Children's Community Health Plan's Response to COVID-19
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.
**Effective January 1, 2022: If POS code 02 is not listed as an allowable POS for a procedure code, the service will not be reimbursed under permanent telehealth policy. See the ForwardHealth Updates below for more information**
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 covered 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.
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:
- 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.
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 billingCOVID-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.
- Transition from Temporary to Permanent Synchronous Telehealth Coverage Policy and Billing Guidelines: July 2021
- Low-Dose Computed Tomography Lung Scan Coverage Policy Changes: July 2021
- New Provider Message Center and Updates to the ForwardHealth Online Handbook: June 2021
- Reimbursement Resumed for Administration of Johnson & Johnson COVID-19 Vaccine
- New COVID-19-Related Diagnosis Codes Available for Claims Submission
- Synagis Carved Out for Managed Care Organization Members
- Ensuring Appropriate COVID-19 Testing
- ForwardHealth Will End Coverage for Procedure Codes 98967 and 98968
- Providers May Not Charge Members Additional Fees for COVID-19 Precautions
- Medicaid-Enrolled Provider Requirement Temporarily Waived for Prescribing, Referring, or Ordering Certain COVID-19-Related Laboratory Codes
- COVID-19 Laboratory Procedure Codes U0002 and 87635 Allowable With Modifier QW
- Enhanced Reimbursement for Therapy Provided as Part of the Birth to 3 Program Using Telehealth
- Nurse Practitioners and Physician Assistants May Temporarily Order Home Health Services
- Temporary Expansion of Provider Enrollment for Medicaid Only Providers
- ForwardHealth will expand Presumptive Eligibility for Express Enrollment
- ForwardHealth is implementing two new diagnosis codes Effective April 1, 2020
- Changes To ForwardHealth Telehealth Policies for Covered Services, Originating Sites, and Federally Qualified Health Centers
- Temporary Changes to Telehealth Policy and Clarifications for Behavioral Health and Targeted Case Management Providers
Additional Resources for Telehealth
- Because this situation continues to evolve, we encourage people to stay informed by visiting the CDC website
- Visit Wisconsin Department of Health Services website for the latest updates and statistics regarding Covid-19
- Read the Medicaid Member Bulletin from the State Medicaid Director on Wisconsin's response to COVID-19 outbreak
- COVID-19 & HIPAA Bulletin
- DHS Provider Resources
- Centers for Medicare & Medicaid Services (CMS) Resources
CMS responses to COVID-19 & latest program guidance
CMS FAQs on Medicare telehealth
CMS chart on Medicare telehealth
CMS guidance on Medicaid telehealth
CMS state guidance on Medicaid telehealth