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 11/24/2021

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, as 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 Date

Testing

U0001

2/4/2020

Testing

U0002

2/4/2020

Testing

87635

3/13/2020

Testing

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

0225U

8/10/2020

Testing

0226U

8/10/2020

Testing

86413

9/8/2020

Testing

0240U

10/6/2020

Testing

0241U

10/6/2020

Testing

87636

10/6/2020

Testing

87637

10/6/2020

Testing

87811

10/6/2020

Testing

U0005

1/1/2021

Screening

Z20.828

2/4/2020

Screening

Z03.818

2/4/2020

Screening/ Specimen Transfer

G2023

3/1/2020

Screening/ Specimen Transfer

G2024

3/1/2020

Screening/Antibody

C9803

3/1/2020

Screening/Antibody

86328

4/10/2020

Screening/Antibody

86769

4/10/2020

Screening/Antigen

87426

6/25/2020

Screening/Neutralizing Antibody

86408

8/10/2020

Screening/Neutralizing Antibody

86409

8/10/2020

Screening/Antigen

87428

11/10/2020

Screening

Z11.52

01/01/2021

Screening

Z20.822

01/01/2021

Treatment

U07.1

4/1/2020

Treatment

B97.29

1/27/2020 – 3/31/2020

Treatment

M35.81

01/01/2021

Monoclonal Infusion*

Q0239*

11/9/2020

Monoclonal Infusion*

M0239*

11/9/2020

Monoclonal Infusion (Regeneron)

Q0243

11/21/2020

Monoclonal Infusion (Regeneron)

M0244

5/6/2021

Monoclonal Infusion (Eli Lily)

Q0245

2/9/2021

Monoclonal Infusion (Eli Lily)

M0245*

2/9/2021

Monoclonal Infusion (Eli Lily)

M0246

5/6/2021

Monoclonal Infusion (Regeneron)

Q0244

6/3/2021

Monoclonal Infusion (GSK)

Q0247

5/26/2021

Monoclonal Infusion (GSK)

M0247*

5/26/2021

Monoclonal Infusion (GSK)

M0248

5/26/2021

Monoclonal Antibody Treatment -(Regeneron)

M0243

11/21/2020

Vaccine Treatment (Pfizer)

91300

12/11/2020

Vaccine Treatment (Pfizer)

0001A

12/11/2020

Vaccine Treatment (Pfizer)

0002A

12/11/2020

Vaccine Treatment (Pfizer)

0003A

8/12/2021

Vaccine Booster Admin (Pfizer)

0004A

09/22/2021

Vaccine Treatment (Moderna)

91301

12/18/2020

Vaccine Treatment (Moderna)

0011A

12/18/2020

Vaccine Treatment (Moderna)

0012A

12/18/2020

Vaccine Treatment (Moderna)

0013A

8/12/2021

Low Dose Vaccine (Moderna)

91306

10/20/2021

Vaccine Booster Admin

0064A

10/20/2021

Vaccine Treatment (Janssen)

91303

2/27/2021

Vaccine Treatment (Janssen)

0031A

2/27/2021

Vaccine Booster Admin (Janssen)

0034A

10/20/2021

In Home Vaccine Admin Add-On Code

M0201

6/8/2021

*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