* Login to find out what options are available to you. Well allow the use of these modifiers for any service on your fee schedule. Network of Preferred Providers: Health plans are offered by Blue Shield of California. Please submit the vaccine administration procedure code and vaccine/toxoid code on the same claim. Yes, you can use your HSA, FSA, or HRA funds to purchase at-home tests. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. Claims for over-the-counter COVID-19 tests submitted for reimbursement will be reimbursed up to $12 per test. To request reimbursement for a fully self-administered FDA authorized test purchased from a non-preferred pharmacy or other retailer between January 15, 2022 and January 31, 2022, submit this form: Need to talk with DIFS? COVID-19 Testing Coverage Website: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. 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, Asymptomatic and without known COVID-19 contact, Contact with and (suspected) exposure to other viral communicable diseases, Symptomatic or has been exposed to COVID-19, Encounter for observation for suspected exposure to other biological agents ruled out, Encounter for screening for COVID-19 (Effective January 1, 2021), Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021), Other coronavirus as the cause of diseases classified elsewhere, SARS-associated coronavirus as the cause of diseases classified elsewhere, 2019-nCOV acute respiratory disease (Effective April 1, 2020), Pneumonia due to COVID-19 (Effective January 1, 2021), Multisystem inflammatory syndrome (Effective January 1, 2021), Other specified systemic involvement of connective tissue (Effective January 1, 2021), Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital, Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home to hospital, Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital), Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiarys home, Hospital to hospital (includes ASCs approved to provide hospital level of care), Hospital to alternative site for skilled nursing facility (SNF), Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility, Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility, Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility, Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiarys home. State-chartered Bank and State-chartered Savings Bank forms. Claims submission and reimbursement for testing. Learn about what coverage and care you can receive through your Medi-Cal benefits. A diagnostic test is used to determine if a person has COVID-19. up to $12 per test under the safe harbor (for plans that provide access to the tests . Note: These changes do not apply to our Medicare Advantage members. The provider should mail you a refund check. As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) has extended the suspension of the mandatory payment reductions known as sequestration through December 31, 2021. Reimbursement Process Link or Description: The updated COVID-19 vaccine boosters better protect against the most recent Omicron subvariants. We extended existing authorizations through December 31, 2020. Per state mandate Chapter 260 of the Acts of 2020 Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting.1. Please see our COVID-19 Temporary payment policy for more information. Network of Preferred Providers: This makes it easier to treat and improve the outcome. COVID-19 testing thats ordered by a healthcare provider who is licensed to order these tests. How am I reimbursed for at-home tests if I use FSA, HSA, or HRA funds? Providers should document ALL of the following for coverage: Inpatient cognitive rehabilitation for cognitive impairment resulting from COVID-19 is not covered unless the patient otherwise meets criteria for inpatient level of care. 1-800-316-BLUE (2583), Dental Network Management Submit a claim online, or download the COVID-19 Over-the-Counter (OTC) Test Kit Claim Form [PDF] and submit via mail or fax using the instructions on the form. Reimbursement Process Link or Description: You can get up to 8 individual tests per calendar month from participating pharmacies and healthcare providers during the COVID-19 public health emergency. With a BCBSTX health plan, you have access to care for COVID-19 related health issues. For help with these documents, please call 1-800-975-6314. . This applies even if you have another card for your Blue Shield or Blue Shield Promise plan. The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. General Reimbursement Information Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. If you purchased an at-home test previously, you may be able to get paid back. Also, there are some limitations to the number of tests that can be reimbursed without a provider order. For example, a physician, a nurse practitioner, or a physician assistant. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells), Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors), Other therapies currently under investigation without published supporting evidence. COVID-19 Testing Coverage Website: See details on the. As of Jan. 15, 2022, and through the end of the public health emergency, all individuals with pharmacy coverage through Blue Cross Blue Shield of Michigan and Blue Care Network have more ways to get at-home COVID-19 rapid diagnostic tests at no cost. Type OTC or Home in the search bar to narrow the results for at-home tests. If you plan to provide a previously approved service to a patient in 2021, please call our. For help with these documents, please call 1-800-975-6314. . Your plan may require you to sign an attestation that the test was purchased: Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test. Testing sites: Not all testing sites are the same. Contact the company for the latest information. For example, a physician, a nurse practitioner, or a physician assistant. For more details please visit fepblue.org. Please refer to the COVID-19 Temporary payment policy for telehealth billing guidelines. For example: Find out what your coverage is for OTC at-home tests. Call the customer service number on your member ID card. When you provide telehealth or telephonic services, bill on a facility claim using a professional revenue code with the telehealth services outlined in our COVID-19 Temporary payment policy. 1-800-882-1178. . Feel free to ask your doctors office what safety steps they are taking to protect patients during the pandemic. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Federal Employee Program (FEP) members Find additional coding information on Provider Central. As of January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 diagnostic tests per month for each person covered by a health plan. This applies to tests purchased on or after January 15. Reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for the diagnosis of COVID-19 is covered when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice. Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19. Some restrictions apply. Your insurance company will reimburse you for the full purchase price of each covered test. Network of Preferred Providers: You should follow existing claims reimbursement processes to obtain an at-home test reimbursement. All rights reserved. Blue Shield of California PO Box 272540 Chico, CA 95927-2540 COVID-19 laboratory tests (PCR tests) If you paid out of pocket for a test that was sent to a laboratory, follow the steps below to file a reimbursement claim. Please also use one of the following applicable place of service codes that describes the location of the drive-through or temporary testing site. If you regularly visit a specialist to manage a chronic condition, you should keep those appointments. You may also submit a digital claim online with a copy of your receipt. 3If you receive your health insurance through your employer, association, trust, etc., please contact your employer, plan sponsor, or benefits administrator to see whether you have a fully-insured or a flex-funded group plan. I have BCBSIL insurance, but don't live in Illinois. For assisted reproductive technology services listed in ourmedical policythat require prior authorization: Durable medical equipment Blue Shield provides coverage for OTC COVID-19 at-home tests purchased prior to January 1, 2022, with a healthcare provider order. Your health is our priority. https://www.priorityhealth.com/covid-19/vaccine, COVID-19 Testing Coverage Website: Contact your primary healthcare provider to find out if they have virtual visits available. Test kit cost $ This policy update applies to all medical providers. Does my plan cover COVID-19 screening and testing? *For the Federal Employee Program, benefits and cost share are applicable according to the members plan. There are no age limits for members who need care through telehealth or phone services. Blue Cross Blue Shield of Massachusetts follows federal and state requirements for SARS CoV-2 (COVID-19) testing coverage. Test-related fees:Most plans cover all fees related to the administration of the COVID-19 test during the public health emergency. Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. Contact the company for the latest information. The authorization process will officially resume for all products effective July 1, 2021. Or, you can call Dental Provider Services at 1-800-882-1178. 24/7 access is provided at no cost. Serologic testing for the presence of antibodies is not covered, Medicare HMO BlueSM and Medicare PPO BlueSM Members. Members are responsible for any fees or tests that are not covered by their plan. If you are currently seeing a mental healthcare provider, you can continue to see that provider virtually. Contact the provider to find out how they want to be reimbursed. The following drugs are not covered outside of the clinical trial setting: We lifted limits on early refills of most prescription medications, allowing members to obtain one additional fill of their existing prescription. Talk to board-certified doctors24/7 by phone or video. The claim entered day 179 of the 180-day timeline on Feb. 29, 2020. . Member cost share continues to be waived for COVID-19 related telehealth visits provided by in-network providers. COVID-19 Testing Coverage Website: Information requested will include: Reimbursement for tests purchased before January 15, 2022: Members will receive test kits from network pharmacies at no cost. Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs - Antigen Diagnostic Tests for SARS-CoV-2 | FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. Please note: You cannot be reimbursed more than once for OTC at-home tests. Commercial members: Managed care (HMO and POS), PPO, and Indemnity. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. All Rights Reserved. Licensed independent clinical social worker, Psychiatric and state psychiatric hospital. Reimbursement for tests purchased before January 15, 2022: If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. Your doctor may also be offering virtual visits if you prefer. Bill all covered services that you render as if you are performing an in-person service using the codes that are currently on your fee schedule. These may include fees for other tests or other services unrelated to the COVID-19 test. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. They include: As Americans continue to monitor the coronavirus outbreak, one thing they should not be concerned with is whether Blue Cross and Blue Shield will be there for them, saidWilliam A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association. This applies to in- and out-of-network providers and to in-person and telehealth/virtual/visits by phone.
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