims with correct coding will be adjusted to reflect provider payments with $0 member liability upon processing. Updating claiming systems to be able to receive new codes by April 1, 2020. Will add Healthcare Common Procedure Coding System (HCPCS) codes to system. 

First Coast Service Options - JN A/B

6/9/2022 - First Coast Claims Processing Issue for Part A Providers - reported 6/9/2022. Outpatient claims billed with COVID-19 and other vaccines not correctly processing. READ MORE

6/2/2022 - First Coast Claims Processing Issue for Part A Providers - reported 5/10/2022. Inpatient claims with diagnosis codes Z28.310, Z28.311, or Z28.39 returned incorrectly with reason code 34931. READ MORE 

5/26/2022 - COVID-19 Vaccine and Monoclonal Antibody Billing for Part A Providers - updated 5/26/22. This article will assist Medicare Part A providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. READ MORE 

5/12/2022 - COVID-19 Vaccine and Infusion Billing Guidance for FQHCs and RHCs. READ MORE 

5/10/2022 - First Coast Claims Processing Issue for Part A Providers - reported 5/10/2022. Inpatient claims with diagnosis codes Z28.310, Z28.311, or Z28.39 returned incorrectly with reason code 34931. READ MORE 

5/6/2022 - Fee Schedule News 5/6/22. COVID-19: Allowances for Laboratory Test Codes.
READ MORE 

5/2/2022 - First Coast Billing News for Part B Providers - reported 5/2/22. Billing the Taxonomy Code. Are you submitting claims for COVID-19 testing, vaccine or monoclonal antibody (mAb) infusion administration and experiencing issues with your claims processing under the incorrect PTAN? READ MORE 

4/19/2022 - COVID-19 Billing News 4/19/22. COVID-19 vaccine and monoclonal antibody billing for Part B providers. READ MORE 

3/14/2022 - COVID-19 Monoclonal antibodies and administration (updated 3/14/22).
READ MORE 

2/24/2022 - COVID-19 Monoclonal antibodies and administration (updated 2/24/22). The following codes are effective 2/11/2022. READ MORE 

2/11/2022 - Billing News 2/11/22. Billing COVID-19 Convalescent Plasma in Outpatient Setting. READ MORE

2/7/22 - Billing News for Part B Providers. Check patient eligibility prior to submitting claims to prevent denials. READ MORE 

2/4/2022 - Billing News 2/4/22 for Part B Providers. Billing the taxonomy code. READ MORE

2/4/22 Billing News for A & B Providers. Billing for COVID-19 vaccine home administration. READ MORE 

1/3/2022 - Payment Rates for COVID-19 Vaccine and Monoclonal Administration. READ MORE  

11/15/2021 - COVID-19 Billing News 11/15/21 for Part B Providers. Check patient eligibility prior to submitting claims to prevent denials. READ MORE

11/5/2021 - COVID-19 Vaccine and Monoclonal Antibody Billing for Part B Providers/updated 10/28/21. This article will assist Medicare Part B providers with proper billing relating to Coronavirus (COVID-19) vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived. READ MORE 

10/20/2021 - First Coast Processing Issues. Claims billed for monoclonal antibodies products are being returned to providers in error. READ MORE 

9/28/2021 - Medicare Enrolled Ambulance Suppliers Administering the COVID-19 Vaccine. READ MORE 

9/28/2021 - COVID-19 Vaccine and Monoclonal Antibody Billing for Part B Providers/updated 9/28/21. READ MORE

9/28/2021 - Fee Schedule News 9/28/21. 2021 Payment Rates for COVID-19 Vaccine Administration. 9/28/21 update as follows. READ MORE

9/14/2021 - Fee News 9/14/21. Payment Rates for COVID-19 Vaccine and Monoclonal Administration. READ MORE 

9/8/2021 - COVID-19 Billing News 9/8/21 for Part B. Check Patient Eligibility Prior To Submitting Claims To Prevent Denials. READ MORE 

8/18/2021 - COVID-19 Update for Part A Providers. Billing CC 90 or 91. CMS issued MLN Matters® (MM) 12049 to implement two new condition codes (CCs).  READ MORE 

8/18/2021 - 2021 Payment Rates for COVID-19 Vaccine and Monoclonal Administration. READ MORE

7/28/2021 - First Coast Processing Issues. Cost Sharing Applied to COVID-19 Claims - Part A Only. READ MORE 

6/28/2021 - COVID-19 Vaccine and Infusion Billing Guidance for FQHCs and RHCs.  READ MORE

6/21/2021 - 2020 Payment rates for COVID-19 vaccine and monoclonal administration (updated 6/21/21). READ MORE 

6/15/2021 - First Coast Medicare Processing Issues. Claims incorrectly received sequestration reduction - resolved 6/15/21. READ MORE 

6/2/2021 - First Coast Medicare Processing Issues. Allowing claims with 'Z' diagnosis codes - Part B claims. READ MORE 

5/26/2021 - Billing News: Providers in Primary Care Alliance ACO not receiving reimbursement on certain SNF claims. READ MORE 

5/13/2021 - First Coast Medicare Processing Issues. Allowance of QW Modifier on Codes U0002 and 87635. Part B.
READ MORE 

5/7/2021 - 2021 Payment Rates for COVID-19 Vaccine and Monoclonal Administration. READ MORE 

5/3/2021 - First Coast Medicare Processing Issues. Revised editing for ordering/referring providers on lab claims.
READ MORE 

4/23/2021 - COVID-19 vaccine and monoclonal antibody billing for Part B providers. READ MORE

4/23/2021 - First Coast Medicare Processing Issues: Claims incorrectly received sequestration reduction. READ MORE 

4/5/2021 - COVID-19 vaccine and infusion billing guidance for FQHCs and RHCs. Federally qualified health centers (FQHCs) administering the COVID-19 vaccine or mAb (monoclonal antibody). READ MORE

3/16/2021 - 2021 Payment Rates for COVID-19 Vaccine and Monoclonal Administration. READ MORE

3/8/2021 - Claim Processing Issues - Allowing Claims with "Z" Diagnosis Codes. READ MORE 

3/5/2021 - COVID-19 Billing Alerts. Use the CS modifier to waive cost-sharing-added March 5.  READ MORE 

3/1/2021 - COVID-19 Billing Alerts. Claims rejecting for Medicare Advantage beneficiaries require CC 78 – Added March 1st. READ MORE 

2/15/2021 - Billing Condition Code 90 or 91. READ MORE 

2/10/2021 - COVID-19 billing Alerts. Place of service (POS) for Part B claims – Added February 10. READ MORE 

2/2/2021 - COVID-19 Billing Alerts. READ MORE 

12/18/2020 - 2021 payment rates for COVID-19 vaccine and monoclonal administration. READ MORE

12/18/2020 UPDATE - 2020 payment rates for COVID-19 vaccine and monoclonal administration. READ MORE

12/7/2020 UPDATE - First Coast Processing Issues/Part B. Allowing Claims With "Z" Diagnosis Codes. READ MORE 

10/9/2020 - Learn About CMS' Amended Repayment Process for Accelerated and Advance Repayments. READ MORE 

9/23/2020 - Current Processing Issues for Part A and Part B. READ MORE 

9/11/2020 Current Processing Issues for Part A and Part B. READ MORE 

9/3/2020 - COVID-19: Skilled Nursing Facility (SNF) Waiver to Extend the Benefit Period.  QHS requirement. READ MORE 

8/31/2020 COVID-19 Allowances for laboratory test codes. READ MORE 

7/28/2020 - Concerning the PHE in response to the 2019 novel coronavirus (COVID-19) pandemic. READ MORE 

5/5/2020 - COVID-19: Skilled nursing facility (SNF) waiver to extend the benefit period for patients who have exhausted their SNF benefits. READ MORE 

4/23/2020 - COVID-19 Provider news: Correctly billing telehealth and telephone-only services during the emergency (updated 4/23/2020). These guidelines are effective for dates of service (DOS) on and after March 1, 2020, until the end of the designated PHE. READ MORE 

Food and Drug Administration (FDA)

6/30/2022 - FDA Roundup 7/1/22. On Wednesday, the FDA revised the Evusheld Fact Sheet for Healthcare Providers to recommend repeat dosing every six months with a dose of 300 mg of tixagevimab and 300 mg cilgavimab if patients need ongoing protection. READ MORE 

6/30/2022 - COVID-19 Update 6/30/22. FDA Recommends Inclusion of Omicron BA.4/5 Component for COVID-19 Vaccine Booster Doses. READ MORE 

6/28/2022 - FDA Roundup 6/28/22. The FDA and HHS/ASPR announced the authorization of an extension to the shelf-life from 18 months to 24 months for specific lots of the refrigerated AstraZeneca monoclonal antibody, Evusheld. READ MORE 

6/17/2022 - FDA Roundup 6/17/22. As of today, 438 tests and sample collection devices are authorized by the FDA under emergency use authorizations (EUAs). READ MORE 

6/17/2022 - The U.S. Food and Drug Administration authorized emergency use of the Moderna COVID-19 Vaccine and the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 to include use in children down to 6 months of age. READ MORE 

6/14/2022 - FDA Roundup 6/14/22. The FDA issued an emergency use authorization (EUA) for the Laboratory Corporation of America (Labcorp) VirSeq SARS-CoV-2 NGS Test on the PacBio Sequel II sequencing system. READ MORE 

6/7/2022 - FDA Roundup 6/7/22. On Friday, the FDA provided additional guidance to help prescribers evaluate potential drug interactions when using Paxlovid therapy for COVID-19. READ MORE 

6/3/2022 - FDA Roundup 6/3/22. The FDA authorized changes to the Fact Sheet for Healthcare Providers Administering Vaccines for the PBS/Sucrose formulation of Pfizer-BioNTech COVID-19 Vaccine for individuals 12 years of age and older (supplied in multiple dose vials with purple caps), to include additional updated expiration dates in the Fact Sheet. A copy of the granting letter and updated Fact Sheet are posted on the FDA’s website. READ MORE 

5/31/2022 - FDA Roundup 5/31/22. The FDA’s Center for Drug Evaluation and Research (CDER), Center for Devices and Radiological Health (CDRH), and Center for Biologics Evaluation and Research (CBER) are pleased to invite you to their free, virtual Regulatory Education for Industry (REdI) Annual Conference 2022 which will be held June 6 through June 10. READ MORE 

5/27/2022 - FDA Roundup 5/27/22. On May 20, the FDA and HHS/ASPR announced the authorization of an extension to the shelf-life from 12 months to 18 months for specific lots of the refrigerated Eli Lilly monoclonal antibody, bebtelovimab, which is currently authorized for emergency use. READ MORE 

5/20/2022 - FDA Roundup 5/20/22. On May 17, the FDA published the refreshed Know Your Treatment Options for COVID-19 Consumer Update with the latest information on COVID therapies. The FDA has approved two drug treatments for COVID-19 and has authorized others for emergency use during this public health emergency. READ MORE 

5/17/2022 - FDA Roundup 5/17/22. On May 15, the FDA issued an Emergency Use Authorization (EUA) for the Laboratory Corporation of America (Labcorp) Pixel by Labcorp COVID-19+Flu+RSV Test Home Collection Kit for use with the Labcorp Seasonal Respiratory Virus RT-PCR DTC Test. READ MORE 

5/17/2022 - COVID-19 Update 5/17/22. The U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine, authorizing the use of a single booster dose for administration to individuals 5 through 11 years of age at least five months after completion of a primary series with the Pfizer-BioNTech COVID-19 Vaccine. READ MORE 

5/16/2022 - COVID-19 Update 5/16/22. FDA Authorizes First COVID-19 Test Available without a Prescription That Also Detects Flu and RSV.
READ MORE 

5/10/2022 - FDA Roundup 5/10/22.  The FDA approved a new indication for Olumiant (baricitinib) for the treatment of COVID-19 in hospitalized adults requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). READ MORE 

5/6/2022 - FDA Roundup 5/6/22. Through the American Rescue Plan Act of 2021, Congress provided temporary funding for the FDA to develop the capacity to sequence SARS-CoV-2 RNA from wastewater samples and to conduct a sampling and sequencing project through 2022. READ MORE 

4/15/2022 - FDA Roundup 4/15/22. On April 14, the FDA issued an emergency use authorization (EUA) to InspectIR Systems for their InspectIR COVID-19 Breathalyzer test. READ MORE 

4/15/2022 - On April 13, the FDA and the Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response issued a statement that the shelf-life of bamlanivimab and/or etesevimab is being evaluated, and an update regarding shelf-life extension is planned for early May 2022. READ MORE 

4/8/2022 - On April 7, the FDA authorized an extension for the shelf life of the refrigerated Janssen COVID-19 Vaccine, allowing the product to be stored at 2-8 degrees Celsius for 11 months. READ MORE 

4/5/2022 - FDA Roundup 4/5/22. The FDA announced sotrovimab is no longer authorized to treat COVID-19 in any U.S. region due to increases in the proportion of COVID-19 cases caused by the Omicron BA.2 sub-variant. READ MORE 

4/1/2022 - FDA Roundup 4/1/22. The FDA published the FDA Voices: “Give Your Community a Boost: Combatting Misinformation Through Communication and Research,” by RADM Richardae Araojo, Pharm.D., M.S., Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity. READ MORE 

4/1/2022 - On March 31, the FDA revised its guidance, Emergency Use Authorization for Vaccines to Prevent COVID-19. The revised guidance updates recommendations for the clinical data to support effectiveness of a COVID-19 vaccine that has been modified to target a particular SARS-CoV-2 variant of concern. READ MORE 

4/1/2022 - On March 30, the FDA updated the list of Health and Human Services U.S. regions where sotrovimab is not authorized. This update is based on the Centers for Disease Control and Prevention (CDC) Nowcast data estimates from March 29 that the proportion of COVID-19 cases caused by the Omicron BA.2 variant is above 50% in these three regions.
READ MORE 

3/29/2022 - FDA Roundup 3/29/22. The FDA authorized a manufacturing change for the Moderna COVID-19 Vaccine to include an additional presentation of the vaccine for booster vaccination doses only. READ MORE 

3/29/2022 - COVID-19 Update 3/29/22. Today, the U.S. Food and Drug Administration authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for older people and certain immunocompromised individuals. READ MORE 

3/22/2022 - FDA Roundup 3/22/22. On March 21, the FDA issued a Letter to Health Care Personnel to provide recommendations, including conservation strategies, for prefilled 0.9% sodium chloride IV lock/ flush syringes. READ MORE 

3/21/2022 - COVID-19 Update 3/21/22. READ MORE 

3/18/2022 - FDA Roundup 3/18/22. READ MORE 

3/11/2022 - FDA Roundup 3/11/22. On March 4, the FDA authorized an extension for the shelf life of the refrigerated Janssen COVID-19 Vaccine, from six to nine months, allowing the product to be stored at 2-8 degrees Celsius. READ MORE 

3/8/2022 - FDA Roundup 3/8/22. COVID-19 testing updates: As of today, 420 tests and sample collection devices are authorized by the FDA under emergency use authorizations (EUAs). READ MORE 

3/1/2022 - FDA Roundup 3/1/22. The FDA issued a safety communication warning people not to use the Celltrion DiaTrust COVID-19 Ag Rapid Test that is in green and white packaging. he test has not been authorized, cleared or approved by the FDA for distribution or use in the United States. The FDA is concerned about the risk of false results when using this unauthorized test. READ MORE 

2/25/2022 - FDA Roundup 2/25/22. READ MORE 

On Feb. 24, the FDA updated the Antibody (Serology) Testing for COVID-19: Information for Patients and Consumers page on FDA.gov to answer questions about SARS-CoV-2 antibody testing. READ MORE 

2/22/2022 - FDA Roundup 2/22/22.  READ MORE 

2/18/2022 - FDA Roundup 2/18/22.  READ MORE 

2/11/2022 - COVID-19 Update 2/11/22. READ MORE 

2/8/2022 - FDA Roundup 2/8/22. READ MORE 

On Feb. 7, the FDA approved an abbreviated new drug application for succinylcholine chloride injection USP 200 mg/10 mL, which is indicated, in addition to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. READ MORE 

2/4/2022 - FDA Roundup 2/4/22. READ MORE 

On Feb. 4, the FDA warned people not to use the E25Bio COVID-19 Direct Antigen Rapid Test (DART). This test has not been authorized, cleared, or approved by the FDA for distribution or use in the United States, and it may include false labeling representing that the test is authorized by the FDA. READ MORE  

2/1/2022 - COVID-19 Update 1/31/22. READ MORE

2/1/2022 - FDA Roundup. READ MORE

FDA News 2/1/22. Today, the U.S. Food and Drug Administration is announcing a virtual meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Feb. 15 to discuss the request for emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine for use in children 6 months through 4 years of age. READ MORE

1/25/22 - FDA Roundup News 1/25/22. READ MORE 

1/24/2022 - COVID-19 Update 1/24/22. READ MORE 

1/21/2022 - FDA News 1/21/22. READ MORE 

1/14/2022 - FDA Roundup News 1/14/22. READ MORE 

1/11/2022 - FDA Roundup News 1/11/22. READ MORE 

1/7/2022 - FDA Roundup News 1/7/22. READ MORE 

1/7/22 - COVID-19 Update 1/7/22. READ MORE 

1/4/2022 - COVID-19 Update. READ MORE 

1/3/2022 - COVID-19 Update. READ MORE 

12/28/2021 - COVID-19 Update for 12/28/21. READ MORE

12/23/2021 - COVID-19 Update 12/23/21. READ MORE 

12/21/2021 - COVID-19 Update 12/21/21. READ MORE 

12/17/2021 - COVID-19 Update 12/17/21. READ MORE 

12/14/2021 - COVID-19 Update. READ MORE 

12/10/2021 -COVID-19 Update. READ MORE 

12/9/2021 -COVID-19 Update. READ MORE 

12/8/2021 -COVID-19 Update. READ MORE 

12/3/2021 - FDA News Release 12/3/21. READ MORE 

11/30/2021 - COVID-19 Update 11/30/21. READ MORE 

11/23/2021 - COVID-19 Update 11/23/21. READ MORE 

11/23/2021 - On Nov. 18, the FDA approved an abbreviated new drug application for vancomycin hydrochloride for injection, indicated to treat serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci. READ MORE

11/19/2021 - COVID-19 Update 11/19/21. READ MORE 

11/16/2021 - COVID-19 Update 11/16/21. READ MORE

11/5/2021 - COVID-19 Update 11/5/2021. READ MORE 

11/5/2021 - On Friday, November 5, 2021, the FDA authorized the use, under the EUA for the Janssen COVID-19 Vaccine, of two additional batches of vaccine drug substance manufactured at the Emergent facility. READ MORE 

11/2/2021 - COVID-19 Update 11/2/21. READ MORE 

10/29/2021 - The FDA is investigating certain imported medical gloves that appear to have been reprocessed, cleaned or recycled and sold as new. READ MORE 

10/26/2021 - COVID-19 Update 10/26/21. READ MORE 

10/22/2021 - COVID-19 Update 10/22/21. READ MORE 

10/20/2021 - COVID-19 Update 10/20/21. READ MORE 

10/19/2021 - COVID-19 Update 10/19/21. READ MORE

10/15/2021 - COVID-19 Update 10/15/21. READ MORE

10/5/2021 - COVID-19 Update 10/5/21. Testing updates. READ MORE 

10/4/2021 - COVID-19 Update 10/4/21. READ MORE 

9/22/2021 - COVID-19 Update. READ MORE 

9/17/2021 - COVID-19 Update 9/17/21. READ MORE 

9/10/2021 - COVID-19 Update 9/10/21. READ MORE 

9/1/2021 - COVID-19 update 9/1/21. READ MORE 

8/31/2021 - COVID-19 News 8/31/21. READ MORE 

8/27/2021 - COVID-19 update 8/27/21. READ MORE

8/24/2021 - COVID-19 Update 8/24/21.  READ MORE 

8/23/2021 - FDA Approves First COVID-19 Vaccine. READ MORE 

8/18/2021 - FDA News Release 8/18/21. READ MORE 

8/13/2021 - COVID-19 Update 8/13/21. READ MORE  

7/30/2021 - COVID-19 Update 7/30/21. READ MORE 

7/16/2021 - COVID-19 Update. READ MORE 

7/13/2021 - The FDA is announcing revisions to the vaccine recipient and vaccination provider fact sheets for the Johnson & Johnson (Janssen) COVID-19 Vaccine to include information pertaining to an observed increased risk of Guillain-Barré Syndrome (GBS) following vaccination. READ MORE 

7/9/2021 - The FDA issued an Emergency Use Authorization (EUA) to Ortho-Clinical Diagnostics, Inc., for the VITROS Immunodiagnostic Products Anti-SARS-CoV-2 IgG Quantitative Test. READ MORE 

7/7/2021 - The FDA authorized the use, under the emergency use authorization (EUA) for the Janssen COVID-19 vaccine, of an additional batch of vaccine drug substance manufactured at the Emergent facility. READ MORE 

7/6/2021 - COVID-19 Update. READ MORE 

6/29/2021 - COVID-19 Update. READ MORE 

6/25/2021 - The FDA is announcing revisions to the patient and provider fact sheets for the Moderna and Pfizer-BioNTech COVID-19 vaccines regarding the suggested increased risks of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the tissue surrounding the heart) following vaccination. READ MORE 

6/24/2021 - The U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the drug Actemra (tocilizumab). READ MORE 

6/15/2021 - COVID-19 Update. READ MORE 

6/11/2021 - COVID-19 Update 6/11/21. READ MORE 

6/8/2021 - COVID-19 Update. READ MORE 

6/4/2021 - COVID-19 Update. READ MORE 

6/1/2021 - COVID-19 Update. READ MORE 

5/26/2021 - COVID-19 Update. READ MORE 

5/25/2021 - COVID-19 Update. READ MORE 

5/21/2021 - The FDA issued a reminder to health care providers to give clear, step-by-step instructions to patients who, in a health care setting, self-collect anterior nasal samples for SARS-CoV-2 testing. Without proper instructions, patients may not collect an adequate sample for testing, which may decrease the sensitivity of the test. READ MORE 

5/19/2021 - FDA Authorizes Longer Time for Refrigerator Storage of Thawed Pfizer-BioNTech COVID-19 Vaccine Prior to Dilution, Making Vaccine More Widely Available. READ MORE A

5/11/2021 - COVID-19 Update. READ MORE 

4/30/2021 - Coronavirus (COVID-19) Update. READ MORE 

4/27/2021 - COVID-19 Update 4/27/21. READ MORE 

4/23/2021 - COVID-19 Update 4/23/21. READ MORE 

4/21/2021 - FDA Continues Important Steps to Ensure Quality, Safety and Effectiveness of Authorized COVID-19 Vaccines. READ MORE 

4/16/2021 - COVID-19 Update. READ MORE 

4/16/2021 - On Tuesday, the FDA and Centers for Disease Control and Prevention (CDC) issued a Statement regarding the Janssen (Johnson & Johnson) COVID-19 Vaccine. READ MORE 

4/6/2021 - COVID-19 Update 4/6/21. READ MORE 

4/2/2021 - COVID-19 Update 4/2/21. READ MORE 

3/19/2021 - COVID-19 Update 3/19/21. READ MORE 

3/12/2021 - The FDA issued a Letter to Clinical Laboratory Staff, Point-of-Care Facility Staff and Health Care Providers to alert them that false positive results can occur with the Roche Molecular Systems, Inc. cobas SARS-CoV-2 & Influenza A/B Nucleic Acid Test for use on the cobas Liat System. READ MORE

3/9/2021 - On Friday, the FDA issued an Emergency Use Authorization (EUA) to Cue Health Inc. for its over-the-counter at-home diagnostic test for COVID-19. READ MORE 

3/5/2021 - Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the Cue COVID-19 Test for Home and Over The Counter (OTC) Use. READ MORE 

3/2/2021 - The agency issued an Emergency Use Authorization (EUA) to Quidel for its QuickVue At-Home COVID-19 Test for at-home use with a prescription. READ MORE 

2/27/2021 - Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the third vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). READ MORE 

2/12/2021 - COVID-19 Update. READ MORE

1/29/2021 - COVID-19 update. READ MORE 

1/29/2021 - COVID-19 Update.  READ MORE 

1/4/2021 - FDA Statement on Following the Authorized Dosing Schedules for COVID-19 Vaccines. READ MORE 

12/18/2020 - FDA issued an EUA for the second vaccine for prevention of COVID-19 caused by SARS-CoV-2. The emergency use authorization allows the Moderna COFID-19 Vaccine to be distributed in the US for use in individuals 18 years of age and older. READ MORE

12/15/2020 - COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech. READ MORE 

12/15/2020 - COVID-19 Update. READ MORE

12/9/2020 - FDA authorized LabCorp's Pixel COVID-19 Test Home Collection Kit for use by any individual 18 years and older without prescription. READ MORE 

12/1/2020 - The FDA has reissued the August 23, 2020 emergency use authorization (EUA) for the emergency use of COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19.  READ MORE 

11/25/2020 - Vaccines and Related Biological Products Advisory Committee will meet 12/10/20. Time: 9:00am - 6:00pm ET.
READ MORE

11/25/2020 - The FDA published Face Masks, Including Surgical Masks, and Respirators for COVID-19, a comprehensive new page on FDA.gov with answers to frequently asked questions about face masks, surgical masks, and respirators. READ MORE

11/20/2020 - COVID-19 Update. READ MORE

11/18/2020 - The FDA issued an EUA for the first COVID-19 diagnostic test for self-testing at home that provides rapid results. READ MORE

11/18/2020 - The FDA also published a new "FDA Insight" podcast titled "Personal Protective Equipment and COVID-19."
READ MORE

11/18/2020 - The FDA has reorganized the FAQs on Testing for SARS-CoV-2 webpage to make it easier to navigate to questions by topic. READ MORE

11/18/2020 - The FDA updated it guidance on investigational COVID-19 convalescent plasma. The updated guidance extends the period of enforcement discretion through the end of February 2021. READ MORE

11/18/2020 - The FDA has been working around the clock to help increase the availability of critical medical product, including diagnostic test, to fight the coronavirus disease 2019 (COVID-19) pandemic. READ MORE

11/17/2020 - The agency also published a new webpage, A Closer Look at COVID-19 Diagnostic Testing, to provide health care providers and other public health professionals, including those who might purchase COVID-19 tests, more technical information and resources. READ MORE

11/9/2020 - FDA issued final guidance with agency's recommendations on designing and executing clinical trials of drugs and biologics that include people with different demographic characteristics (e.g., sex, race, ethnicity, age) and non demographic characteristics (e.g., patients with organ dysfunction, comorbid conditions, and disabilities.) READ MORE

10/22/2020 - The U.S. Food and Drug Administration approved the antiviral drug Veklury (remdesivir) for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds) for the treatment of COVID-19 requiring hospitalization. READ MORE

10/13/2020 - The FDA issued and immediately implemented a new guidance: Enforcement Policy for Modifications to FDS-Cleared Molecular Influenza and RSV Tests During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency.
READ MORE

10/8/2020 - The FDA updated the dashboard on the Coronavirus Treatment Acceleration Program (CTAP) webpage. As of September 30, 2020, 550+ drug development programs were in planning stages, 350+ trials were reviewed by FDA and 5 COVID-19 treatments were currently authorized for emergency use. READ MORE

10/7/2020 - The FDA issued a letter to health care providers recommending that health care providers give clear, step-by-step instructions to patients who, in a health care setting, are self-collecting anterior nasal samples for SARS-CoV-2 testing. Without proper instructions, patients may not collect an adequate sample for testing, which may decrease the sensitivity of the test. READ MORE

10/6/2020 - FDA In Brief: FDA Issues Guidance on Emergency Use Authorization for COVID-19 Vaccines. READ MORE

10/2/2020 - The FDA revised its Emergency Use Authorization (EUA) to reflect changes in the distribution and allocation of the antiviral drug Veklury (remdisivir). READ MORE

9/23/2020 - FDA Authorizes First Point-of-Care Antibody Test for COVID-19. READ MORE

9/21/2020 - COVID-19 Daily update. READ MORE

9/16/2020 - COVID-19 Daily Update. READ MORE

9/11/2020 - As part of the FDA's effort to protect consumers, the agency issued a warning letter jointly with the Federal Trade Commission to Pharmacy Plus, Inc. dba Vital Care Compounder for selling unapproved products with fraudulent COVID-19 claims. READ MORE

9/8/2020 - The FDA issued an updated FDA COVID-19 Response At-A-Glance Summary that provides a quick look at facts, figures, and highlights of the agency's response efforts. Testing updates: To date, the FDA has currently authorized 242 tests under EUAs: these include 194 molecular tests, 44 antibody tests, and 4 antigen tests. READ MORE

9/3/2020 - The FDA's COVID-19 related consumer updates are now available in at least five languages: Chinese, Korean, Vietnamese, Tagalog, Hmong and Somalia. READ MORE

9/2/2020 - The FDA updated its guidance, "Investigational COVID-19 Convalescent Plasma," to provide additional information related to the recently issued Emergency Use Authorization (EUA) for the use of COVID-19 convalescent plasma to treat hospitalized patients with COVID-19.  READ MORE

8/28/20 - COVID-19 Update. READ MORE

8/28/2020 - The FDA approved an abbreviated new drug application for dexmedetomidine hydrochloride in 0.9% sodium chloride injection (ANDA 212571), indicated for the sedation of initially intubated and mechanically ventilated patients during treatment in an intensive-care setting as well as the sedation of non-intubated patients prior to and/or during surgical and other proceduresREAD MORE

8/26/2020 - The U.S. Food and Drug Administration issued an emergency use authorization for the first antigen test where results can be read directly from the testing card, a similar design to some pregnancy tests. READ MORE

8/24/2020 - The FDA has taken steps to encourage the development of SARS-CoV-2 tests. The FDA posted a new webpage that provides an overview of available resources related to SARS-CoV-2 screening testing and testing using pooled samples. Testing updates: To date, the FDA has currently authorized 221 tests under EUAs; these include 179 molecular tests, 39 antibody tests, and 3 antigen testsREAD MORE

8/23/2020 - The U.S. Food and Drug Administration issued an emergency use authorization (EUA) for investigational convalescent plasma for the treatment of COVID-19 in hospitalized patients as part of the agency’s ongoing efforts to fight COVID-19. READ MORE

8/15/2020 - The U.S. Food and Drug Administration issued an emergency use authorization (EUA) to Yale School of Public Health for its SalivaDirect COVID-19 diagnostic test, which uses a new method of processing saliva samples when testing for COVID-19 infection.  READ MORE

7/22/2020 - COVID-19 Daily Update: The FDA created a new website section about COVID-19 for people with cancer and health care professionals to highlight FDA resources and how FDA is working diligently to meet the needs of this vulnerable community during this critical time.  READ MORE

7/13/2020 - FDA Daily Update 7/13/2020.  FDA scientists have identified specific areas of the so-called spike proteins on the surface of the COVID-19-causing virus that appear to be key to triggering strong protective antibody responses in rabbits exposed to the virus.  READ MORE

7/13/2020 - The FDA added content to the question-and-answer appendix in its guidance titled “Conduct of Clinical Trials of Medical Products during COVID-19 Public Health Emergency." READ MORE

7/13/2020 - COVID-19 Daily Update 7/1/2020. Today, the U.S. Food and Drug Administration (FDA) further supported its effort to evaluate diagnostic tests for COVID-19 by distributing the first round of SARS-CoV-2 reference panel materials. READ MORE

7/13/2020 - The FDA issued a Letter to Clinical Laboratory Staff and Health Care Providers recommending that they stop using COVID-19 antibody tests that are listed on the FDA’s “removed” test list. READ MORE

7/13/2020 - Testing updates: To date, the FDA has authorized 144 tests under EUAs; these include 122 molecular tests, 21 antibody tests, and 1 antigen test. READ MORE

7/10/2020 - COVID-19 Daily Update 7/10/2020.  The FDA issued a statement in conjunction with preparations to resume domestic inspections, guided by a new a risk-assessment system. READ MORE

6/16/2020 - The FDA revoked the emergency use authorization (EUA) of the Chembio Diagnostic System, Inc.’s, DPP COVID-19 IgM/IgG System, a SARS-CoV-2 antibody test, due to performance concerns with the accuracy of the test. READ MORE

6/15/2020 - The FDA revoked the emergency use authorization (EUA) that allowed for chloroquine phosphate and hydroxychloroquine sulfate donated to the Strategic National Stockpile to be used to treat certain hospitalized patients with COVID-19 when a clinical trial was unavailable, or participation in a clinical trial was not feasible. READ MORE

6/10/2020 - FDA and NIH have made updates to the CURE ID crowd-sourcing app to make it easier for healthcare providers to share — via mobile device or website — their experiences treating COVID-19 patients who are unable to be enrolled in a clinical trial. READ MORE

6/5/2020 - The FDA is changing the hours for the COVID-19 Industry Hotline (1-888-INFO-FDA, press *). READ MORE

6/4/2020 - FDA Publicly Shares Antibody Test Performance Data From Kits as Part of Validation Study. READ MORE

5/22/2020 - Updated FAQs on Testing for SARS-CoV-2 to clarify information about at-home self-collection and what tests should no longer be distributed for COVID-19. READ MORE

5/15/2020 - FDA Provides Promised Transparency for Antibody Tests. Today, the FDA posted a list of antibody tests that are being removed from the “notification list” of tests being offered under the Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency.  READ MORE

5/15/2020 - The FDA issued a Consumer Update, Coronavirus Testing Basics, to provide information about the different types of tests available and the steps involved in obtaining results. READ MORE

5/7/2020 - On 5/12/2020, the FDA Commissioner Stephen M. Hahn will testify before the U.S. Senate Committee on Health, Education, Labor and Pensions. Full Committee Hearing begins at 10 a.m. (COVID-19 and Safely Getting Back to Work and School). READ MORE

5/4/2020 - The FDA authorized the first serology, or antibody, test where the results of a new independent validation effort by the U.S. Government provided the scientific evidence used to support the authorization. READ MORE

5/1/2020 - The U.S. Food and Drug Administration issued an emergency use authorization for the investigational antiviral drug remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease. The emergency use authorization allows for remdesivir to be distributed in the U.S. and administered intravenously by health care providers to treat suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease. READ MORE

4/30/2020 - The FDA included the NASA VITAL (Ventilator Intervention Technology Accessible Locally) under the ventilator EUA (emergency Use Authorization). VITAL is intended to last three to four months and is specifically tailored for patients with COVID-19. READ MORE

4/24/2020 - The FDA issued guidance immediately in effect as of April 24, 2020 - Enforcement Policy for Remote Digital Pathology Devices During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency - to help expand the availability of devices for remote reviewing and reporting of scanned digital images of pathology slides during this public health emergency. READ MORE 

Georgia Medicaid

6/30/2022 - COVID-19 Vaccines and Administration for Pediatric Patients 6-Months and Older. Effective June 17, 2022, the Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine has been authorized for emergency use by the FDA for children who are at least 6 months old. The authorization includes a three-dose series Pfizer Covid-19 vaccine for children 6 months to 4 years of age and a two-dose series Moderna Covid-19 vaccine for children 6 months to 5 years of age. READ MORE 

6/10/2022 - Place of Service Updates for Telehealth. As announced in a recent CMS Medicare Learning Network release there are new updates to the Place of Service (POS) Codes for Telehealth. The POS description of POS code 02 has been revised and a new POS code 10 has been created.
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