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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.

COST SHARE

Medicare has released new lab tests and antibodies specifically for identifying a patient’s COVID-19 status. ATRIO is waiving member cost share for FDA authorized services with these codes (codes 0014M eff 04/01/2020, C9803, G2023 and G2024 all three eff 03/01/2020, U0001 and U0002 both eff 02/04/2020, U0003 and U0004 both eff 03/15/2020, 87635 eff 03/13/2020 and 86328, 86769 both eff 04/10/2020).

As of March 18th, the below services are $0 cost share when performed in conjunction with COVID-19 related testing, evaluation or treatment and when billed with a CS modifier:

  • Office and other outpatient services
  • Hospital observation services
  • Emergency department services
  • Nursing facility services
  • Domiciliary, rest home, or custodial care services
  • Home services
  • Online digital evaluation and management services

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.

SEQUESTRATION

With the passage of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), sequestration is suspended for service dates from May 1, 2020 through December 31, 2020.

IPPS DRG

During this emergency period, ATRIO has increased twenty percent (20%) to the IPPS and specific to discharges occurring during the emergency period in the case of an individual diagnosed with COVID-19. The weighting factor that would otherwise apply to the DRG group to which the discharged is assigned is increased by 20%.

The "emergency period" is the retroactive date as declared by HHS Secretary (January 27, 2020) with currently no end date.

See section 3710 of the CARES Act.

RESOURCES:

For more updated information please visit the resource links below: