5 Private payer policies regarding the COVID-19 pandemic you should know!

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Private payer policies regarding the COVID-19 pandemic

We are closely monitoring private payer policies regarding the COVID-19 pandemic. The following answers are based on information from each payer’s respective website. Policies are changing rapidly. We will update this page as we receive additional information. Your local provider representatives may have updated information.

While many payers have provided flexibilities and waivers, much remains unclear. We are in frequent contact with payers to better understand their policies and to continue advocating for additional flexibilities for our members.

1. Are payers covering COVID-19 testing for members?

Aetna: Aetna is waiving co-pays and applying no cost-sharing for all diagnostic testing
related to COVID-19. The policy covers the cost of the physician-ordered test and the
physician visit that results in the ordering or administration of the COVID-19 test. This
policy applies to all Commercial, Medicare, and Medicaid lines of business.

Anthem: Anthem Affiliated health plans will waive cost shares for fully-insured employer,
individual, Medicare, and Medicaid plan members. This includes copays, coinsurance,
and deductibles for COVID-19 tests and visits associated with the COVID-19 test,
including visits to determine if testing is needed.

Cigna: Cigna is waiving out-of-pocket costs for COVID-19 FDA-approved testing and
diagnostic COVID-19 related laboratory tests (other than the COVID-19 test). Physicians
should use diagnosis code Z03.818, Encounter for observation exposure to other
biological agents ruled out; or Z20.828, Contact with and (suspected) exposure to other
viral communicable diseases. The CR modifier should be used on CMS1500 claims.

Humana: Humana is covering with no out-of-pocket costs COVID-19-related testing,
including the COVID-19 test and viral panels that rule out COVID-19. The cost-share
waivers also apply to physician office visits or emergency department visits that result in
the ordering or administration of the test. For office visits related to COVID-19,
physicians should include the modifier CS and the appropriate ICD-10-CM diagnosis
code.

United Health Care (UHC): UHC is waiving cost-sharing for COVID-19 testing and cost-sharing for COVID-19 testing related visits, whether the testing related visit is received in
a health care provider’s office, an urgent care center, an emergency department, or
through a telehealth visit. This policy applies to Medicare Advantage, Medicaid, and
employer-sponsored plans.

2. Are plans waiving out-of-pocket costs for telemedicine visits?

Aetna: Aetna is waiving member cost-sharing for a covered telemedicine visit (general
medicine, behavioral health, and dermatology), regardless of diagnosis. This policy
applies to in-network providers.

Anthem: Anthem’s Affiliated health plans will waive member cost shares for telehealth
visits, including visits for mental health or substance use disorders, for fully insured
employer plans, individual plans, Medicare plans, and Medicaid plans, where
permissible.

Cigna: Cigna is waiving out-of-pocket costs for telehealth screenings for COVID-19. This
policy is effective through May 31, 2020. Physicians should use the usual face-to-face
E/M code and use diagnosis code Z03.818, Encounter for observation exposure to other
biological agents ruled out; or Z20.828, Contact with and (suspected) exposure to other
viral communicable diseases. Physicians must use the CS modifier for Cigna to waive
cost-sharing. The GQ, GT, or 95 modifier should be used for telehealth claims. Normal
cost-sharing applies to telehealth visits not related to COVID-19.

Humana: Humana is waiving out-of-pocket costs for telemedicine visits. Humana will
waive member cost-sharing for telehealth services, regardless of whether they are
related to COVID-19, if the services are rendered by an in-network provider. Services
provided by out-of-network providers for non-COVID-19 visits are subject to member
cost-sharing.

UHC: UHC is waiving member cost-sharing for COVID-19 testing-related visits.

3. Are telehealth services paid at the same rate as in-person visits?

Aetna: Yes, Aetna will pay visits delivered via telehealth at the same rate as in-person
visits.

Anthem: Where required by state law, Anthem pays evaluation and management (E/M)
services delivered via telemedicine at the same rate as in-person visits. A list of states
with payment parity laws can be found here.

Cigna: Physicians will be paid consistent with their typical face-to-face rate. Physicians
should bill using the face-to-face evaluation and management code and append the GQ,
GT, or 95 modifier for telehealth visits. Physicians must use the CS modifier for Cigna to
waive cost-sharing for COVID-19-related visits. The place of service should the code
they would use if the service was provided face-to-face. Normal cost-sharing applies to
telehealth visits not related to COVID-19.

Note: Cigna telehealth services billed with a Place of Service (POS) 02 may result in reduced payment or denied claims. Billing the typical POS will ensure physicians receive
the same payment as they typically would for a face-to-face service.

Humana: Humana will temporarily reimburse for telehealth visits with in-network
providers at the same rate as in-office visits. Humana recommends submitting charges
for telehealth services using the Place of Service (POS) that would have been used if
the service had been provided in-person and append modifier -95. Claims previously
submitted with the POS 02 – Telehealth do not need to be resubmitted. Humana will
apply waivers and calculate payment according to this policy to those claims.

UHC: Audio/video visits are paid at the physician’s contracted rate. For most physicians,
that is equal to the in-person visit rate. However, physicians should review their
individual contracts and fee schedules to verify. Physicians should bill the appropriate
office visit E/M and use the place of service that would have been used if the service had
been provided in-person and append modifier -95.

4. Do I need to be contracted with each payer to provide telehealth services?

Aetna: Any in-network physician can provide telehealth services.

Anthem: All contracted physicians can provide telehealth and telephonic services, as
clinically appropriate.

Cigna: In-network physicians

Humana: Any in-network physician can bill for telehealth services.

UHC: Telehealth claims will be paid for in-network and out-of-network providers.

5. Are payers providing advance payments or financial support to practices?

Following Medicare’s recent announcement of accelerated and advance payments to
provide emergency funding to address cash-flow issues, commercial payers have also
started to offer financial assistance programs. On April 7, the nation’s largest private payer,
UnitedHealth Group, announced that it would accelerate payments and other financial
support to health care providers to address the short-term financial pressure caused by the
COVID-19 emergency. Similarly, two Blue Cross Blue Shield plans have announced related
policies to physicians affected by the pandemic.

Information is based on COVID-19 Private Payer Frequently Asked Questions published by AAFP on 04/20/2020.

 

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