Testing, treatment, and coding for COVID-19 (Coronavirus)

April 7, 2020

This article was revised on April 7, 2020, to include information on treatment, home testing, prescribing, and updates to billing and coding.  

AmeriHealth is committed to providing our members with access to the care they need. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.

We encourage all AmeriHealth members to visit our dedicated COVID-19 webpages for AmeriHealth New Jersey or AmeriHealth Pennsylvania regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Member coverage for COVID-19 testing and treatment

Testing

AmeriHealth will cover and reimburse member cost-sharing (i.e., copayment, deductible, and coinsurance) for the COVID-19 test and the administration of the test in an in-network physician's office, urgent care center, or emergency department.

As a reminder, a Home Health provider can administer the test during an in-person visit and send the specimen as outlined below to an in-network lab for processing.

Since the U.S. Food & Drug Administration has not approved any test kits for home use to detect and diagnose COVID-19, AmeriHealth does not cover COVID-19 home tests. To learn more about home health testing, please read this article.

Please visit our AmeriHealth New Jersey or AmeriHealth Pennsylvania websites for current listing of available patient testing sites.

Treatment

The following is effective as of March 30, 2020, and extends through May 31, 2020:

  • AmeriHealth will waive cost-sharing for in-network, in-patient, acute care treatment of members diagnosed with COVID-19, whether for medical or behavioral health.
  • AmeriHealth will waive cost-sharing for emergency department visits associated with admissions for in-network, in-patient, acute care treatment of COVID-19 whether for medical or behavioral health.

Please see the “Billing and coding for COVID-19 tests" section of this article for specific COVID-19 HCPCS and CPT® codes.

For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing.

This includes members enrolled in our fully insured commercial plans and the individual and family plans available through the Affordable Care Act. Self-funded customers can opt out of waiving cost-sharing for the treatment of COVID-19.

In addition, cost-sharing is waived for AmeriHealth New Jersey members for any telemedicine services from an in-network provider. Cost-sharing is waived for AmeriHealth Pennsylvania members for primary care physician telemedicine visits. To learn more about our telemedicine positions, please read the article for AmeriHealth New Jersey or AmeriHealth Pennsylvania

AmeriHealth will reimburse health care providers for the testing and treatment of COVID-19 as outlined above at their contracted rates including the member cost-share amount.

Capitation/Referral requirements

Lab specimens for members enrolled in HMO and HMO-POS products may need to be sent to a different laboratory that is not the member's designated capitated laboratory site, when the designated capitated laboratory site does not have the ability to perform the COVID-19 test. The referral and out-of-capitation authorization requirements are being removed for the newly created Centers for Medicare & Medicaid Services (CMS) HCPCS codes U0001 and U0002, and CPT code 87635, to enable members to access an alternate participating lab when necessary. See additional billing and coding information below. 

Prescribing

In response to COVID-19 and potential shortages of medications that may be effective against the virus such as hydroxychloroquine, prescribers should include the patient's diagnosis on the prescription. If written for a COVID-19 diagnosis, the diagnosis needs to be confirmed by a positive test result and documented on the prescription.

Working with LabCorp

Laboratory Corporation of America® Holdings (LabCorp), the exclusive national outpatient laboratory provider for AmeriHealth, is equipped to process COVID-19 specimen testing for all AmeriHealth members, even those who are not capitated to LabCorp.

Testing

  • The test is available to all offices – hospitals, urgent care centers, and physician offices. Please follow the CDC guidelines for ordering the test. When ordering the test through LabCorp, use code 139900.
  • LabCorp will not obtain COVID-19 specimens at their patient service centers (PSC). Any person trying to get a COVID-19 test at a LabCorp PSC will be referred to their physician. 

Sending test specimens

The specimen should be sent in LabCorp's Universal Transport Media (UTM) tube from a Nasopharyngeal (NG) or Oropharyngeal (OP) swab collected and frozen in the office. If offices need swabs/UTM tubes, they can order from the normal supply process (i.e., email, call, beacon Link). Be sure to use a viral transport media swab for testing as a dry swab will not be accepted. Tests from other viral transport media may be acceptable; however, please contact LabCorp customer service at 1-800-631-5250 to confirm acceptable specimen types.

If your office does not have a routine pickup with LabCorp, please call 1-800-631-5250 for scheduling.

Supplies

clip_image002.png 

Specimen collection reminders

  • LabCorp's COVID-19 test requires the collection of ONLY 1 swab, either an NP or OP but not both
  • LabCorp's test requires only one specimen type.
  • If a provider collects both an NP and OP swab, both swabs can be placed into a single UTM tube. The single UTM tube will not be rejected for COVID-19 testing.

Resources

Note: The Supply Order form can be faxed or emailed. Both swabs and UTMs can be ordered using this form. The UTM is on the form and the swab can be written in as the Nasopharyngeal or Oropharyngeal Swab.

A LabCorp account is needed to order the test. If you need to set up an account with LabCorp, visit NENewaccounts@labcorp.com or call 1-888-295-5915.

Billing and coding for COVID-19 tests

HCPCS procedure codes

CMS has developed two HCPCS codes to allow for the billing of COVID-19 diagnostic tests U0001 and U0002.

The newly created HCPCS codes are effective and must be used for dates of service as of February 4, 2020, and after: 

  • U0001: CDC 2019 novel coronavirus (2019-nCoV) Real-Time RT-PCR diagnostic panel
  • U0002: 2019-nCoV coronavirus, SARS-CoV-2 /2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

CPT procedure code

Newly created CPT code 87635 for COVID-19 nucleic acid testing is effective and must be used for dates of service as of March 13, 2020, and after:

  • 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID- 19]), amplified probe technique

ICD-10 diagnosis codes

From a laboratory testing perspective, if the test is confirmed, effective April 1, 2020, include the ICD-10 diagnosis code U07.1. This code should be used for members diagnosed with an illness confirmed as due to COVID-19. If the testing is not confirmed, the claim could be submitted with Z20.828 or R68.89.

You can view the complete announcement, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) – updated March 24, 2020, on our Medical Policy Portal in the News & Announcements section.

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources:

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.