9/3/2021
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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.
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.
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COST-SHARE WAIVERS
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|
Type
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Line of Business
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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
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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
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|
Type
|
Line of Business
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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
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|
Medicare/Dual
|
4/23/2021
|
|
Telemedicine
|
Medicaid/Marketplace
|
6/15/2021
|
|
Medicare/Dual
|
6/15/2021
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Coding - Updated 01/31/2022
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, 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
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Code
|
Effective Date
|
|
Testing
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U0001
|
2/4/2020
|
|
Testing
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U0002
|
2/4/2020
|
|
Testing
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87635
|
3/13/2020
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|
Testing
|
0202U
|
5/20/2020
|
|
Testing/Throughput
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U0003
|
4/14/2020
|
|
Testing/Throughput
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U0004
|
4/14/2020
|
|
Testing/Antigen
|
0223U
|
6/25/2020
|
|
Testing/Antigen
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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
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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
|
|
Treatment - Tixagev and cilgav, inj
|
M0220
|
12/8/2021
|
|
Treatment - Tixagev and cilgav, hm
|
M0221
|
12/8/2021
|
|
Monoclonal Infusion (Eli Lily)
|
M0245*
|
2/9/2021
|
|
Monoclonal Infusion (Eli Lily)
|
M0246
|
5/6/2021
|
|
Treatment - Tixagev and cilgav, 300 mg
|
Q0220
|
12/8/2021
|
|
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
|
|
Pfizer (5-11): Vaccine Product
|
91307
|
11/03/2021
|
|
Pfizer (5-11): Admin Code, First Dose
|
0071A
|
11/03/2021
|
|
Pfizer (5-11): Admin Code, Second Dose
|
0072A
|
11/03/2021
|
|
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