Provider Information on COVID-19 Coverage

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We've taken steps to lower costs and provide our members easier access to care related to COVID-19.

Testing and Treatment Coverage

We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance. The waiver applies to cost-share associated with COVID-19 treatment with providers, including facilities, from April 1 to Oct. 23, 2020, so long as the treatment is provided and consistent with the terms of the member's benefit plan. We will reassess this waiver as events warrant. This includes these plans:

  • Fully insured employer-based
  • Individual and Family
  • Medicare (excluding Part D)
  • Medicare Supplement

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

See our BCBSOK Waives Customer Cost-Sharing for COVID-19 Treatment News & Updates article for more information.

Providers should use the most appropriate CPT or HCPCS code that describes the service they are rendering and append any appropriate modifiers.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles for the treatment of COVID-19, based on their employer's election to participate in this benefit. Members can call the number on their ID card for specific benefit questions.

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through Oct. 23, 2020

Blue Cross Medicare SupplementSM members do not have network restrictions unless otherwise noted on their plans. Members should always call the number on their ID card for answers to their specific benefit questions. See our FAQs for Medicare Providers  for more details.

Check Members Eligibility and Benefits

Use the Availity® Provider Portal Learn more about third-party links or your preferred vendor for eligibility and check benefit verifications.

Claims for COVID-19 Testing

If you are collecting a COVID sample from a member, have a lab capable of testing, or are a lab testing a member, submit the claim using the appropriate collection or lab code. Member cost-share for the test will be waived during the public health emergency, regardless of the diagnosis.

Testing must be:

  • For individualized diagnosis or treatment of COVID-19
  • Medically appropriate
  • In accordance with generally accepted standards of care, including the Centers for Disease Control (CDC) guidance

For more detail on COVID-19 coding and guidance, refer to the American Medical Association Learn more about third-party links website or the Centers for Disease Control and Prevention Learn more about third-party links.


COVID-19 Collection Codes

Codes

Description

C9803

Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) any specimen source

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source


COVID-19 Lab Codes

Codes

Description

0202U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR

0223U

Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

87426

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

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

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

U0003

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, making use of high throughput technologies as described by CMS-2020-01-R

U0004

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


COVID-19 Testing Before Non-COVID-19 Treatment or Procedures

When screening for COVID-19 before elective procedures or treatment not related to COVID-19 active disease or suspicion, bill the test on a separate claim from the rest of the services being rendered. By doing this, we will ensure our members receive the cost-share waiver for COVID testing and the claim will be processed promptly. The appropriate benefits will apply to the remainder of each member’s non-COVID related care. The diagnosis code Z11.59 may be used on these claims but is not required.

Claims for COVID-19 Antibody Testing

Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with Emergency Use Authorized (EUA), regardless of the diagnosis. This waiver will last through the end of the public health emergency. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

Antibody Testing Requirements

Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care provider. We encourage members to consult with their health care provider to determine the best, medically appropriate test for their condition. Refer to the current FDA position on antibody testing Learn more about third-party links. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

At-Home Antibody Tests

We cover at-home collection methods for antibody testing if the tests are FDA-authorized and are clinically indicated for the member as determined by the member’s health care provider. We encourage members to consult with their healthcare provider to determine whether the test is medically appropriate for their condition. Medical or invoice records may be requested to support if an antibody test is FDA authorized or if EUA approval has been requested.

COVID-19 Antibody Testing Codes

Code

Description

0224U

Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed

86318

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method

86328

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method, severe acute respiratory syndrome coronavirus (SARS-CoV-2) (Coronavirus disease COVID-19)

86769

Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] testing via multiple-step method


Out-of-Network Providers

If you are not in our networks, we will reimburse the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website.

Claims for COVID-19 Testing- and Antibody-Related Services

Use the following coding process for services that are related to COVID-19 testing or antibody testing.

COVID-19 Diagnosis Codes

To indicate services performed in conjunction with the testing for COVID-19 or COVID-19 antibodies, include one of the following diagnosis codes:

Code

Description

U07.1

COVID-19

B97.29

Other coronavirus as the cause of diseases classified elsewhere

B34.2

Coronavirus infection, unspecified

Z03.818

Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

Z20.828

Contact with and suspected exposure to other viral communicable diseases (actual exposure to COVID-19)


Modifier CS

For services furnished on March 18, 2020, through the end of the Public Health Emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19. This is for testing-related services when COVID-19 testing or antibody testing must be performed at an alternate location and is not part of the evaluation and management claim.

Credentialing Process Simplified for COVID-19

BCBSOK is temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing and processes will apply.

What's Changing? We are simplifying the process of joining our network.
Subject to state actions on licensing and practice requirements, we will credential providers who meet the following conditions for the duration of the state-declared Executive Order:

  • Oklahoma Board approved healthcare professional intending to participate in Oklahoma.
  • We will accept temporary licenses.
  • We will waive accreditation requirements, CMS certification and site visits for institutional providers.
  • We will accept expired documents if they have been inactive or expired for less than six-months and the provider is unable to obtain a current document from the issuer due to the COVID-19 emergency. Licenses, accreditations or certifications that have been revoked for cause will not be accepted.

All occupational licenses extended during the Executive Order by Governor Stitt will expire fourteen (14) days following the withdrawal of termination of the Order.

Credentialing criteria and verification sources may change. Please check back often for updates.

Telemedicine

Professional claims may be submitted for services where the provider is acting within the scope of their state license, the service being rendered can be performed via telemedicine and meets the definition of the procedure code billed. Claim should include POS 2 (professional) and appropriate modifier (95, GT, GQ).

If you are not in our networks, our allowed amounts are consistent with our out-of-network pricing and our member's benefits. Please call the customer service number on the member's ID card for benefit information.

For more information visit our Blue Cross and Blue Shield of Oklahoma Further Expands Telemedicine to All In-Network Providers News & Updates article.

Pharmacy

For members who have BCBSOK pharmacy benefits administered through Prime Therapeutics, BCBSOK will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Note on Medicare members: Members of these plans can get 90-day fills through mail order:

  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Group MedicareRx (PDP)SM
  • Blue Cross Medicare Advantage (HMO)SM
  • Blue Cross Medicare Rx (PDP)SM

What is the risk of COVID-19?

According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC's Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by the COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.

More Information
Continue to use Centers for Disease Control guidance Learn more about third-party links on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSOK News and Updates and Newsroom.

If you have any questions or if you need additional information, please email provider inquiries or call the Provider Contract Support Unit at 800-722-3730, Option 2.

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Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty and home delivery pharmacy.

Prime Therapeutics LLC is a pharmacy benefit management company, contracted by BCBSOK to provide pharmacy benefit management and related other services.

BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.