CCHP COVID-19 Updates and Telehealth
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CCHP COVID-19 Updates and Telehealth

Children's Community Health Plan's Response to COVID-19

During the Covid-19 public health emergency, the health and well-being of our members remains our highest priority.  Children’s Community Health Plan (CCHP) is expanding our coverage and policies for our Medicaid and Marketplace members in response to the COVID-19 outbreak.

Member Coverage during COVID-19

CCHP has waived all member cost sharing, including copays, coinsurance and deductibles for both Medicaid and Marketplace members for any Covid-19 related services provided to establish the diagnosis of COVID-19 when performed at participating provider locations or laboratories. Keep in mind that cost sharing may apply for the Together with CCHP members for services not related to COVID-19 testing.

Prior Authorizations

Updated on 7/17/2020: The health and well-being of our members remains Children’s Community Health Plan’s highest priority.  As hospital systems in the state of Wisconsin begin to resume services, CCHP is modifying the authorization processes put in place due to COVID-19. The modifications include:

  • CCHP will resume medical necessity reviews for all acute inpatient stays effective June 22, 2020 
    • On that day we will request clinical information that supports the medical necessity for all new acute inpatient admissions
    • During the hospitalization ongoing clinical documentation will be needed to support the medical necessity of the ongoing stay and to allow CCHP to assist with the discharge plan
  • CCHP will continue to approve requests for admissions to long-term acute care hospitals (LTACH), inpatient rehab (IPR) and skilled nursing facilities (SNF) without clinical information
    • We are still requesting the admitting facility notify us within 24-hours of any admission by 5 PM weekdays, or the next business day for weekend and holiday admissions
    • To facilitate the discharge plan for our members, please communicate with us in advance any discharge plans so we can help coordinate a successful transition to home or next level of care
  • CCHP will continue to approve all requests for durable medical equipment related to the treatment of COVID 19. This includes but is not limited to oxygen supplies and respiratory devices
  • CCHP will continue to extend non-inpatient authorizations for 90 days
  • CCHP will not be amending contracts for COVID-19 measures. We will add applicable COVID-19 codes to all appropriate fee schedules. 

COVID-19 Testing Codes

CMS has created the following HCPCS codes for laboratory testing. The codes below should be used when billing for COVID-19 testing:

HCPCS Laboratory Testing Codes

CPT Code

Description

U0001

Laboratory test created by the CDC

U0002

Lab test developed by entities other than CDC

U0003

Infectious agent detection by nucleic acid (DNA or RNA) Effective 4/14/2020

U0004

Any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R." Effective 4/14/2020

G2023

Specimen Collection for Covid-19

G2024

Specimen collection for Covid-19 for individuals in an SNF or by a lab on behalf of a HHA

87635

Lab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

86328

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) Effective 4/10/2020

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) Effective 4/10/2020

 
  • CCHP wants to ensure that providers are using the correct diagnosis codes when submitting COVID-19 related claims. The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report. View the CDC Interim code guidelines. 
  • Codes are effective Feb, 4, 2020 and will be available for claims processing on April 1, 2020 (Unless otherwise stated). 
  • CCHP is following the reimbursement rates that were announced by the CMS for COVID-19 testing.

CCHP Telemedicine: Coding & Reimbursement for COVID-19 and NON-COVID-19 Related Services

Our goal is to make it easier and safer for patients to connect with their health care provider. There are three main types of virtual services that providers can now use to connect with their patients. CCHP’s definitions of telehealth, virtual check-ins and e-visits align with the current CMS Medicare Telemedicine Health Care Provider Fact Sheet.

TELEHEALTH: An office visit for a new or existing patient with a provider that uses audio or video and is similar to an in person visit between a provider and a patient. This includes services for Covid-19 evaluations, diagnostic testing, and care as well as all non Covid-19 related care. These services can be performed through Skype, Zoom, FaceTime, Doximity or any other face-to-face technology.

VIRTUAL CHECK INS: A brief (5-10 minute) check-in for a new or existing patient with a provider that uses audio or video to decide whether an office visit or other service is needed. It can include a remote evaluation of recorded video and/or images submitted by an established patient.

E-VISITS:  A patient initiated communication between a patient and their provider through an online patient portal such as My Chart.

Please refer to CCHP’s Coding Guide to help navigate through each type of visit to help with billing Covid-19 and Non Covid-19 services. View the Telehealth Billing Guide.

  • At this time, CCHP will continue to be on the same payment cycle as prior to the Covid-19 pandemic. (Updated on 4/16/2020)
  • These policy changes will be effective until further notice. CCHP will communicate any changes to the effective date when necessary.
  • CCHP is waiving the originating site requirement for telehealth services and allowing services to be provided regardless of the member location. This will allow providers to bill telehealth services for patients that are at home or another location.

ForwardHealth Updates

Additional Resources for Telehealth

 

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

National Committee for Quality Assurance (NCQA) Accreditation

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