COVID-19 Payer Information - Archives

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Past Updates (O-W)

Ohio Department of Health

 

11/17/2020 - Vaccine Prepositioning Plan. Governor DeWine today provided details on Ohio's vaccine prepositioning plan. 

10/13/2020 - COVID-19 News Update: Lab Capacity Dashboard. 

9/29/2020 - Governor DeWine provided an update today on the Ohio Coronavirus Wastewater Monitoring Network which tests wastewater for gene fragments of COVID-19

5/29/2020 - Ohio Governor Mike DeWine and Lt. Governor Jon Husted provided updates on Ohio's response to the COVID-19 pandemic. 

Ohio Hospital Association

11/4/2020 - Governor Mike DeWine signed Executive Order 2020-38D, which authorizes the Ohio Department of Medicaid to temporarily and substantially increase hospital-specific coverage add-ons, or CCAs. READ MORE

Ohio Medicaid 

5/4/2021 - Ohio Governor Mike DeWine today announced that Ohio Department of Health Director Stephanie McCloud signed the following orders regarding COVID-19 testing frequency of residents and staff at assisted living facilities and nursing homes and opening of Senior Centers and Older Adult Day Services Centers.  READ MORE

9/24/2020 - COVID-19 News Update: Governor DeWine announced that Ohio's Responsible Restart guidelines for higher education will now include a recommendation that all residential colleges and universities regularly test a sample population of asymptomatic students. READ MORE

9/10/2020 - Testing in Ohio Nursing Homes and Assisted Living Facilities.  

9/9/2020 - PANDEMIC ELECTRONIC BENEFIT TRANSFER PROGRAM

7/22/2020 - OH MCD Advisory Letter No. 645 to eligible Medicaid Providers. 

7/17/2020 - COVID-19 Telehealth Update:  In our continued response to the COVID-19 pandemic, the Ohio Department of Medicaid (ODM) adopted new emergency rule 5160-1-18, “Telehealth.”  

4/13/2020 - ODM’s emergency provides a list of practitioner types allowed to render services via telehealth.

4/9/2020 - COVID-19 Managed Care Plan Emergency Provisions: MCPs and MCOPs are extending timely filing limits to accept claims from all provider types for up to 365 calendar days from the date of service. 

3/31/2020 - During this time, the Medicaid Director will: Classify certain Medicaid providers as COVID-19 community providers, Request the Director of Budget and Management to designate additional funds related to the COVID-19 outbreak for Medicaid payments to COVID-19 community providers, Make payments to COVID-19 community providers, Facilitate payments to COVID-19 community providers by transferring funds to the Departments of Developmental Disabilities and Mental Health and Addiction Services via intrastate transfer vouchers. Questions? Call 1-833-4-ASK-ODH.

3/20/2020 - New telehealth rule that is in effect during any time period in which the Governor of the State of Ohio declares a state of emergency and when authorized by the Medicaid director. During this time period, 5160-1-21 supersedes Medicaid’s other telehealth rule, 5160-1-18. Telehealth FAQs and links to ODM Rules for Medicaid, MCPs, MCOPs.  READ MORE

Oscar

8/6/2020 - OSCAR COVID-19 Updates. Here are some of the steps we have taken to help providers and members. READ MORE

8/5/2020 - Introducing Oscar's Virtual Primary Care. Oscar Virtual Primary Care will be offered as part of some Oscar individual and family coverage beginning January 1, 2021. READ MORE 

7/10/2020 - COVID-19 Provider Facts. READ MORE

Palmetto GBA, CGS

3/20/2020 - Temporary Provisional Medicare Billing Privileges. Allows physicians and non-physician practitioners to initiate temporary provisional Medicare billing privileges via telephone and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver. READ MORE

Palmetto GBA -
JJ A/B, JM A/B

3/22/2022 - Coming Soon: Offset Percentage Increase for COVID-19 Accelerated or Advanced Payment Refunds. READ MORE 

2/15/2022 - Palmetto GBA Claims Processing Issues. READ MORE 

1/19/2022 - Palmetto GBS News 1/19/22. NEW: 2022 Billing for COVID-19 Vaccine and Monoclonal Antibody Products for Medicare Advantage Plan Patients. READ MORE

1/14/2022 - Palmetto GBA News 1/14/22. Billing VEKLURY (Remdesivir) Antiviral Medication in Outpatient Settings. READ MORE 

1/12/2022 - Palmetto GBA News 1/12/22. NEW: 2022 Billing for COVID-19 Vaccine and Monoclonal Antibody Products for Medicare Advantage Plan Patients. READ MORE 

12/22/2021 - Palmetto GBA News 12/22/21. NEW: 2022 Billing for COVID-19 Vaccine and Monoclonal Antibody Products for Medicare Advantage Plan Patients. READ MORE 

11/23/2021 - Palmetto Claims Payment Issues Log/Updated 11/23/21. READ MORE 

11/8/2021 - Palmetto Claims Payment Issues Log/Updated 11/8/21. READ MORE

10/11/2021 - Palmetto GBA Claims Processing Issues Log. New Codes for an Additional Dose of the Pfizer and Moderna Vaccines for COVID-19. READ MORE

9/24/2021 - Palmetto GBA Claims Processing Issues Log. New Codes for an Additional Dose of the Pfizer and Moderna Vaccines for COVID-19. READ MORE

8/23/2021 - Biden-Harris Administration Takes Additional Action to Protect America's Nursing Home Residents from COVID-19. READ MORE 

7/27/2021 - Palmetto GBA Claims Processing Issues Log: Suspension of Outpatient Prospective Payment System (OPPS) Claims Bill Types 12X, 13X or 34X with COVID-19 Vaccine and Monoclonal Antibodies Services for Medicare Advantage Beneficiaries. READ MORE 

6/15/2021 - Palmetto GBA Claims Payment Issues Log. CLIA Waived Modifier - Resolved 6/15/21. READ MORE 

6/10/2021 - COVID-19 News. CMS recently released an infographic (PDF, 127 KB) to assist the provider community with understanding Medicare Payments for the COVID-19 Vaccine when administered in the home. READ MORE 

5/21/2021 - How long does a Public Health Emergency (PHE) declaration last? READ MORE 

5/12/2021 - Palmetto GBA Claims Payment Issus Log. CLIA Waived Modifier. READ MORE 

4/29/2021 - CMS COVID-19 Vaccine Toolkits 04/29/2021. READ MORE 

4/28/2021 - Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636.
READ MORE

4/28/2021 - CMS Proposes to Enhance the Medical Workforce in Rural and Underserved Communities to Support COVID-19 Recovery and Beyond. READ MORE 

4/22/2021 - COVID-19: Partnership to Vaccinate Dialysis Patients & Health Care Personnel. READ MORE 

4/21/2021 - Palmetto GBA Education Events for Providers. READ MORE 

4/12/2021 - Palmetto News: COVID-19 Accelerated/Advance Payment Repayment Tracking. This communication is to provide an update to the COVID-19 Accelerated/Advance Payment (CAAP) repayment activities. READ MORE 

4/7/2021 - Palmetto News. COVID-19 Provider Enrollment and Accelerated Payment Telephone Hotline. READ MORE

4/5/2021 - CAAP (COVID-19 Accelerated and Advance Payments) Repayments. READ MORE 

3/31/2021 - Claims with 'Cost-Sharing is Waived' Modifier Rejected in Error (for COVID-19 PHE). READ MORE

3/31/2021 - COVID-19 Accelerated/Advance Payment Reminder Emails. READ MORE

3/22/2021 - RESOLVED: Waived Laboratory Billing Requirement for Ordering/Referring Professional for COVID-19 PHE. READ MORE 

3/22/2021 - COVID-19 Laboratory Test Place of Service Limitation. READ MORE

3/10/2021 - eServices Electronic Billing for Mass Immunizers Tutorial Webinar | Ready for OnDemand Viewing | Duration: approx. 25 min  READ MORE 

3/3/2021 - COVID-19 Vaccines and Monoclonal Antibodies Administration Allowances. READ MORE 

3/3/2021 - Waived Laboratory Billing Requirement for Ordering/Referring Professional for COVID-19 PHE. READ MORE

2/18/2021 - CMS COVID-19 Vaccine Toolkits. Have questions about COVID-19 vaccines? Check out the CMS COVID-19 Vaccine Toolkits external link . CMS has developed these toolkits to provide you with up-to-date information about COVID-19 vaccines. READ MORE 

2/16/2021 - Palmetto Claims Payment Issues Log. COVID-19 Antibody Testing. READ MORE 

2/16/2021 - CMS to Limit the Use of the CS HCPCS Modifier. READ MORE 

2/10/2021 - Palmetto GBA Current and Upcoming Events. Jurisdiction J/M Part B Medicare Enrollment for Administering COVID-19 Vaccine Shots and/or Monoclonal Antibody Infusion Therapy Webinar. Contract - Part B. Date - February 16, 2021, 11am- 12pm ET. 

2/9/2021 - eServices Roster Billing. Providers currently enrolled as mass immunizers can electronically submit roster bills for the Pneumococcal, Influenza and COVID-19 vaccine through our eServices portal.READ MORE 

2/5/2021 - What Partners Need to Know Now about Medicare Fraud. READ MORE

2/2/2021 - MLN Matters Article 12093 Outlines Use of CLIA Waiver Modifier for Two Codes. READ MORE 

2/1/2021 - CMS Questionnaire to Determine Primary Payer During the PHE. READ MORE 

2/1/2021 - COVID-19 Vaccine Resources: What Partners Need to Know Now.
READ MORE 

2/1/2021 - Coming Soon. eServices Roster Billing. READ MORE 

1/15/2021 - COVID-19 Vaccine and Monoclonal Antibody Therapy Roster Billing Packet. READ MORE 

12/23/2021 - CMS COVID-19 Vaccine Toolkits. READ MORE 

12/23/2020 - Jurisdiction JM Part B Medicare Enrollment for Administering COVID-19 Vaccine Shots and/or Monoclonal Antibody Infusion Therapy Webinar. READ MORE 

12/16/2020 - Claims Payment Issues Log posted 12/16/20. READ MORE

12/16/2020 - UPDATE - COVID-19 Laboratory Test Pricing. READ MORE

12/16/2020 - Palmetto Claims Payment Issues Log. COVID-19 Antibody Testing. READ MORE

12/15/2020 - CMS COVID-19 Vaccine Toolkits. Have questions about COVID-19 vaccines? Check out the CMS COVID-19 Vaccine Toolkits external link . CMS has developed these toolkits to provide you with up-to-date information about COVID-19 vaccines. READ MORE

11/25/2020 - Palmetto Claims Payment Issues Log. COVID-19 Antibody Testing. READ MORE 

11/24/2020 - Clinicians Ordering Oxygen and Oxygen Equipment - Reference Guide with Information for the COVID-19 Public Health Emergency (PHE). READ MORE 

11/19/2020 - Part B COVID-19 Laboratory Test Pricing. READ MORE 

11/17/2020 - Claims Payment Issues Log posted 11/13/20. READ MORE 

11/13/2020 - Claims Payment Issues Log posted 11/13/20. Issue: COVID-19 Tests: HCPCS U0003 and U0004. READ MORE 

10/28/2020 - Palmetto GBA JM Part B Medicare Advisory Newsletter/November 2020. eServices - COVID-19 Transition.
READ MORE 

10/14/2020 - Update on the Accelerated/Advance Payments Related to COVID-19. As of October 8, 2020, CMS will no longer accept applications for the Accelerated and Advance Payments Program as they relate to the COVID-19 Public Health Emergency. READ MORE 

10/1/2020 - RESOLVED Claims Payment Issues Log. Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model Editing. 

8/24/2020 - Claims Payment Issues Log. Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model Editing. READ MORE 

8/13/2020 - CMS to Limit the Use of the CS Modifier. READ MORE 

7/9/2020 - Modifiers Used during the COVID-19 Public Health Emergency. READ MORE 

7/7/2020 - Teaching Physicians and Residents: the GE Modifier. READ MORE 

7/31/2020 - Issue Resolved 7/31/2020. Interim Final Rule CMS-5531-IFC: CPT Code 99211 Editing - all adjustments have been completed 7/31/20. READ MORE 

6/29/2020 - COVID-19 Accelerated/Advance Payment (AAP) Repayment Facts for Providers - updated 6/29/2020. READ MORE 

6/23/2020 - COVID-19 Diagnostic Laboratory Tests: Billing for Clinical Services. READ MORE 

6/23/2020 - Medicare Fee-for-Services (FFS) Response to the Public Health Emergency on the COVID-19. READ MORE 

6/15/2020 - Interim Final Rule CMS-5531-IFC: CPT Code 99211 Editing. READ MORE 

6/12/2020 - COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services.  READ MORE 

5/14/2020 - Jurisdiction J and M Part B providers are invited to join Palmetto GBA on May 22, 2020, at 11 a.m. ET for a webcast to review recent updates to Part B Medicare COVID-19 flexibilities. READ MORE 

5/11/2020 - CMS Updates Telehealth Video - Medicare Coverage and Payment of Virtual Services. This updated video external link provides answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. READ MORE 

5/8/2020 - Ambulance services submitted with the GY modifier began paying in error on April 8, 2020. Palmetto GBA will perform adjustments on claims that were paid incorrectly. These adjustments will result in the recoupment of dollars previously paid in error. READ MORE 

5/5/2020 - Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) are allowed to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency. Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners may bill the following codes G0179, G0180, and G0181. The descriptors of the three codes will be revised at a later date to include the non-physician practitioner specialties. READ MORE 

4/9/2020 - ePass is Available to Ease Burden of Repeated Authentication When Calling Palmetto GBA's Provider Contact Center. Authentication is required before Palmetto GBA is authorized to discuss Medicare information with a provider. READ MORE 

4/9/2020 - eServices Profile Verification has been extended from 90 to 250 days, allowing more time to complete this process. During this time, please make sure that all eServices user ID profiles are up to date to avoid interruption or deactivation.
READ MORE 

4/8/2020 - Accelerated Payment Hotline facts, common questions and answers.  READ MORE 

4/6/2020 - Accelerated/Advance Payments Related to COVID-19. READ MORE 

4/6/2020 - Medical Review Administrative Relief related to the COVID-19 Pandemic. READ MORE 

4/6/2020 - Provider Enrollment Hotline: Temporary Provisional Medicare Billing Privileges. READ MORE 

4/6/2020 - The Accelerated/Advance Payment Request form has been updated to reflect only information needed related to COVID-19 relief requests. Note: It is not necessary to resubmit previous requests using this new form. Use the new form only for new requests for COVID-19 relief. READ MORE 

4/2/2020 - COVID-19 Accelerated Payment Hotline FAQs. Common questions and answers. Repayment Plan - For Part A PIP Hospitals, no immediate repayment is required. The payment will be settled with the cost report. For all other providers, repayment will begin 120 days after the issuance of the accelerated/advance payment. READ MORE 

Regence BCBS

4/19/2022 - COVID-19 Update 4/19/22 for Providers. READ MORE 

12/9/2021 - COVID-19 Update 12/9/2021. The Centers for Medicare & Medicaid Services has created a new place of service code for telehealth services (POS 10). READ MORE 

12/1/2021 - COVID-19 Treatment. We will cover the cost of FDA-authorized treatment for COVID-19 received from in-network providers without any out-of-pocket costs through December 31, 2021. READ MORE 

Select Health SC/First Choice 

6/1/2021 - COVID-19 Vaccines - With the emergency use authorization and distribution of the COVID-19 vaccine, our members will likely be looking to you, their health care provider, for direction. READ MORE 

6/1/2021 - COVID-19 testing - First Choice will cover all medically necessary services required to facilitate testing and treatment of COVID-19 for its eligible members, in accordance with federal and state guidance. No prior authorization is required for COVID-19 testing. 

4/26/2021 - First Choice recommends that providers follow CDC, Centers for Medicare & Medicaid Services, and state-specific guidance with regard to COVID-19 evaluation, testing, diagnosis, treatment, and reporting. READ MORE 

4/26/2021 - Select Health of South Carolina covers telehealth visits for our members in accordance with state and federal policy. Similar to Medicare, many states are adopting expanded or interim policies related to the originating site, payment for telephonic visits, and expanded licensure. READ MORE 

4/26/2021 - Use of certified out-of-network and/or out-of-state providers will be allowed for medically necessary services. READ MORE 

12/30/2020 - COVID-19 Testing. First Choice will cover all medically necessary services required to facilitate testing and treatment of COVID-19 for its eligible members, in accordance with federal and state guidance. No prior authorization is required for COVID-19 testing. READ MORE

12/30/2020 - Public Health Emergency (PHE) Extended. As an important reminder, on Friday, October 2, 2020, U.S. Department of Health and Human Services Secretary Alex Azar renewed his declaration of a PHE due to the coronavirus pandemic. The renewal is effective October 23, when the previous 90-day renewal would have expired, and extends the PHE through January 20, 2021. READ MORE 

6/15/2020 - In accordance with guidance issued by South Carolina Department of Health and Human Services (SCDHHS), in the Medicaid bulletin dated April 16, 2020 Select Health will reimburse for well-child visits delivered via telehealth and/or telemedicine during the COVID-19 pandemic. READ MORE

3/30/2020 - No prior authorization is required for COVID-19 testing. Testing codes to use are U0001 and U0002. First Choice recommends that providers follow CDC, CMS, and State-specific guidelines with regard to COVID-19 evaluation, testing, diagnosis, treatment, and reporting. READ MORE

3/19/2020 - Effective for dates of service on and after 3/15/20 SCDHHS is expanding coverage for Telephonic and Telehealth services. SCDHHS will begin accepting claims for these services beginning 4/1/20. Codes to use for these services can be found on the website. READ MORE

South Carolina Medicaid

4/29/2022 - Provider Bulletin: Update on Telehealth Flexibilities Issued During the COVID-19 Public Health Emergency. READ MORE 

9/8/21 - Provider Bulletin: COVID-19 Third Dose of Vaccine Administration Coverage.
READ MORE 

7/30/2021 - Provider Alert - Vaccines for Children Policy and Coding Update. READ MORE 

6/21/2021 - Resuming Onsite Visits for Provider Reviews. READ MORE

2/18/2021 - SCDHHS’ COVID-19 website also includes additional resources for providers including previously released fee schedules for telehealth services, information about federal resources and policy changes, and guidance the agency has issued in preparation and response to the COVID-19 pandemic. READ MORE 

1/22/2021 - Approval of SC's Appendix K Amendment Request for the Palmetto PCSC Waiver. READ MORE 

12/31/2020 - Coronavirus Disease 2019 (COVID-19) Testing. In response to circumstances surrounding COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing additional testing resources available to healthcare personnel within South Carolina Healthy Connections Medicaid-enrolled nursing facilities beginning Jan. 1, 2021. READ MORE 

12/23/2020 - COVID-19 Vaccination Administration Coverage. The South Carolina Department of Health and Human Services (SCDHHS) will reimburse for COVID-19 vaccine administration, without patient cost-sharing, when provided to Healthy Connections Medicaid members in a manner consistent with recommendations of the Advisory Committee on Immunization Practices (ACIP).READ MORE

10/27/2020 - Provider Alert. U.S. Department of Health and Human Services Announces Expanded Pool of Providers Eligible for Additional Provider Relief Funds. READ MORE

10/13/2020 - Provider Alert: The U.S. Department of Health and Human Services (HHS) announced it is distributing an additional $20 billion in new relief funds to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers who participate in state Medicaid and CHIP programs, including the South Carolina Healthy Connections Medicaid program. READ MORE 

9/9/2020 - Update on COVID-19 Regulatory and Reimbursement Flexibilities for Nursing Facilities. READ MORE 

8/27/2020 - COVID-19 Level of Care and Notice of Admission, Authorization and Change of Status for Long Term Care (SCDHHS Form 181) Guidance. READ MORE 

8/6/2020 -SC Medicaid Alert 8/6/20 regarding updated COVID-19 Testing Fee Schedule. READ MORE 

7/6/2020 - Provider Medicaid Bulletin. Provider Reimbursement Available for COVID-19 Testing for the Uninsured. READ MORE 

7/10/2020 - COVID-19 Temporary Telephonic and Telehealth Services Updated. READ MORE 

6/16/2020 - COVID-19 Testing Fee Schedule, Provider Facts Page Updated. READ MORE 

4/24/2020 - Updated COVID-19 Provider Facts Responses/Billing & Reimbursement. READ MORE 

4/20/2020 - 2020 Provider Revalidation: Group 2 Temporarily Delayed Due to COVID-19. READ MORE 

4/16/2020 - SCDHHS will begin accepting claims for these policy changes beginning May 1, 2020, for dates of service on or after April 1, 2020. READ MORE 

4/6/2020 - This bulletin is being issued to clarify flexibilities authorized in previously issued departmental guidance and is effective immediately. READ MORE 

4/3/2020 - Healthy Connections Medicaid members who are not enrolled in a managed care organization (MCO) are now able to speak with a nurse by phone for non-emergency health care-related questions. If a patient is enrolled in an MCO, the patient currently has access to a 24-hour nurse call line where they can ask non-emergency health care-related questions. READ MORE 

3/17/2020 - Effective for dates of service on or after February 4, 2020, SCDHHS will reimburse for COVID-19 testing, using HCPCS codes U0001 (Centers for Disease Control and Prevention [CDC]) and U0002 (non-CDC), without prior authorization or co-payment. Billing for these tests must conform to general billing standards and the definitions established for each HCPCS code. READ MORE 

South Dakota Medicaid

Beginning March 16 through March 20, 2020,  South Dakota Medicaid will be operating with reduced staff at a limited capacity. Essential functions will be maintained during the office closure; however, phone lines will not be staffed, and fax lines will not be monitored. South Dakota Medicaid has provided a list of topics for specific directions regarding alternative resources during the office closure.  Of particular interest are notices concerning Prior Authorizations, Claims Submission, and the Telephone Service Unit. 

SummaCare

4/28/2020 -Telehealth services will be covered regardless of patient location (use modifier 95 if not billing with location 02). READ MORE

4/10/2020 - SummaCare covers the cost of telehealth services for a wide array of health care needs effective through 06/30/2020. READ MORE

3/26/2020 - Waiving any co-pays and deductibles related to provider-ordered testing of COVID-19 for our Medicare Advantage, Individual and Commercial members regardless of where the test is ordered and performed. Self-insured plans will determine how their coverage will apply. Will pay 100% Medicare rates for COVID-19 testing regardless of provider affiliation.  Will accept CPT code 87635 (effective 03/13/2020) or HCPCS Level II U0002 (effective 2-4-20) for the COVID-19 testing. There are no special modifiers at this time.  READ MORE

Texas Medicaid

4/27/2022 - Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE. READ MORE 

4/27/2022 - Effective April 1, 2022, COVID-19 convalescent plasma procedure code C9507 is a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for dates of service on or after December 28, 2021. READ MORE 

4/27/2022 - Telephone (Audio-only) Delivery of Some Medicaid and HTW Plus Substance Use Services Ending. Effective May 31, 2022, the Texas Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for behavioral health services described below. The following flexibility will no longer be allowed for dates of service beginning June 1, 2022. READ MORE 

4/26/2022 - CMS Publishes Revised CLIA Requirements About COVID-19 Test Reporting. The Centers for Medicare and Medicaid Services has issued revised QSO-21-10-CLIA. READ MORE

4/13/2022 - CMS to End COVID-19 Waivers for NFs, ICF/IIDs, Inpatient Hospices on May 7 or June 6, 2022 (QSO-22-15-NH & NLTC & LSC). READ MORE 

4/8/2022 - COVID-19 ICF Mitigation, Response Rule Revised Effective April 6. HHSC Long-term Care Regulation has published a revised Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Mitigation and Response Emergency Rule. It is effective April 6, 2022. READ MORE 

3/28/2022 - Nursing Facility COVID-19 Mitigation and Response Rule Revised Effective March 28, 2022. READ MORE 

3/25/2022 - Providers with Emergency Temporary Licenses From the Texas Medical Board Are Eligible for Enrollment With TMHP. READ MORE 

3/25/2022 - TMPPM Update for Monoclonal Antibodies Benralizumab, Mepolizumab, and Reslizumab. READ MORE 

3/21/2022 - New COVID-19 Diagnosis Codes and Inpatient ICD-10-PCS Procedure Codes Effective April 1, 2022. READ MORE 

3/1/2022 - COVID-19 Vaccine Administration Procedure Codes 0051A, 0052A, 0053A, and 0054A Are Now a Benefit. READ MORE 

2/16/2022 - Reimbursement Rate Changes and Updates for Procedure Codes Presented at the December 13, 2021, Public Rate Hearing. Effective for dates of service on or after March 1, 2022, reimbursement rate changes and updates for procedure codes, which were presented at a public rate hearing on December 13, 2021, will be implemented. READ MORE 

2/15/2022 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes Effective January 3, 2022. Beginning February 10, 2022, for dates of service on or after January 3, 2022, reimbursement rates for COVID-19 vaccine administration procedure codes 0051A, 0052A, 0053A, and 0054A will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. READ MORE 

2/14/2022 - Effective 1/21/22, Procedure Code J0248 (Veklury) Is a Benefit. Effective for dates of service on or after January 21, 2022, in accordance with the Food and Drug Administration (FDA) emergency use authorization (EUA), procedure code J0248 for administration of Veklury (remdesivir) as a treatment for COVID-19 is now a benefit of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program in outpatient settings. READ MORE 

2/11/2022 - QW Modifier Required for Procedure Code 87801. Following changes to the Clinical Laboratory Improvement Amendments (CLIA) regulations, the Centers for Medicare & Medicaid Services (CMS) has released updated guidance for COVID-19 test billing. READ MORE

1/27/2022 - Nursing Facility and Assisted Living Facility COVID-19 Webinar Recordings. In light of the dramatic surge in COVID-19 transmission rates, Nursing Facility (NF) and Assisted Living Facility (ALF) providers are strongly encouraged to make the COVID-19 training webinars available to all direct care staff. WATCH HERE

1/27/2022 - HHSC Publishes Revised End of Temporary Suspension of Certain LTCR Requirements During COVID-19 Outbreak for NF, ICF/IID, DAHS, PPECC, HCS, HCSSA, and TxHmL - January 26, 2022. READ MORE

1/26/2022 - Monoclonal Antibody Administration Procedure Codes M0220 and M0221 for COVID-19 Now a Benefit. Effective for dates of service on or after December 8, 2021. READ MORE

1/25/2022 - COVID-19 Vaccine Administration Procedure Code 0004A Now a Benefit for Individuals 12 or Older. Effective for dates of service on or after January 3, 2022. READ MORE

1/20/2022 - Update to “Claims for Telephone (Audio-only) Behavioral Health Services.” This is an update to the article titled “Claims for Telephone (Audio-only) Behavioral Health Services,” which was posted on this website on March 20, 2020. READ MORE 

1/19/2022 - HHSC Updates the ICF COVID-19 Response Plan and FAQ Documents – January 18, 2022. The Texas Health and Human Services Commission (HHSC) Long-term Care (LTC) Regulation updated the Intermediate Care Facility (ICF) COVID-19 Response Plan and Frequently Asked Questions (FAQ) documents. READ MORE 

1/18/2022 - HB4: Interim Guidance for Physical Therapy, Occupational Therapy, Speech Therapy Services Delivered by Synchronous Audiovisual. Effective February 1, 2022, the Texas Health and Human Services Commission (HHSC) will transition certain COVID-19 flexibilities to interim guidance in line with House Bill (H.B.) 4 (87th Legislature, Regular Session, 2019). READ MORE

1/18/2022 - Synchronous Audiovisual Technology Telemedicine and Telehealth Services for Healthy Texas Women (HTW). READ MORE 

1/14/2022 - ** All Providers - On December 23, 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the Merck oral COVID-19 drug Molnupiravir for the treatment of mild to moderate COVID-19 in adults 18 or older. Details are available on the TMHP website at www.tmhp.comREAD MORE 

1/5/2022 - Final Reminder: Senate Bill 809/Rider 143 COVID-19 Reporting. READ MORE 

1/4/2022 - Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary. READ MORE 

1/4/2022 - COVID-19 At-Home Test Kits Available as a Pharmacy Benefit. READ MORE 

1/3/2022 - Updated COVID-19 Response Plan for Nursing Facilities. The Health and Human Services Commission Long-term Care Regulation (HHSC-LTCR) updated the Nursing Facility COVID-19 response plan on December 31, 2021.
READ MORE 

12/31/2021 - Pfizer-BioNTech COVID-19 Vaccine Booster Dose Age Change and New Formulation. READ MORE 

12/30/2021 - Rural Hospital COVID-19 in Healthcare Relief Grant (RH-CHRG) Program, Tier 1: Direct Grant Awards, Action Required. The Texas Health and Human Services Commission (HHSC) disseminated a pre-award survey through SurveyMonkey to each rural hospital identified as eligible (PDF). READ MORE 

12/30/2021 - CSHCN COVID-19 Telehealth and Telemedicine Extensions Through February 28, 2022. READ MORE 

12/30/2021 - HHSC Continues Suspension of Deallocation of Nursing Facilities Medicaid Beds Due to COVID-19. Beginning January 1, 2022, the Texas Health and Human Services Commission (HHSC) will continue to suspend the deallocation of Medicaid beds for the 2022 calendar year due to the impact of COVID-19. READ MORE 

12/30/2021 - COVID-19 Guidance for New and Initial CSHCN Prior Authorizations. This is an update to the article titled “Guidance for Providers Regarding New and Initial Prior Authorizations,” published November 1, 2021, on this website. READ MORE 

12/29/2021 - What is changing? Per the Texas Health Steps (THSteps) and Texas Health and Human Services Commission (HHSC), we are extending the end date for remote delivery of medical checkups for THSteps through January 31, 2022. During this time, telemedicine and telephone delivery for certain components of THSteps checkup are allowed. This applies only to children over 24 months of age. READ MORE 

12/29/2021 - What is new? Per the Texas Health and Human Services Commission , we will continue to waive CHIP co-payments for medical office visits only through Jan. 31, 2022, unless the federal public health emergency ends sooner. READ MORE 

12/29/2021 - What is changing? The Texas Health and Human Services Commission (HHSC) is extending the end date for RHC telehealth and telemedicine reimbursement through January 31, 2022. READ MORE 

12/29/2021 - Will RHCs be reimbursed for telehealth/telemedicine? Yes, per the HHSC Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid will reimburse RHCs as telemedicine and telehealth distant site providers statewide for service dates from March 20, 2020 through January 31, 2022.

12/29/2021 - Reminder 12/29/21: SB 809/Rider 143 COVID-19 Reporting. READ MORE 

12/28/2021 - Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Extended Through January 31, 2022. READ MORE 

12/23/2021 - Multiple Medicaid COVID-19 Flexibilities Extended Through January 31, 2022. READ MORE

12/22/2021 - Update to "New ICD-10 COVID-19 Diagnosis Code Updates Effective January 1, 2021." READ MORE 

12/22/2021 - Update to "New ICD-10 COVID-19 Procedure Codes for Therapeutics and Vaccines." READ MORE 

12/22/2021 - Updated Age Ranges for COVID-19 Monoclonal Antibody Therapy Procedure Codes M0245 andM0246 Approved Through Emergency Use Authorization. READ MORE 

12/18/2021 - Claims for Telemedicine and Telehealth Services for HTW Plus Extended Through January 31, 2022. his is an update to the article titled “Claims for Telemedicine and Telehealth Services for HTW Plus,” published on this website on December 4, 2020. READ MORE 

12/6/2021 - COVID-19 Moderna and Janssen (Johnson & Johnson) Vaccine Booster Doses – Texas Medicaid. READ MORE

12/6/2021 - ICF Emergency Rule Extended: COVID-19 Vaccination Data Reporting, Emergency Communication System – December 9, 2021. READ MORE 

12/2/2021 - NF COVID-19 Webinar with HHSC, LTCR and DSHS | December 8, 2021. READ MORE  

11/30/2021 - NF COVID-19 Mitigation and Response Rules Revised Effective 11/28/21. READ MORE 

11/30/2021 - NF COVID-19 Visitation Rule Revised Effective 11/28/21. READ MORE 

11/29/2021 - COVID-19 Reimbursement Rate for Vaccine Administration Code 0004A Effective Sept. 22, 2021.
READ MORE 

11/29/2021 - COVID-19 Pfizer Vaccine Update, Age Change and Comirnaty. READ MORE 

11/15/2021 - COVID-19 Vaccine Administration Procedure Codes 0034A and 0064A are Benefits. READ MORE 

11/15/2021 - Update to Durable Medical Equipment (DME), Client Signature Waived During COVID-19. READ MORE

11/15/2021 - COVID-19: Provider Enrollment Revalidation Extensions to End on February 28, 2022. READ MORE 

11/15/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes 0071A and 0072A Effective 10/29/2021. READ MORE 

11/10/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes 0034A and 0064A, Effective 10/20/2021. READ MORE 

11/9/2021 - Extension of NF COVID-19 Emergency Rules: Vaccine Data Reporting and Emergency Communication System Enrollment. READ MORE 

11/1/2021 - COVID-19: Physical, Occupational, Speech Therapy Groups Accessing Telehealth Services. READ MORE 

10/27/2021 - Additional Provider Types and Places of Service Added for Monoclonal Antibody Therapy Administration Codes M0240, M0241, M0243 and M0244. READ MORE 

10/25/2021 - Medicaid DME Certification and Receipt Form COVID-19 Flexibility Extended Through December 31, 2021. READ MORE 

10/25/2021 - COVID-19 Guidance for New and Initial Medicaid Prior Authorizations. READ MORE 

10/25/2021 - URGENT: HHSC Needs to Know NF COVID-19 Vaccination Booster, Additional Dose Needs. COVID-19 delta variant cases are increasing across Texas. Some nursing facility (NF) residents and staff may be eligible for an additional or booster COVID-19 vaccine dose. READ MORE 

10/20/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Code 0004A Effective 9/22/2021. READ MORE 

10/15/2021 - COVID-19 Vaccine Administration Procedure Code 0004A is Now a Benefit. READ MORE 

10/8/2021 - Texas Health and Human Services Publishes Updated COVID-19 FAQs and Response Plan for ICF Providers - October 2021. READ MORE 

10/8/2021 - COVID-19 Mitigation and Response Emergency Rule for ICF Providers Extended to December 6, 2021.
READ MORE 

9/30/2021 - Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Extended through December 31, 2021. This is an update to the article titled “Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Extended Through September 30, 2021,” published on this website on August 26, 2021. READ MORE 

9/29/2021 - COVID-19 Guidance for New and Initial Medicaid Prior Authorizations. READ MORE

9/29/2021 - CHIP Copayments Waived Through October 31, 2021. This is an update to an article titled “CHIP Copayments Waived Through September 30, 2021,” which was published on this website on August 26, 2021. READ MORE

9/29/2021 - 3rd Quarter 2021 HCPCS Updates for the CSHCN Services Program. READ MORE 

9/29/2021 - Extension of NF COVID-19 Emergency Rules: Mitigation and Response, Expansion of Reopening Visitation. The following emergency rules were set to expire on September 28, 2021 but have been extended to November 27, 2021. READ MORE

9/28/2021 - Pharmacies Should Verify General Information in PEMS. READ MORE

9/28/2021 - Reimbursement Rate Updates for COVID-19 Monoclonal Antibody Infusion Procedure Codes. READ MORE

9/24/2021 - Reminder - ICF Providers' Deadline to Submit Attestations and Forms for COVID-19 Therapeutic Leave. READ MORE 

9/21/2021 - NHSN Level-3 Access Required to Submit NF October 3, 2021, Weekly COVID-19 Vaccination Data. Nursing facilities must have a National Healthcare Safety Network (NHSN) user with Level-3 access to submit or update weekly COVID-19 vaccination data for reporting weeks starting with end date October 3, 2021. READ MORE 

9/17/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Code M0201 Effective June 8, 2021. READ MORE

9/17/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes 0003A and 0013A Effective August 12, 2021. READ MORE 

9/1/2021 - CSHCN COVID-19 Telehealth and Telemedicine Extensions through 9/30/21. READ MORE 

8/31/2021 - COVID-19 Guidance for New and Initial CSHCN Prior Authorizations. This is an update to the article titled “Guidance for Providers Regarding New and initial Prior Authorizations,” which was published July 2, 2020, on this website. READ MORE 

8/31/2021 - Client Signature Requirement on CSHCN Documentation of Receipt Waived Through 9/30/21. READ MORE 

8/25/2021 - Monthly Provider Reporting Requirements Beginning 9/1/21 in Compliance with SB809 and Rider 143.
READ MORE 

8/24/2021 - COVID-19 Vaccine Administration Procedure Codes 0003A and 0013A Are Now Benefits. READ MORE 

8/23/2021 - COVID-19 Visitation Emergency Rules for Inpatient Hospice Providers Extended. READ MORE 

8/23/2021 - COVID-19 Visitation Emergency Rules for ICF Providers Extended. READ MORE 

8/16/2021 - HHSC Publishes Guidance for Ending of the Temporary Suspension of Certain LTCR Requirements During the COVID-19 Outbreak (PL 2021-29). READ MORE 

8/11/2021 - LTC Provider COVID-19 Resource Contacts Have Changed. READ MORE

8/9/2021 - Nursing Facility and Assisted Living Facility Providers: Resumption of Option for In-Person MCO Service Coordination Visit. READ MORE 

8/9/2021 - Provider Enrollment Application Waiver to End. READ MORE 

8/9/2021 - HHSC Publishes Requirements for Certain COVID-19 Flexibilities Expiring for CAS, PHC and FC Providers (IL 2021-38). READ MORE 

8/6/2021 - QW Modifier Required for COVID-19 Testing Procedure Code 87637. READ MORE 

8/4/2021 - HHSC Ends Suspension of Certain LTCR Requirements Related to the COVID-19 Outbreak. READ MORE

8/3/2021 - Information on Payments for Leave Due to the COVID-19 Pandemic Published (IL 2021-37). READ MORE 

8/2/2021 - HHSC Publishes Updated COVID-19 Response Plan and Frequently Asked Questions for ICF Providers.
READ MORE 

8/2/2021 - NF COVID-19 Therapeutics Available for Onsite Use – Qualifying Conditions Expanded. READ MORE 

7/28/2021 - COVID-19 Guidance for New and Initial CSHCN Prior Authorizations. This is an update to the article titled, “Guidance for Providers Regarding New and initial Prior Authorizations,” which was published July 2, 2020, on this website. READ MORE 

7/27/2021 - CSHCN COVID=19 Telehealth and Telemedicine Extensions through 8/31/2021. READ MORE 

7/27/2021 - Client Signature Requirement on CSHCN Documentation of Receipt Waived Through 8/31/21. READ MORE 

7/27/2021 - COVID-19 Update to Telehealth Guidance on CLASS Professional and Specialized Therapies. READ MORE 

7/26/2021 - CHIP Copayments Waived Through 8/31/2021. This is an update to the article titled, “CHIP Copayments Waived Through July 31, 2021,” which was posted on this website on June 28, 2021. READ MORE 

7/26/2021 - Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Extended through 8/31/2021. READ MORE 

7/23/2021 - LTC Providers - Follow Rules and Related COVID-19 Response Plans. READ MORE

7/13/2021 - Public Health Emergency Enrollment Application to be Discontinued Effective 8/1/2021. This is an update to the article titled “Public Health Emergency Enrollment Application Now Available,” which was posted on this website on April 1, 2020. READ MORE 

7/9/2021 - Some Medicaid and Children's Health Insurance Plan (CHIP) COVID-19 flexibilities have been extended through July 31, 2021, unless the federal public health emergency (PHE) ends sooner. Details are available on the TMHP website at www.tmhp.com. READ MORE 

7/8/2021 - Application Period Extended for CARES Act Community Development Block Grant. READ MORE 

7/8/2021 - A recording of the June 30, 2021 Nursing facility provider (NF) COVID-19 webinar with Long-term Care Regulation (LTCR) and Department of State Health Services (DSHS) is available for those unable to attend. READ MORE 

7/6/2021 - NF COVID-19 Webinar with HHSC LTCR, DSHS | July 14, 2021 2:30 PM CT. READ MORE 

7/6/2021 - FDA Tells Public to Stop Using Certain Innova COVID-19 Antigen Tests. READ MORE 

7/2/2021 -  July 1, 2021 MCS COVID-19 Stakeholder Information Session. Audio from Texas Medicaid Children’s Health Insurance Program (CHIP) COVID-19 Information Session. READ MORE 

7/1/2021 - Reimbursement Rate Updates for COVID-19 Monoclonal Antibody Therapy Procedure Codes M0247 and Q0247 Effective May 26, 2021. READ MORE

7/1/2021 - COVID-19: Claims for Telephone Medical Services. READ MORE 

COVID-19: Rural Health Clinics (RHC) and Checkups – Texas Medicaid. READ MORE

COVID-19: THSteps Remote Delivery of Medical. READ MORE

Durable Medical Equipment (DME) Client Signature - Waived During COVID-19. READ MORE

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

6/30/2021 - COVID-19 Guidance for New and Initial CSHCN Prior Authorizations. This is an update to the article titled, “Guidance for Providers Regarding New and initial Prior Authorizations,” which was published July 2, 2020. READ MORE 

6/30/2021 - COVID-19 Policy Extended for Service Providers of Respite and CFC PAS/HAB. READ MORE 

6/30/2021 - COVID-19 Telehealth Guidance for CLASS Professional and Specialized Therapies. The following Community Living Assistance and Support Services (CLASS) professional and specialized therapy services are extended through July 31 and are temporarily available by telehealth. READ MORE

6/30/2021 - COVID-19 Policy Update for FFS Service Coordinators and Case Managers. READ MORE

6/25/2021 - Attention All Medicaid Providers: Effective for dates of service on or after May 18, 2021, home health agencies administering medical services for Texas Medicaid clients may be reimbursed for COVID-19 vaccine procedure codes 0001A, 0002A, 0011A, 0012A, and 0031A. Details are available on the TMHP website at www.tmhp.com. READ MORE 

6/24/2021 - QW Modifier Required for COVID-19 Testing Procedure Code 87636. READ MORE 

6/18/2021 - Attention Medicaid, CSHCN and FPP Program Providers: This is an update to the article titled, "Change to Provider Enrollment Revalidation Due Dates in Response to COVID-19 Emergency," which was published on the TMHP website on February 2, 2021. Providers are strongly encouraged to avoid potential enrollment delays by submitting Revalidation applications immediately before the end of the current COVID-19 Public Health Emergency. Details are available on the TMHP website at www.tmhp.com.READ MORE 

6/16/2021 - June 16th NF COVID-19 Webinar with HHSC, LTCR and DSHS. READ MORE 

6/11/2021 - Attention All Medicaid Providers: Effective for dates of service on or after April 1, 2020, procedure code S8301 for infection control supplies above and beyond normal protocol can be billed by THSteps-CCP personal care services (PCS) providers in the home setting. Details are available on the TMHP website at www.tmhp.com. READ MORE 

6/11/2021 - Pediatric Providers can Enroll in COVID-19 Vaccine Program. READ MORE

6/11/2021 - Attention All Medicaid Providers: ** Multiple Medicaid and Children's Health Insurance Plan (CHIP) COVID-19 flexibilities have been extended through June 30, 2021. READ MORE

6/11/2021 - Updated: COVID-19 Pfizer Vaccine expanded to ages 12 and Older. READ MORE 

6/7/2021 - June 7th ICF COVID-19 Webinar Rescheduled to June 14th. If you have already registered for the June 7 webinar you do not need to register again. READ MORE 

6/1/2021 - New COVID-19 Vaccine Authority Emergency Rule for Home Health and Hospice Providers. READ MORE 

6/1/2021 - COVID-19: Provider Enrollment Revalidation Due Dates Extended. READ MORE 

6/1/2021 - COVID-19: Claims for Telephone Medical Services (Audio Only). READ MORE 

5/28/2021 - Multiple Medicaid COVID-19 Flexibilities Extended Through June 30th, 2021. READ MORE 

5/28/2021 - COVID-19 Guidance for New and Initial CSHCN Prior Authorizations. This is an update to the article titled, “Guidance for Providers regarding New and Initial Prior Authorizations,” which was published July 2, 2020, on this website. READ MORE 

5/272021 - Telemedicine and Telehealth Extended Through June 30th, 2021. This is an update to the article titled “Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Extended Through May 31, 2021,” which was posted on this website on April 30, 2021. READ MORE 

5/20/2021 - What You Need to Know About COVID-19 Vaccine Protocols. READ MORE

5/4/2021 - COVID-19: Provider Enrollment Revalidation Due Dates Extended. READ MORE  

5/4/2021 - DSHS Urges Providers to Order More COVID-19 Vaccine as Needed. READ MORE 

5/3/2021 - COVID-19: Claims for Telephone Medical Services (Audio Only). READ MORE 

5/3/2021 - COVID-19: Rural Health Clinics (RHC) and Telehealth/Telemedicine. READ MORE

5/3/2021 - COVID-19: THSteps Remote Delivery of Medical Checkups. READ MORE

5/3/2021 - COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). READ MORE

5/3/2021 - Durable Medical Equipment (DME) Client Signature Waived During COVID-19. READ MORE 

4/15/2021 - New Texas Department of State Health Services (DSHS): COVID-19 Vaccine Resource for Medicaid Providers. READ MORE 

4/9/2021 - Updated COVID-19 Response Plan for NF's. READ MORE 

4/7/2021 - Reimbursement Rate Updates for COVID-19 Vaccine Administration Procedure Codes Effective April 1, 2021. READ MORE 

3/29/2021 - Updated 03/29/2021 | Posted 04/15/2020
Durable Medical Equipment (DME) Client Signature Waived During COVID-19 Texas Health and Human Services Commission (HHSC) is extending the signature requirement waiver for the DME Certification and Receipt Form through April 30, 2021. READ MORE 

3/29/2021 - Updated 03/29/2021 | Posted 06/22/2020
COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP). 
READ MORE 

3/22/2021 - COVID-19 Janssen (Johnson & Johnson) Vaccine Coverage. READ MORE

3/10/2021 - Due to the impact COVID-19 has had on Texas nursing facilities, HHSC will continue suspension of the deallocation of Medicaid beds for 2021. Annually, HHSC reviews Medicaid bed allocation and deallocates beds from nursing facilities who are not utilizing them as defined in rule 26 TAC §554.2322(j)(5). READ MORE 

2/26/2021 - COVID-19 Vaccine Suspension of Out-of-Network Limits for Texas Medicaid and CHIP. READ MORE

Updated 02/26/3021 | Posted 04/15/2020  READ MORE 

Updated 02/26/2021 | Posted 04/14/2020 READ MORE 

Updated 02/26/2021 | Posted 06/22/2020 READ MORE 

2/23/2021 - COVID-19: New ICD-10 Diagnosis Codes Updates for Texas Medicaid. READ MORE

2/17/2021 - Effective January 12, 2021, for dates of service on or after January 1, 2021, the reimbursement rates for COVID-19 related procedure codes U0003, U0004, and U0005 have been updated. 

2/1/2021 - Reimbursement Rate Update for COVID-19 Administration Procedure Code M0239 Effective 11/9/2020.
READ MORE 

2/1/2021 - Reimbursement Rate Update for COVID-19 Administration Procedure Code M0243 Effective 11/21/2020.
READ MORE

2/1/2021 - Reimbursement Rate Update for COVID-19 Procedure Code 87428 Effective 11/10/2020. READ MORE 

1/29/2021 - Provider-Facing COVID-19 Vaccine Key Messages: How to enroll to be a COVID-19 vaccinator. READ MORE

1/29/2021 - COVID-19 Vaccine and Vaccine Administration Codes. READ MORE  

1/29/2021 - COVID-19 Vaccine Coverage Includes Moderna for Texas Medicaid. READ MORE

1/28/2021 Updated | Posted 06/22/2020
COVID-19: Office Visit Co-Payments Reimbursement Process for Children's Health Insurance Program (CHIP).
READ MORE 

1/28/2021 Updated | Posted 04/14/2020
COVID-19: Rural Health Clinics (RHC) and Telehealth/Telemedicine. READ MORE 

1/27/2021 - COVID-19 Guidance for New and Initial Medicaid Prior Authorizations. READ MORE 

1/1/2021 - Reimbursement Rate Updates for Procedure Codes 86328, 86769 and 87426 Effective 1/1/2021. READ MORE 

12/30/2020 - New ICD-10 COVID-19 Diagnosis Code Updates Effective January 1, 2021.READ MORE 

12/23/2020 - COVID-19 Vaccine Information. READ MORE 

12/18/2020 - Reimbursement Rate Updates for Procedure Codes 0011A and 0012A Effective 12/18/2020. READ MORE 

12/17/2020 - Updated| Posted 04/15/2020 COVID-19: Claims for Telephone Medical Services (Audio Only) – Texas Medicaid. READ MORE 

12/16/2020 - Reimbursement Rate Updates for Procedure Codes 0001A and 0002A Effective December 11, 2020. READ MORE

12/15/2020 - COVID-19 Update to Telehealth Guidance on CLASS Professional and Specialized Therapies - December 14.
READ MORE 

12/15/2020 - Multiple Medicaid COVID-19 Flexibilities Extended Through January 21, 2021, or Through January 31, 2021.
READ MORE 

12/14/2020 - COVID-19 Emergency Rules for ICF Providers Extended. READ MORE 

12/14/2020 - COVID-19 Vaccine Administration Procedure Codes 0001A and 0002A Are Now Benefits. READ MORE 

12/8/2020 - Emergency Rules for NF Providers Extended. READ MORE 

12/4/2020 - Claims for Telemedicine and Telehealth Services for HTW Plus. READ MORE 

12/3/2020 - 90-Day Prior Authorization Extensions to End December 31, 2020. READ MORE 

12/1/2020 - HHSC Has Updated Reporting Guidance for Long-Term Care Providers – Point-of-Care Antigen Testing (PL 20-46). READ MORE 

11/30/2020 - COVID-19 Testing Procedure Code 87428 Now a Benefit. READ MORE 

11/24/2020 - Multiple Medicaid COVID-19 Flexibilities Extended Through December 31, 2020. READ MORE 

11/24/2020 - NHSN POC Test Reporting Tool Defects and Changes to LTCF COVID-19 Module. READ MORE 

11/24/2020 - Effective December 1, 2020, reimbursement for telemedicine (physician delivered) and telehealth (non-physician delivered) services for federally qualified health centers (FQHCs) became benefits of Texas Medicaid. Providers can refer to the articles “Benefits for Telemedicine Services to Change for Texas Medicaid December 1, 2020,” and “Benefits for Telehealth Services to Change for Texas Medicaid December 1, 2020,” for additional information about the benefit changes. For more information, call the TMHP Contact Center at 1-800-925-9126.

11/19/2020 - HHSC Publishes Flu Vaccine Guidance During COVID-19 (PL 20-50). READ MORE 

11/19/2020 - HHSC Publishes Revised Reporting Guidance for Long-Term Care Providers (PL 20-37).  READ MORE 

11/17/2020 - New State Reporting Requirements for Facilities Currently Reporting COVID-19 Lab Data to the National Healthcare Safety Network Effective November 14, 2020, long-term care facilities who are currently submitting COVID-19 laboratory data into the National Healthcare Safety Network (NHSN) should discontinue their direct reporting to the Department of State Health Services’ National Electronic Disease Surveillance System. READ MORE 

11/16/2020 - November 18th NF Provider COVID-19 Webinar with HHSC LTC Regulation and DSHS. READ MORE  

11/16/2020 - CMS/CDC Targeted COVID-19 Training for NF, ALF Providers.  READ MORE 

11/12/2020 - Reminder: HHSC 2020 COVID-19 Impact Survey. The Texas Health and Human Services Commission wants to remind you that this is the final week to fill out the COVID-19 Impact Survey for HHSC health care providers. The deadline to complete the survey is TODAY November 13 at 5:00 p.m.  READ MORE 

11/9/2020 - HHSC Publishes Process to Request Free COVID-19 Point of Care Antigen Test Kits (PL 20-49).  READ MORE 

11/6/2020 - The deadline to apply for Federal COVID-19 Relief Fund for Providers was November 6, 2020.  READ MORE 

10/26/2020 - COVID-19 Guidance for New and Initial Prior Authorizations.  READ MORE 

10/26/2020 - TMHP To Extend Prior Authorizations for 90 Days. READ MORE 

10/26/2020 - Update to ‘Provider Enrollment Revalidation Due Dates Extended in Response to COVID-19 Emergency.’
READ MORE 

10/26/2020 - COVID-19 Testing Procedure Codes 87636, 87637 and 87811 Are Now Benefits. READ MORE 

10/26/2020 - CSHCN COVID-19 Telehealth and Telemedicine Extensions through 11/30/20. As part of its continued response to COVID-19 (coronavirus), the Children with Special Health Care Needs (CSHCN) Services Program will provide reimbursement for previously identified telemedicine and telehealth services through November 30, 2020, dates of service.  READ MORE 

10/23/2020 - Unless your agency currently provides laboratory services in accordance with 26 TAC §558.284, you will need to apply for a Clinical Laboratory Improvement Amendment waiver to offer and perform certain COVID-19 testing for employees and clients directly.  READ MORE 

10/23/2020 - Multiple Medicaid COVID-19 Flexibilities Extended Through 11/30/20. The following Medicaid and Children’s Health Insurance Plan (CHIP) flexibilities have been extended through November 30, 2020. READ MORE 

10/19/2020 - HHSC Publishes PL 20-43 COVID-19 Response - Expansion of Reopening Visitation for ICF Providers.  READ MORE 

10/19/2020 - HHSC Adopts New Expansion of Reopening Visitation Emergency Rules for ICF Providers. READ MORE

10/16/2020 - October 21 NF Provider COVID-19 Webinar with HHSC LTC Regulation and DSHS.  READ MORE

10/14/2020 - October 12 Updated Nursing Facility COVID-19 Facts (revised 10/14/20)READ MORE

10/13/2020 - Addition of Procedure Code 86413 COVID-19 Testing.  READ MORE

10/13/2020 - COVID-19 Testing Procedure Codes 86408 & 86409 Are Now Benefits.  READ MORE

10/12/2020 - HHSC Long-term Care Regulation has updated the Nursing Facility COVID-19 response plan.  READ MORE

10/6/2020 - IPC COVID-19 Policy Guidance for CLASS, DBMD, HCS, and TxHmL Programs. READ MORE 

10/6/2020 - Resident Leave Reimbursement During COVID-19 for ICF/IID Program Providers (IL2020-43).  READ MORE

9/30/2020 - Updates to Some COVID-19 Related Procedure Codes.  READ MORE

9/30/2020 - Reimbursement Rate Updates for COVID-19 Related Procedure Codes for the CSHCN Services Program.  
READ MORE

9/30/2020 - Procedure Codes Addition and Update for COVID-19 for the CSHCN Services Program.  READ MORE

9/29/2020 - Updates to some COVID-19 Related Procedure Codes.  READ MORE

9/25/2020 - HHSC Issues COVID-19 Response - Expansion of Reopening Visitation Guidance for Long-term Care Providers.
READ MORE
 

9/18/2020 - Spell of Illness Limitation for COVID-19-related Admissions.  READ MORE

9/15/2020 - Existing EVV Users: Best Practices for Temporary EVV Policies for COVID-19.  READ MORE

9/10/2020 HHSC Publishes PL 20-37 - - COVID-19 and Death Reporting Guidance for Long-Term Care Providers. READ MORE

9/9/2020 Reimbursement Rate Updates for COVID-19 Related Procedure Code 87426 - Effective June 25, 2020, for Medicaid. READ MORE

9/2/2020 - COVID-19 MEDICAID-Medicaid and CHIP Allocation: Deadline to Apply for CARES Act Extended to September 13, 2020. READ MORE

8/21/2020 - COVID-19 Reminder to Providers. This is an update to the article titled “Medicaid and CHIP Allocation: Deadline to Apply for CARES Act Extended to August 3, 2020,” which was posted on this website on July 22, 2020.  READ MORE

8/14/2020 - Effective for dates of service on or after October 1, 2020, telemonitoring benefits will change for Texas Medicaid.  READ MORE

8/14/2020 - Beginning August 13, 2020, for dates of service on or after June 25, 2020, new procedure code 87426 will require modifier QW when billed.  READ MORE

8/6/2020 - Updated Provider Enrollment Re-validation Due Dates Extended in Response to the COVID-19. The article specified revalidation due dates would be extended 30 calendar days to prevent provider disenrollment.  READ MORE

7/31/2020 - To help ensure continuity of care during the COVID-19 (coronavirus) response, the Health and Human Services Commission has directed TMHP to move forward with processing new and initial prior authorization requests, including recertification requests, by relaxing document submission time frames for providers if they are unable to provide certain required documentation during the COVID-19 emergency. READ MORE

6/30/2020 - New Value Point of Origin for Admission or Visit Code "G" to be Used Beginning 7/1/2020.  READ MORE

6/4/2020 - Additional Procedure Codes for COVID-19 Testing.  READ MORE

6/4/2020 - Update on code 87635.Effective for dates of service on or after March 20, 2020, procedure code 87635 must be submitted with modifier QW.  READ MORE

6/4/2020 - Update to the article titled, "Coronavirus Testing Procedure Codes to Become a Benefit," which was published on the website March 16, 2020. The article stated procedure code U0002 is a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for dates of service on or after February 4, 2020. The Centers for Medicare & Medicaid Services (CMS) has categorized procedure code U0002 as a Clinical Laboratory Improvement Amendments (CLIA) waived test. Effective for dates of service on or after March 20, 2020, procedure code U0002 must be submitted with modifier QW.  READ MORE

5/27/2020 - Provider Enrollment Re-validation Due Dates Extended in Response to the COVID-19.  READ MORE

5/7/2020 - Waiver Extension for DME Certification and Receipt Form; the payer has updated the waiver to extend through May 31, 2020. READ MORE

4/30/2020 - Stakeholder Update: Covid 19. Several Waiver requests were submitted for Texas Medicaid to the Texas Health & Human Services Commission (HHSC), but there are no regulatory updates at this time.  READ MORE

4/30/2020 - COVID-19 information can be found at the TMHP Coronavirus (COVID-19) Information page for Providers.  READ MORE

4/15/2020 - HHSC has directed TMHP to extend prior authorizations that require recertification and are set to expire March 1, 2020, through May 31, 2020 for 90 days. This extension does not apply to current authorizations for one-time services (e.g., single non-emergency ambulance trip, but a recurrent non-emergency ambulance authorization for dialysis would be extended).  READ MORE

3/30/2020 - Office visit copayments for all CHIP members for services provided from March 13, 2020, through April 30, 2020 are waived. Co-payments are not required for covered services delivered via telemedicine or telehealth to CHIP members.
READ MORE

The member’s MCO will reimburse the provider the full rate for the service, including what would have been paid by the member through cost-sharing. Providers must attest that the office visit copayment was not collected by using the attestation form and submit an invoice to the appropriate MCO. MCOs have 30 calendar days to pay an invoice received from a provider.  READ MORE

Tricare East

3/29/2022 - The Biden-Harris Administration launched a new nationwide Test to Treat initiative to give individuals an important new way to quickly access free lifesaving treatment for COVID-19. READ MORE

1/15/2022 - Starting January 15, 2022, private health insurers must cover the cost of eight at-home COVID-19 tests per month. However, this policy will not apply to TRICARE. Beneficiaries must still have a prescription indicating a medical necessity for the test for the beneficiary to be reimbursed. If a beneficiary buys an at-home test without a prescription, TRICARE will not cover it. READ MORE 

12/30/2021 - First oral treatment, Paxlovid, authorized for emergency use. Paxlovid is covered for TRICARE beneficiaries if ordered by a provider. READ MORE 

8/5/2021 - COVID-19 Update - ABA Telemedicine Expiration. READ MORE 

6/15/2021 - Providers delivering telemed services must be licensed in the state where the services are provided and received. Get more iformation on the latest Tricare Covid 19 telemedicine benefits for providers. READ MORE 

4/22/2021 - Telemedicine: TRICARE covers the use of interactive audio/video technology to provide clinical consultations and office visits when appropriate and medically necessary. READ MORE 

1/7/2021 - COVID-19 vaccination providers participating in the CDC COVID-19 Vaccination Program are required to sign a CDC COVID-19 Vaccination Program Provider Agreement.  READ MORE 

11/10/2020 - Tricare Provider News Issue 4 2020. COVID-19 News: Serology testing: COVID-19 serology/antibody testing is covered by TRICARE only when medically necessary and when the results of the test will impact the clinical management of the beneficiary. READ MORE  

8/12/2020 - Tricare Humana Military network providers receive a discount with new telemedicine platforms, which are Medici, Doxy.me, Vsee, and Chiron Telehealth. As telemedicine continues to play an important role in healthcare, TRICARE has updated its policy on the coverage and expansion of services, costs and other benefits. READ MORE 

5/18/2020 - Already-approved referrals and authorizations have been extended 180 days from the expiration date. Humana Military has automatically updated the referral/authorization end dates and the updates are reflected in provider self-service. READ MORE 

5/1/2020 - Tricare and commercial self funded ASO clients are not eligible for the waived testing and treatment costs. Humana is reaching out to these plans to see if they will follow Humana's approach.  READ MORE   

4/29/2020 - TRICARE has approved use of telehealth services to include otherwise-covered behavioral health services during the COVID-19 outbreak.  READ MORE 

4/20/2020 - At this time, no guidance has been received regarding reimbursement for COVID-19 testing. Payer states that Providers should not refile claims until Tricare gives more instruction. Reimbursement will be based on billed charges (less network provider discounts) until criteria is met to establish a state prevailing rate.  READ MORE 

3/31/2020 - Prior- authorization is not required for COVID-19 testing. Humana Military will follow the Centers for Medicare & Medicaid Services (CMS) coding U0001 and U0002; HCPCS codes for billing.  READ MORE 

Tricare West

4/1/2022 - Provider News 4/1/22. One-Stop Test to Treat for COVID-19 Now Available. When your office is unable to schedule patient visits, we encourage you to inform your TRICARE patients about using One-Stop Test to Treat locations for COVID-19 testing and oral antiviral treatment. READ MORE

4/1/2022 - Provider Newsletter April 2022. COVID-19 Updates. TRICARE continues to follow Centers for Disease Control and Prevention (CDC) guidelines on COVID-19 testing, treatment and vaccines. In this ever-changing environment, be sure to visit cdc.gov, tricare-west.com and tricare.mil for up-to-date information. READ MORE 

3/22/2022 - COVID-19 clinical trials may be cost-shared for beneficiaries participating in the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored studies. READ MORE 

1/26/2022 - As of Jan. 24, 2022, the FDA has revoked the Emergency Use Authorization (EUA) for two of the four EUA-approved COVID-19 monoclonal antibodies due to ineffectiveness against the current primary variant, Omicron. EUAs are still in place for one outpatient and one inpatient monoclonal antibody treatment. READ MORE 

1/20/2022 - TRICARE continues to cover medically necessary COVID-19 tests ordered by a TRICARE-authorized provider and performed at a TRICARE-authorized lab or facility. FDA-approved at-home test kits may be covered with a physician's order. There are no copayments or cost-shares for covered tests. READ MORE 

1/6/2022 - Tricare West Provider News/January 2022: COVID-19 Vaccine Update. READ MORE

1/6/2022 - COVID-19: Monoclonal Antibody Treatment to Help Prevent Hospitalization. READ MORE 

12/29/2021 - Tricare West Provider Updates Newsletter/December 2021. READ MORE 

11/30/2021 - Monoclonal Antibody Treatment May Help High-Risk Avoid COVID-19 Hospitalization. READ MORE 

11/15/2021 - Third doses and boosters. READ MORE 

11/11/2021 - Tricare Provider News Nov. 2021. COVID-19 Vaccines. READ MORE 

10/27/2021 - The COVID-19 vaccine is covered in accordance with Centers for Disease Control and Prevention (CDC) guidelines. READ MORE 

8/3/2021 - COVID-19 Provider News. Notifying HNFS of Patients' COVID-19 Clinical Trial Participation. READ MORE 

7/12/2021 - Update to Tricare's COVID Testing Coverage. TRICARE covers age-appropriate vaccines in accordance with CDC guidelines. Prior authorization is not required. READ MORE

5/19/2021 - The COVID-19 vaccine is covered in accordance with Centers for Disease Control and Prevention (CDC) recommendations. READ MORE 

4/22/2021 - Tricare Coverage of COVID-19 Vaccine. READ MORE 

4/22/2021 - COVID-19 Clinical Trials. READ MORE 

4/22/2021 - Let Your Patients Know About Telehealth Options: TRICARE continues to waive copayments and cost-shares for covered telemedicine services. READ MORE 

4/15/2021 - Tricare Coverage of COVID-19 Vaccine. READ MORE 

3/26/2021 - The Department of Defense (DoD), in collaboration with the Department of Health and Human Services, has launched a program to provide COVID-19 vaccines to service members, retirees, and their families. Under this program, the DoD will distribute the vaccines through a series of phases. READ MORE 

3/5/2021 - Will DoD make the COVID-19 vaccine mandatory, similar to the yearly influenza vaccine? When formally licensed by the FDA, a vaccine may become mandatory for military personnel. This is the case for the influenza vaccine. READ MORE 

3/2/2021 - An approval from Health Net Federal Services, LLC is not required; however, TRICARE Prime beneficiaries who see non-network providers require a referral. READ MORE

1/29/2021 - Further details for COVID-19 vaccines for Tricare beneficiaries. Details on becoming a COVID-19 vaccine provider and the Vaccine Program Provider Agreement. READ MORE 

1/15/2021 - Vaccine will eventually be available via local military hospital or clinic or civilian provider. TRICARE non-network providers or TRICARE non-network pharmacies: patients may have to pay a cost-share based on their TRICARE plan. Patients may have to pay out of pocket and file a claim for reimbursement. READ MORE

12/22/2020 - DME Reimbursement per the CARES Act - Update. READ MORE 

12/18/2020 - COVID-19 Clinical Trials. READ MORE 

12/18/2020 - TRICARE coverage of COVID-19 clinical trials. READ MORE 

11/24/2020 - Recent COVID-19 and TRICARE policy updates: investigational drugs, long-term care reimbursement, skilled nursing facility stays. READ MORE

11/19/2020 - Tricare West Provider Resources for COVID-19 updated on 11/19/2020. Find up to date information regarding benefits, provider education and online resources. READ MORE 

11/10/2020 - Tricare Provider Newsletter Nov. 2020. Navigating the COVID-19 Pandemic. Telemedicine - Help beneficiaries and other providers locate you as a telemedicine provider by updating your Network Provider Directory listing. 

10/19/2020 - Tricare West "In Case You Missed It" for September 2020: Durable medical equipment reimbursement and the CARES Act. 

10/7/2020 - Coronavirus (COVID-19) diagnostic and antibody (serology) testing is a covered benefit when medically necessary. 

8/18/2020 - DME Reimbursement: CARES Act Impact to Rates. 

8/13/2020 - Policy Changes Due to COVID-19. 

7/21/2020 - Place of Service Update for Telemedicine Claims.

5/29/2020 - With provider offices across the country rescheduling patient appointments due to the COVID-19 outbreak, we recognize some already-approved authorizations for your TRICARE patients may expire before pandemic restrictions are lifted. 

5/21/2020 - Temporary Expansion of Telemedicine Benefit.  

4/13/2020 - Due to restrictions in access to military installations and therefore Uniformed Services identification (USID) card renewal services, the Department of Defense is allowing beneficiaries to use USID cards that expired on or after Jan. 1, 2020 through Sept. 30, 2020. 

Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for COVID-19 testing and related services, and office visits, urgent care or emergency room visits (to include telemedicine) during which tests are ordered or administered. COVID-19 diagnostic tests must meet Families First Coronavirus Response Act (FFCRA) criteria in order to be eligible for the cost-share and copayment waivers. 

4/6/2020 - The Prior Authorization, Referral and Benefit Tool allows you to easily determine HNFS approval requirements. Prior authorizations for certain services and/or procedures require Health Net Federal Services, LLC (HNFS) review and approval, prior to being provided.  READ MORE

3/31/2020 - Due to the COVID-19 outbreak, the Military Health System Nurse Advice Line is experiencing a larger than usual call volume, and wait times are long. They are working to reduce wait times. View frequently asked questions at www.tricare.mil/coronavirus. 

UnitedHealthcare

11/9/2021 - COVID-19 Vaccine Updates 11/9/21. Medicare Advantage/Medical - Please note: For services rendered through Dec. 31, 2021, bill claims for COVID-19 vaccine administration to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). READ MORE

11/9/2021 - COVID-19 Testing Guidance (Updated 11/9/21). READ MORE 

10/15/2021 - COVID-19 Vaccine Administration Reimbursement/updated 10/15/21. The cost of COVID-19 FDA-authorized vaccine serums will initially be paid for by the U.S. government. READ MORE 

10/6/2021 - Arizona News 10/6/21: Update COVID-19 Vaccination Records Through ASIIS. You help meet Arizona requirements when you keep your patients’ vaccination records updated in the Arizona State Immunization Information System (ASIIS). READ MORE 

8/18/2021 - COVID-19 Update. Health care professionals should use published AMA CPT codes when submitting COVID-19 vaccine administration claims to UnitedHealthcare under the member’s medical benefit. READ MORE 

8/18/2021 - COVID-19 Vaccines- Billing and Reimbursement. READ MORE 

7/19/2021 - COVID-19 national public health emergency extension. READ MORE 

7/16/2021 - Skilled Nursing Facility Payment for Outpatient COVID-19 Testing. READ MORE 

7/9/2021 - COVID-19 Testing Guidance (updated 7/9/21). READ MORE 

6/29/2021 - COVID-19 Credentialing Updates 6/29/21. Effective July 1, 2021, UnitedHealthcare resumes our standard credentialing and recredentialing process and policies. READ MORE 

5/14/2021 - COVID-19 Vaccine Administration in Urgent Care Facilities. READ MORE 

5/13/2021 - UnitedHealthcare will cover medically appropriate COVID-19 testing during the national public health emergency period (currently scheduled to end July 19, 2021), at no cost share, when ordered by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member. READ MORE

3/1/2021 - UnitedHealthcare will cover medically appropriate COVID-19 testing during the national public health emergency period (currently scheduled to end April 20, 2021), at no cost share, when ordered by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member. READ MORE 

2/15/2021 - COVID-19 Vaccine Guidance. The cost of COVID-19 FDA-authorized vaccine serums will initially be paid for by the U.S. government. UnitedHealthcare will reimburse CDC COVID-19 vaccination program providers for the administration of FDA-authorized and U.S. government provided COVID-19 vaccines. READ MORE 

1/11/2021 - COVID-19 Testing/Treatment/Vaccines coding and reimbursement. READ MORE

1/5/2021 - Select Prior Authorization Suspensions in Effect Nationally Dec. 18, 2020 – Jan. 8, 2021. READ MORE 

12/30/2020 - COVID-19 Information Updates. Suspended prior authorization period. READ MORE 

12/30/2020 - COVID-19 - Extensions of Temporary Cost Share Waivers. READ MORE 

12/30/2020 - COVID-19 Reminder on New Telehealth Policies. READ MORE 

12/17/2020 - COVID-19 Vaccine Guidance. Medicare Advantage health plans: Charges for COVID-19 vaccine administration for all Medicare beneficiaries should be billed to the Center for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC). READ MORE 

12/4/2020 - COVID-19 Monoclonal Antibody Study. 

11/25/2020 - Claim Coding/Submissions/Reimbursement. 

11/13/2020 - COVID-19 Vaccine Trial.

11/2/2020 - UnitedHealthcare is temporarily updating our credentialing policies to implement provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. 

10/26/2020 - COVID-19 Credentialing Update 10/26/20. 

10/2/2020 - COVID-19 Telehealth Update 10/2/20. 

9/28/2020 - COVID-19 Testing, Treatment, Coding & Reimbursement.

8/18/2020 - COVID-19 Testing & Cost Share Updates on 8/14/2020. 

7/24/2020 - UnitedHealthcare is extending many of the COVID-19 temporary program, process and coverage changes through Oct. 22, 2020. 

7/24/2020 - COVID-19 Provider Resources/Administration: Timely Filing Guidelines. 

6/26/2020 - COVID-19 Telehealth Services updated 6/26/2020. NEW! Date Expansion and Cost Share Updates for Telehealth Services. 

6/17/2020 Updates that apply to our Medicare Advantage and Individual and fully insured Group Market health plans. 

5/22/2020 - UnitedHealthcare will reimburse appropriate claims for telehealth services for dates of service from March 18, 2020 through June 18, 2020. Waiving cost sharing for the treatment of COVID-19 until May 31, 2020 for Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans. 

5/21/2020 - UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all office-based professional services performed by both primary care physicians and specialists. UnitedHealthcare will reimburse the full cost share the health care professional would have received from the member. This applies for dates of service starting May 11, 2020 until at least Sept. 30, 2020. 

5/12/2020 - UnitedHealthcare is temporarily updating our credentialing policies to implement provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more of our networks. 

5/12/2020 - For a testing-related office visit to be paid at no cost-share, a COVID-19 test code or a COVID-19 diagnosis code is required on the claim. Otherwise, a revised claim will need to be submitted. Appeals are being reviewed through an exception process on a case by case basis for those claims. 

5/8/2020 - Updated Telehealth Audio-Visual Requirements. 

5/7/2020 - UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all professional services performed by both primary care physicians and specialists. This applies for dates of service starting May 11, 2020 until at least Sept. 30, 2020.

5/5/2020 - UHC Network Bulletin May 2020. UHS is delaying implementation of the following programs, policies, protocols and site of service reviews.  Additional information and updates will be provided in future Network Bulletin editions and online at UHCprovider.com/Network-News

5/4/2020 - UnitedHealthcare is extending the care provider recredentialing cycle by two months, to 38 months. UnitedHealthcare will continue to initiate the recredentialing requests for information based on standard time frames and will complete all that are received prior to the 38 months. 

5/1/2020 - Payer is delaying implementation of the following programs due to the Public Health Emergency: Emergency E& M Code policy for 99285 delayed until 3rd quarter 2020, Genetic & Molecular Prior Auth Code Update (OH until 6-1-20, WA- until further notice, Medicare Advantage- no date), Hospital Reference Lab Protocol (delayed until 6-1-20). 

4/21/2020 - The United Health Foundation is partnering with the CDC Foundation, Direct Relief and the American Nurses Foundation in a $5 million initiative as part of UnitedHealth Group's initial $60 million commitment to fight COVID-19 and support impacted populations, including health care workers, seniors, hard-hit communities and people experiencing homelessness and food insecurity. READ MORE

4/17/2020 - For Medicare Advantage, Medicaid, and Individual and Group Market fully insured health plans for claims submitted on or after April 7, 2020, providers may receive payment anywhere from a few days to two weeks earlier than usual. 

4/13/2020 - COVID-19 Testing Coverage Expanded. 

4/13/2020 - COVID-19 Credentialing Update. 

4/10/2020 - Provider Relief Funding. For information, visit hhs.gov/providerrelief. For questions regarding the distribution of funds, call the toll-free CARES Provider Relief line at (866) 569-3522. 

4/8/2020 - UnitedHealth Group is taking steps to Accelerate Nearly $2 Billion in Payments and Support to Health Care Providers to Help with COVID-19 Financial Challenges. 

4/8/2020 - Sequestration Waiver: UnitedHealthcare will apply the CARES Act waiver of the 2 percent Medicare Sequester to provider payments temporarily from May 1, 2020 until Dec. 31, 2020 for Contracted Care Providers. UHC intends to implement the waiver according to the terms of care provider participation agreements.  

4/7/2020 - The implementation date for UHC's new Medicare Advantage Emergency Department (ED) Professional Evaluation & Management (E/M) Coding Policy has been delayed until Aug. 1, 2020 due to the COVID-19 public health emergency. The policy focuses on professional ED claims submitted with a level 5 (99285) E/M code for Medicare Advantage claims. 

4/6/2020- Starting March 18, 2020, UnitedHealthcare expanded our policies around telehealth services for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. In addition, effective from March 31, 2020 until June 18, 2020, we will also waive cost sharing for in-network telehealth visits for medical, outpatient behavioral and PT/OT/ST, with opt-in available for self-funded employers. 

4/4/2020 - Practice Administration: We will extend timely filing deadlines for claims during the COVID-19 public health emergency period for Medicare Advantage, Medicaid, and Individual and Group Market health plans. Claims will not be denied for failure to meet timely filing deadlines if submitted between now and June 30, 2020 with date of service (DOS) on or after January 1, 2020. 

4/1/2020 - Effective immediately, UHC is temporarily updating credentialing policies to implement provisional credentialing for out-of-network care providers who are licensed independent practitioners and want to participate in one or more networks. 

3/30/2020 - UHC is waiving member cost sharing for the treatment of COVID-19 through May 31, 2020 for its fully-insured commercial, Medicare Advantage and Medicaid plans. Starting March 31, 2020 until June 18, 2020, UHC will now also waive cost-sharing for in-network, non-COVID-19 telehealth visits for its fully-insured Commercial, Medicare Advantage, and Medicaid members. 

3/26/2020 - Use new CPT code 87635 for lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2). CMS created the following HCPCS codes for COVID-19 testing performed on or after Feb. 4, 2020: HCPCS U0001: This code is used for the laboratory test developed by the CDC. HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC. 

3/26/2020 - Waiving prior authorization through May 31, 2020 for: admissions to long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF). 

3/25/2020 - Waiving their copays, coinsurance and deductibles for COVID-19 testing related visits, whether the care is received in a physician’s office, an urgent care center, a telehealth visit or an emergency department.  

3/20/2020 - Cost sharing is waived for COVID-19 tests and testing related visits and FAQs. This coverage applies to Medicare Advantage, Medicaid and employer-sponsored plans. 

Washington Medicaid

3/10/2022 - Provider Alert 3/10/22. COVID-19 testing clinical policy updates, effective 2/21/2022. What changed? READ MORE 

3/3/2022 - Provider Alert 3/3/22. Revised policy for therapies for COVID-19. What changed? The Health Care Authority (HCA) has updated its COVID-19 therapies policy with information regarding new COVID-19 monoclonal antibodies. READ MORE 

2/8/2022 - Provider Alert 2/8/22. Telehealth/telemedicine - new modifiers for audio-only services and information on place of service 10 when billing for COVID-19 related services. What changed? READ MORE 

12/17/2021 - Provider Alert 12/17/21. Telehealth and Telemedicine. READ MORE 

12/6/2021 - Apple Health coverage will continue during the public health emergency. READ MORE 

10/8/2021 - Provider Alert - Language access providers must provide proof of full vaccination. READ MORE 

10/7/2021 - Provider Alert 10/7/21 - COVID-19 Vaccine Clinical Policy Update Effective 9/22/2021. Effective for claims with dates of service on and after September 22, 2021, the Health Care Authority (HCA) covers HCPCS code 0004A, COVID vaccine booster. READ MORE 

10/4/2021 - Monoclonal Antibody Treatment COVID-19 Clinical Policy. Updated clinical policy is available on the Apple Health (Medicaid) Drug Coverage Criteria webpage. This policy outlines coverage criteria used by the Apple Health (Medicaid) fee-for-service (FFS) and Managed Care (MCO) pharmacy programs. READ MORE 

10/1/2021 - Apple Health Medicaid Provider Alert 10/1/21. This alert replaces the COVID-19 testing clinical policy update alert sent on September 28, 2021. The Health Care Authority has increased the total limit for PCR and antigen tests. READ MORE

10/1/2021 - Apple Health Medicaid Provider Alert 10/1/2021. READ MORE

9/28/2020 - Physical Health Providers/COVID-19 Resources - Apple Health Medicaid Clinical Policy and Billing Facts for COVID-19 (updated 9/23/20). 

4/22/2020 - Retroactive to dates of service on and after February 29, 2020, ground and air ambulance providers are eligible to receive enhanced rates for transports related to COVID-19

3/31/2020 - This page offers billing guidance for Providers COVID-19 related telemedicine, prior authorization requirements, and provider enrollment FAQs. 

WellCare

5/20/2020 - Centene, which offers Medicare Advantage plans nationally through the WellCare and Allwell brands and locally through the Health Net brand, announced new efforts to help support its nearly 1 million Medicare Advantage members during the COVID-19 pandemic. 

5/4/2020 - Centene announced today a plan to provide additional mental health resources to populations impacted by the COVID-19 pandemic. Through a series of local partnerships, Centene will enable providers to better support communities that are experiencing elevated levels of stress and mental strain caused by an increase in grief, loss, economic pressure, unemployment and social isolation. 

4/22/2020 - Centene announced the creation of a Medicaid Telehealth Partnership with the National Association of Community Health Centers (NACHC) to help Federally Qualified Health Centers (FQHCs) quickly ramp-up their capacity to provide telehealth solutions to meet the needs created by the COVID-19 crisis. Centene is dedicating $5 million to the partnership's efforts, which will be used to purchase equipment and provide training and technical assistance to FQHCs. 

4/22/2020 - Centene also announced a series of initiatives designed to support the disability community affected by the COVID-19 pandemic. 

4/1/2020 - Will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state. 

Wellmark

3/19/2020 - Wellmark will be waiving copays, coinsurance and deductibles for virtual visits with dates of service from March 16 to June 16, 2020. Wellmark will pay the allowed amount for telehealth services in full. Services that are not a covered benefit, not medically necessary, experimental or investigational are excluded from the member’s copay or other cost-shares that are being waived. This is only applicable to in-network providers. More information on testing and which codes to use for testing to come. READ MORE

Wisconsin Physicians Service (WPS)

3/23/2020 - Due to COVID-19 impacts, WPS reports they are suspending Provider Enrollment revalidations at this time. They will not deactivate billing privileges and will notify Providers who were set to revalidate when they can do so. READ MORE

WPS Government Health Administrators - J5 A/B, J8 A/B

3/18/2022 - Sequestration Reduction Adjustment Effective April 1, 2022. Effective April 1, 2022, through June 30, 2022, all Medicare FFS claims will be subject to a 1% payment reduction per The Protecting Medicare and American Farmers from Sequester Cuts Act signed into law on December 10, 2021. READ MORE 

3/18/2022 - Update on Billing VEKLURY (Remdesivir) Antiviral Medication in Outpatient Settings. CMS created the new HCPCS code J0248 for VEKLURY™ (remdesivir) antiviral medication. This code is effective for dates of service on or after December 23, 2021, when administered in outpatient settings. READ MORE 

2/16/2022 - Increase in the COVID-19 Accelerated and Advance Payment (CAAP) Recovery Rate. READ MORE 

2/14/2022 - COVID-19 News 2/14/2022. COVID-19 Vaccines or Monoclonal Antibody Infusion Roster Form. READ MORE 

2/7/2022 - COVID-19 News 2/7/22. Increase in the COVID-19 Accelerated and Advance Payment (CAAP) Recovery Rate. Jurisdictions: J8A, J5A, J8B, J5B. READ MORE

1/24/2022 - WPS Government Health Administrators policy staff review and revise Local Coverage Determinations (LCDs) and Billing and Coding Articles to ensure accuracy. We updated the following LCDs and Billing and Coding Articles for February 2022. Please note: Our LCDs and coverage articles will reflect these changes on January 27, 2022. READ MORE 

12/27/2021 - Palmetto GBA News 12/27/21. Sequestration Suspension Extended. READ MORE 

12/17/2021 - WPS GHA News 12/17/21. Lump Sum Payments Available for RHCs/FQHCs for COVID-19 Vaccine Administration. READ MORE 

7/12/2021 - Overpayment Search Feature is Now Available. READ MORE 

6/9/2021 - CMS Sequestration Questions & Answers (Last Update 6/9/21).  READ MORE 

6/1/2021 - COVID-19 News 6/1/21. 2021 Annual Direct Data Entry (DDE) Recertification. Jurisdictions: J8A, J5A. Due to the COVID-19 Pandemic, the 2021 DDE Recertification is delayed until further notice. READ MORE 

5/24/2021 - June 2021 Local Coverage Determination (LCD) and Billing & Coding/Policy Article Updates. READ MORE 

5/11/2021 - MCS Claims Processing Alerts. READ MORE

5/10/2021 - MCS Claims Processing Alerts. READ MORE 

4/29/2021 - Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636. READ MORE 

4/7/2021 - MCS Claims Processing Alerts. READ MORE 

4/6/2021 - COVID-19 Accelerated & Advance Payment (CAAP) Repayment Terms – April Update. Last updated Apr 06 2021. READ MORE

3/29/2021 - April 2021 LCD - Billing and Coding/Policy Article Updates (COVID-19 related). READ MORE 

3/22/2021 - COVID-19 Accelerated & Advance Payment (CAAP) Repayment Terms – UPDATE 3/22/2021. READ MORE 

3/3/2021 - New YouTube Training Available - Mandatory COVID-19 Data Reporting Requirements. This video contains information on the new COVID-19 data reporting requirements for hospitals and critical access hospitals effective on January 1, 2021. READ MORE 

2/24/2021 - New YouTube Training Available - Monoclonal Antibodies Medicare Billing and Payment. Jurisdictions: J8A, J5A, J8B, J5B. This video contains information about Medicare payment of the administration of the monoclonal antibody therapy. READ MORE 

2/17/2021 - Ordering Oxygen and Oxygen Equipment - Reference Guide with Information for the COVID-19 PHE.
READ MORE 

2/16/2021 - Centralized Billing Claims.  READ MORE 

2/2/2021 - COVID-19 Vaccines or Monoclonal Antibody Infusion Roster Form. (News Post Updated 2/2/21). READ MORE 

2/1/2021 - COVID-19 Vaccine and Monoclonal Antibody (mAB) Infusion Billing for Part A Providers. READ MORE

1/29/2021 - Modifier CS Fact Sheet (1/29/21). READ MORE

1/25/2021 - COVID-19 Vaccines or Monoclonal Antibody Infusion Roster Form. (News Post 1/25/21). READ MORE 

11/12/2020 - MCS Claims Processing Alerts. READ MORE

10/21/2020 - MCS Claims Processing Alerts. 

10/14/2020 - CMS No Longer Accepting COVID-19 Accelerated/Advance Payment Applications. Jurisdictions: J8A, J5A, J8B, J5B. 

10/7/2020 - COVID-19 Accelerated/Advance Payment Revised Repayment Terms.

10/1/2020 - COVID-19 News: Find information regarding new CPT Code 99072 in the CMS October 2020 Update of Hospital Outpatient Prospective' (MLN Matters MM11960 revision 9/24/20); which indicates: New Category I CPT code 99072 for Reporting of Additional Practice Expenses Incurred During a Public Health Emergency (PHE), Including Supplies and Additional Clinical Staff Time. 

9/14/2020 - CPT Codes 99441-99443 during the Public Health Emergency (PHE). 

9/11/2020 - MCS Claims Processing Alerts for Providers.  

8/3/2020 - CPT Codes 99441-99443 during the Public Health Emergency. 

7/21/2020 - RHC Productivity Standard Exception Requests for RHCs Impacted by COVID-19 (J8A and J5A)

7/13/2020 - Modifiers Used during the COVID-19 Public Health Emergency. Modifiers are CS, CR, 95 and CG, and Condition Code DR.  Refer to the full article for the specific billing requirements and circumstances for billing. 

7/13/2020 - UPDATE - J8A and J5A - Filing Deadline Extended for Fiscal Year End (FYE) Cost Reports December 2019, January 2020 and February 2020. 

6/10/2020 - WPS GHA Claims Processing Alert. 

4/15/2020 - To prevent a delay in the processing of an advance payment request, group physicians and suppliers are to include on their request form the assigned PTAN and NPI they use to submit claims and receive payments. 

4/8/2020 - CMS is instructing all Medicare Administrative Contractors (MACs) to suspend requests for documentation until May 15, 2020, for several types of Medicare Cost Report activities. This includes desk reviews, audits (including S-10 audits), and reopenings. 

4/3/2020 - Requesting Advance Payment due to the COVID-19 Pandemic - NEW FORM. Providers experiencing financial hardship relating to the COVID-19 pandemic can submit a request for an advance payment. If approved, the payment amount will be based on a 90-day representation of claims that have already been paid. Use the WPS GHA Accelerated and Advance Payment Request form to submit a request. Please note, this form is different than the form we made available on April 1st. Send the completed form, as well as questions relating to the advance payment request, to AccAdvPymtReq@wpsic.com. 

3/30/2020 - Temporary Suspension of Provider Enrollment Revalidations. Due to COVID-19 impacts, we are suspending Provider Enrollment revalidations at this time.