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HomeProvidersProvider ResourcesCOVID-19 Updates

Important Updates Regarding Coronavirus COVID-19

Posted by Provider Relations

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.

COVID-19 Coverage as of August 1, 2023

In compliance with New York State and Federal requirements pertaining to the end of the Public Health Emergency (PHE), Fidelis Care is modifying certain coverage for COVID-19 related services for dates of service beginning August 1, 2023. Below is a summary of benefit coverage as of August 1, 2023.

 

 

Medicaid/CHP/HARP

Essential Plan

Marketplace

Medicare

 

Immunizations

Covered with no cost-sharing when provided by a participating provider.

 

 

Not covered out of network.

Covered with no cost-sharing when provided by a participating provider.

 

 

Not covered out of network.

Covered with no cost-sharing when provided by a participating provider.

 

 

Not covered out of network.

Covered with no cost-sharing when provided by a participating or a non-participating provider.

 

 

Prior Authorization not required.

 

In-Office Testing

 

Covered with no cost-sharing when provided by a participating provider.

 

 

Not covered out of network.

Covered with no cost-sharing when provided by a participating or a non-participating provider.

Covered with cost-sharing when provided by a participating provider.

 

 

Not covered out of network.

Covered with cost-sharing when provided by a participating or a non-participating provider.

 

 

Prior Authorization not required.

Specimen collection and high throughput testing is not covered. For Medicaid enrollees, there is FFS reimbursement effective 5/12/23, for PCR, antigen, multiplex, and antibody tests For Marketplace enrollees, office visit cost-sharing has been reinstated. All other testing codes will be covered until 9/30/24 across all LOBs.

 

Over-the Counter Tests

Up to 4 OTC tests per month are covered through NYRx.

CHP: Up to 4 OTC tests per month covered with no cost-sharing.

Up to 8 OTC tests per month covered with no cost-sharing.

Not covered.

Covered through Medicare FFS (fee for service).

 

COVID-19 Treatment

Covered with no cost-sharing when provided by a participating.

 

Out of network coverage requires prior authorization.

Covered with no cost-sharing through 9/30/2024, when provided by a participating.

 

Not covered out of network.

Covered with cost-sharing when provided by a participating provider.

 

Not covered out of network.

Covered with cost-sharing when provided by a participating provider.

  

Out of network coverage dependent on plan.

 

Telemedicine

Telemedicine is covered with no cost-sharing when provided by a participating provider.

 

 

 

 

Not covered out of network.

Telemedicine is covered with no cost-sharing when provided by a participating provider.

 

 

 

 

 

Not covered out of network.

Telemedicine rendered via Fidelis Care’s Telemedicine Program is covered with no cost-sharing.   Telemedicine by other participating providers is covered with cost-sharing.

 

 

Not covered out of network.

Telemedicine* is covered with no cost-sharing when provided by a participating provider.

 

Not covered out of network.

 

* As of 5/12/2023, Medicare will no longer cover codes “99441” through “99443” for telemedicine.

 

 

Vaccine Counseling : Effective 5/12/2023, Medicaid, Essential Plan, and Marketplace members under the age of 21 are covered as a standalone service, while members 21 years old and older are not separately reimbursable and should be included in the E&M.

 

COVID-19 Pharmacy Updates
Coding - Updated 9/25/2023

Reimbursable Billing Codes (Updated 9/25/2023)

Fidelis Care has updated our claims systems to reflect the codes currently reimbursable across all lines of business.

 

 

Code Type

Code

Effective

Testing (PCR)

U0002

5/12/2023

Testing (PCR)

87635

5/12/2023

Testing (Infectious Disease)

0225U

8/10/2020

Testing (Infectious Disease)

0240U

10/6/2020

Testing (Infectious Disease)

0241U

10/6/2020

Testing (Antigen)

87426

5/12/2023

Testing (Antigen)

87811

5/12/2023

Testing (Antigen)

0223U

6/25/2020

Testing (Antigen)

0224U

6/25/2020

Testing (sVNT)

0226U

8/10/2020

Testing

86413

9/8/2020

Testing (Multiplex)

87428

5/12/2023

Testing (Multiplex)

87636

5/12/2023

Testing (Multiplex)

87637

5/12/2023

Testing (Antibody)

86328

5/12/2023

Testing (Antibody)

96769

5/12/2023

Mutation identification SARS CoV-2

87913

2/21/2022

Screening (Neutralizing Antibody)

86408

8/10/2020

Screening (Neutralizing Antibody)

86409

8/10/2020

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

Pfizer Vaccine (Pediatric)

91307

10/29/2021

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 30MCG/0.3ML - 1st Dose

0121A

04/18/2023

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 30MCG/0.3ML - Additional Dose             

0124A

08/31/2022

Moderna - ADM SARSCOV2

Bivalent - 50MCG/0.25ML - Additional Dose

0134A

08/31/2022

Moderna - ADM SARSCOV2

25MCG/0.25ML - 1st Dose (ages 6mos - 11yrs)

0141A

04/18/2023

Moderna - ADM SARSCOV2

25MCG/0.25ML - 2nd Dose (ages 6mos - 11yrs)

0142A

04/18/2023

Moderna - ADM SARSCOV2

Bivalent - 25MCG/0.25ML - Additional Dose (6mos - 11yrs)

0144A

10/12/2022

Pfizer-BioNTech - ADM SARSCOV2

10MCG/0.2ML Trs-Sucr - 1st Dose (5 - 11yrs)

0151A

04/18/2023

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 10MCG/0.2ML - Additional Dose (5 - 11yrs)

0154A

10/12/2022

Moderna - ADM SARSCOV2

Bivalent - 10MCG/0.2ML - Additional Dose (6mos - 5yrs)

0164A

12/8/2022

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 3MCG/0.2ML - 1st Dose (6mos - 4yrs)

0171A

04/18/2023

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 3MCG/0.2ML - 2nd Dose (6mos - 4yrs)

0172A

04/18/2023

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 3MCG/0.2ML - 3rd Dose (6mos - 4yrs)

0173A

12/8/2022

Pfizer-BioNTech - ADM SARSCOV2

Bivalent - 3MCG/0.2ML - Additional Dose (6mos - 4yrs)

0174A

03/14/2023

Novavax Covid-19 Vaccine, Adjuvanted 1 st Dose Administration

0041A

7/13/2022

Novavax Covid-19 Vaccine, Adjuvanted 2nd Dose Administration

0042A

7/13/2022

Novavax Covid-19 Vaccine, Adjuvanted Booster Dose Administration

0044A

10/19/2022

Novavax Covid-19 Vaccine, Adjuvanted, Ages 18 years and older

91304

7/13/2022

Immunization administration by intramuscular (IM)injection of SARS-CoV-2 (COVID-19) vaccine, single dose

90480

09/11/2023

Pfizer-BioNTech SARS-COV-2 (COVID-19) vaccine, mRNA, spikeprotein, LNP, preservative free, tris-sucrose, 3 mcg/0.3 mL dose

91318

09/11/2023

Pfizer-BioNTech SARS-COV-2 (COVID-19) vaccine, mRNA,spike protein, LNP, preservative free, tris-sucrose, 10 mcg/0.3 mL dose

91319

09/11/2023

Pfizer-BioNTech SARS-COV-2 (COVID-19) vaccine, mRNA,spike protein, LNP, preservative free, tris-sucrose, 30 mcg/0.3 mL dose

91320

09/11/2023

Moderna SARS-COV-2 (COVID-19) vaccine, mRNA, spikeprotein, LNP, preservative free, 25 mcg/0.25 mL dose

91321

09/11/2023

Moderna SARS-COV-2 (COVID-19) vaccine, mRNA, spikeprotein, LNP, preservative free, 50 mcg/0.5 mL dose

91322

09/11/2023