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COVID-19 (Coronavirus) information

ATRIO is following all Medicare coverage guidelines for COVID-19. There have been modifications for COVID-19 and telehealth, virtual visits, testing, prior authorizations and member cost-sharing.

LAB TESTS:

Medicare has released two new lab tests specifically for identifying patients with COVID-19 (U0001 and U0002). ATRIO is waiving member cost share for both of these tests.

TELEHEALTH:

Due to COVID-19, Medicare is opening up telehealth/telecommunication/telemedicine coverage to allow while the patient is in their place of residence. Historically, these were only allowed when the patient was in a hospital or clinic setting.

These services can be furnished via a number of communication technology modalities. For example, HCPCS code G2012 (virtual check-in) can be furnished using synchronous technology such as a telephone call. HCPCS code G2010 (Remote evaluation of recorded video and/or images submitted by an established patient) can be furnished using asynchronous technology such as e-mail. And CPT codes 99421-99423 (patient-initiated digital communication) and HCPCS codes G2061-G2063 (online assessment) can be furnished using an online patient portal.

Additional allowed Telehealth codes can be located here.

Medicare will also pay for several services that are brief communications with practitioners for specific purposes.

At this time, ATRIO is not waiving cost-share on telehealth services. The same cost share applies as if the patient were face to face with their provider. Example: A telehealth office visit performed by the member’s PCP will take the PCP cost share. Medicare does not provide a separate benefit for telehealth services.

For more information around Medicare’s expansion of telehealth coverage can be found here.

Highlights: Text, portal, phone calls are OK, but only for virtual check-ins. For regular telehealth visits, the technology must be an interactive audio-video communication. They’ve relaxed the HIPAA requirements around the technology and FaceTime/Skype-like technology is permissible.

AUTHORIZATION REQUIREMENTS:

For the duration of this emergency, we are removing the prior authorization requirement for out of network services for SNP members. We will still follow the prior authorization grid, but if the service is not on the grid, it no longer requires prior authorization whether being provided/performed/supplied by an in or out of network provider.

Following CMS’ policy, we are loosening requirements for required criteria, such as face to face evaluations for lost, stolen, or damaged DME equipment.

ATRIO’s reviewers will address special circumstances on an individual basis. Our priority is our members' health and safety.

PHARMACY:

ATRIO is allowing early refills for all medications except opioids. We also encourage providers to talk with their patients about switching to mail order. View our Pharmacy Directory for a complete list of mail order options.

RESOURCES:

For more updated information please visit the resource links below: