Important Updates Regarding Coronavirus COVID-19

As an important resource for providers, we encourage you to access the information on Fidelis Care’s Provider Portal at providers.fideliscare.org. On the portal, you can:

• check claim status
• confirm member eligibility and benefits
• submit authorization requests
• check on the status of an authorization
• view provider remittance advice

We also encourage you to use Fidelis Care’s Interactive Voice Response as another way to check claim status and member eligibility.

Using these tools and resources will provide you with the information you need, 24/7, and help to reduce anticipated call volume and wait times for our Provider Call Center.

Emergency Preparedness Plan Providers should have an emergency preparedness plan in place for their facilities. The latest NYS-specific information can be found on the SDOH website at the following link: https://www.health.ny.gov/diseases/communicable/coronavirus/.

Below, we have summarized any waivers still active at this time as they relate to COVID services. If not explicitly called out below, any other services are to be considered business as usual. We will keep this summary up-to-date as information changes. Member-specific questions can be reviewed through the Provider Portal.


COST-SHARE WAIVERS

Type

Line of Business

Date of Cost-Share Waiver Reinstatement (DOS)

COVID-19 Screening

ALL

6/1/2021

COVID-19 Immunizations

ALL

Waiver Active

COVID-19
Testing

ALL

Waiver Active 

COVID-19 Treatment

Medicare/Dual

6/1/2021

Medicaid

Waiver Active 

Marketplace

Waiver Active

Mental Health Services

Medicare/Dual

6/1/2021

Medicaid

6/15/2021

Marketplace

6/15/2021

Telemedicine

Medicare/Dual

6/1/2021

Telemedicine

Marketplace

6/28/2021



PRIOR AUTHORIZATION WAIVERS

Type

Line of Business

Date of Prior-Authorization Waiver Reinstatement (DOS)

COVID-19 Immunizations

ALL

Waiver Active

COVID-19 Testing

ALL

Waiver Active

COVID-19 Treatment - Outpatient

Medicaid/Marketplace

6/15/2021

Medicare/Dual

6/1/2021

COVID-19 Treatment - Inpatient

Medicaid/Marketplace

7/23/2021

Medicare/Dual

4/23/2021

Telemedicine

Medicaid/Marketplace

6/15/2021

Medicare/Dual

6/15/2021

 

Coding - Updated 8/3/2022

Coding – Updated 08/3/2022

Fidelis Care has updated our claims systems to be able to receive new codes associated with COVID 19 testing and has added Healthcare Common Procedure Coding System (HCPCS) codes as they become available. Providers should continue to follow evolving CDC ICD-10-CM Official Coding Guidelines available here: https://www.cdc.gov/nchs/icd/icd10cm.htm when selecting a diagnosis code and procedure code to ensure proper reporting.

 

*Please Note:  The coding guidelines referenced below is not a guarantee of reimbursement in all products.  The date indicated below is the effective date of the code and may not necessarily reflect the date in which a rate was published for each particular code.  Codes may not have published rates for all products. In addition, coding may be subject to National Correct Coding Initiatives or CMS standards.

 

 

Code Type

Code

Effective*

Testing (CDC)

U0001

2/4/2020

Testing (Non-CDC)

U0002

2/4/2020

Testing (Industry Standard)

87635

3/13/2020

Testing (Infectious Disease)

0202U

5/20/2020

Testing (Throughput)

U0003

4/14/2020

Testing (Throughput)

U0004

4/14/2020

Testing (Antigen)

0223U

6/25/2020

Testing (Antigen)

0224U

6/25/2020

Testing (Infectious Disease)

0225U

8/10/2020

Testing (sVNT)

0226U

8/10/2020

Testing

86413

9/8/2020

Testing (Infectious Disease)

0240U

10/6/2020

Testing (Infectious Disease)

0241U

10/6/2020

Testing (Infectious Agent Detection)

87636

10/6/2020

Testing (Infectious Agent Detection)

87637

10/6/2020

Testing (Infectious Agent Detection)

87811

10/6/2020

Mutation identification SARS CoV-2

87913

2/21/2022

Testing (Add-On Payment)

U0005

1/1/2021

OTC At Home COVID Tests

N/A

1/15/2022

Screening

Z03.818

2/4/2020

Screening (Specimen Transfer)

G2023

3/1/2020

Screening (Specimen Transfer)

G2024

3/1/2020

Screening (Specimen Transfer)

C9803

3/1/2020

Screening (Antibody Testing)

86328

4/10/2020

Screening (Antibody Testing)

86769

4/10/2020

Screening (Antigen Detection)

87426

6/25/2020

Screening (Antigen Detection)

87428

11/10/2020

Screening (Neutralizing Antibody)

86408

8/10/2020

Screening (Neutralizing Antibody)

86409

8/10/2020

Encounter for Screening COVID-19

Z11.52

1/1/2021

Contact with and (suspected) exposure to COVID-19

Z20.822

1/1/2021

VEKLURY Antiviral Medication

J0248

12/23/2021

Convalescent Plasma

C9507

12/28/2021

Multisystem inflammatory syndrome (MIS)

M35.81

1/1/2021

Treatment

U07.1

4/1/2020

Treatment

B97.29

1/27/2020-3/31/2020

AstraZeneca – Tixagev and Cilgav Injection

Q0220

12/8/2021

AstraZeneca – Tixagev and Cilgav Injection

M0220

12/8/2021

AstraZeneca – Tixagev and Cilgav Injection

M0221

12/8/2021

AstraZeneca – Tixagev and Cilgav Injection

Q0221

2/24/2022

Eli Lily – Bebtelovimab Injection

Q0222

2/11/2022

Eli Lily – Bebtelovimab Injection

M0222

2/11/2022

Eli Lily – Bebtelovimab Injection

M0223

2/11/2022

Eli Lily Monoclonal - Bamlan/Etesev Injection

Q0245

2/9/2021

Eli Lily Monoclonal - Bamlan/Etesev Infusion

M0245*

2/9/2021

Eli Lily Monoclonal - Bamlan/Etesev Infusion

M0246

5/6/2021

GSK Monoclonal - Sotrov Injection

Q0247

5/26/2021

GSK Monoclonal - Sotrov Infusion

M0247*

5/26/2021

GSK Monoclonal - Sotrov Infusion In Home

M0248

5/26/2021

Genentech Monoclonal - Tocili Injection

Q0249

6/24/2021

Genentech Monoclonal - Tocili 1st Infusion

M0249*

6/24/2021

Genentech Monoclonal - Tocili 2nd Infusion

M0250*

6/24/2021

Eli Lily Monoclonal - Bamlan Injection

Q0239

11/10/2020 - 5/6/21

Eli Lily Monoclonal - Bamlan Infusion

M0239*

11/10/2020 - 5/6/21

Regeneron Monoclonal - Casiri/Imdev Injection

Q0243

11/21/2020-1/23/22

Regeneron Monoclonal - Casiri/Imdev Infusion

M0243*

11/21/2020-1/23/22

Regeneron Monoclonal - Casiri/Imdev Injection

Q0244

6/3/2021-1/23/22

Regeneron Monoclonal - Casiri/Imdev Infusion

M0244

5/6/2021-1/23/22

Regeneron Monoclonal - Casiri/Imdev Injection

Q0240

7/30/2021-1/23/22

Regeneron Monoclonal - Casiri/Imdev Infusion

M0240

7/30/2021-1/23/22

Regeneron Monoclonal - Casiri/Imdev Infusion

M0241

7/30/2021-1/23/22

Home Vaccine Admin

M0201

6/8/2021

Pfizer Vaccine

91300

12/11/2020

Pfizer Vaccine Admin - 1st Dose

0001A

12/11/2020

Pfizer Vaccine Admin - 2nd Dose

0002A

12/11/2020

Pfizer Vaccine Admin - 3rd Dose

0003A

8/12/2021

Pfizer Vaccine Admin - Booster

0004A

9/22/2021

Moderna Vaccine

91301

12/18/2020

Moderna Vaccine Admin - 1st Dose

0011A

12/18/2020

Moderna Vaccine Admin - 2nd Dose

0012A

12/18/2020

Moderna Vaccine Admin - 3rd Dose

0013A

8/12/2021

Moderna Vaccine (Low Dose)

91306

10/20/2021

Moderna Vaccine (Low Dose) - Booster

0064A

10/20/2021

Janssen Vaccine

91303

2/27/2021

Janssen Vaccine Admin - Single Dose

0031A

2/27/2021

Janssen Vaccine Admin – Booster

0034A

10/20/21 

Pfizer Vaccine (Pediatric)

91307

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 1st Dose

0071A

10/29/2021

Pfizer Vaccine (Pediatric) Admin - 2nd Dose

0072A

10/29/2021

Pfizer SARS-COV2 Vaccine, mRNA-LNP 10MCG/0.2mL for 5 - 11 years - Booster

0074A

5/17/2022

Pfizer Vaccine (Ready to use)

91305

1/3/2022

Pfizer Vaccine (Ready to use) Admin - 1st Dose

0051A

1/3/2022

Pfizer Vaccine (Ready to use) Admin - 2nd Dose

0052A

1/3/2022

Pfizer Vaccine (Ready to use) Admin - 3rd Dose

0053A

1/3/2022

Pfizer Vaccine (Ready to use) Admin – Booster

0054A

1/3/2022

Moderna COVID-19 Vaccine 50MCG/0.5ML – Booster Administration

0094A

3/7/2022

Moderna SARS-COV2 Vaccine, mRNA-LNP 50MCG/0.5mL 6 years – 11 years

91309

3/7/2022

Pfizer -SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months – 5 years – 1st Dose  Administration

0081A

2/2/2022

Pfizer - SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months – 5 years – 2nd Dose Administration

0082A

2/1/2022

Pfizer -SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months – 5 years

91308

2/1/2022

NEW - Moderna Covid-19 Pediatric Vaccine 6 months - 5 years 250MCG/0.25ML

91311

7/1/2022

NEW - Moderna Covid-19 Pediatric Vaccine 6 months - 5 years Administration – 1st dose

0111A

7/1/2022

NEW - Moderna Covid-19 Pediatric Vaccine 6 months - 5 years Administration – 2nd dose

0112A

7/1/2022



*On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. Due to this revocation, the Medicaid and Medicare programs will not pay for claims with HCPCS codes M0239 or Q0239 with dates of service after 4/16/2021.

 

More Online Resources

Source for number of cases is from Johns Hopkins University (Updated daily)

https://coronavirus.jhu.edu/map.html

Centers for Medicare & Medicaid Services (CMS) 
CMS is part of the U.S. Department of Health and Human Services (HHS)

www.cms.gov/newsroom

COVID-19 FAQs for State Medicaid and CHIP agencies
www.medicaid.gov/state-resource-center/disaster-response-toolkit/covid19/index.html

American Medical Association

https://www.ama-assn.org

World Health Organization (WHO) Q&A

www.who.int/news-room/q-a-detail/q-a-coronaviruses

NYS Department of Health Fact Sheet - What You Should Know About: COVID-19 Vaccines, Testing, Treatment, and You

https://www.health.ny.gov/health_care/medicaid/fact_sheets/docs/covid/english.pdf