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Guidance to bill for the screening and treatment of COVID-19

Date: 04/07/20

Heritage Health (Medicaid):

We are working to quickly address and support screening, testing and treatment for COVID-19, and are closely following guidance from the Centers for Medicare and Medicaid Services (CMS). As of April 1, 2020, the following guidance can be used to bill for services related to the screening and treatment of COVID-19.

COVID-19 Screening Services

All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.

If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:

  • Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
  • Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation

This applies to services that occurred as of February 4, 2020.

Providers billing with these codes will not be limited by provider type.

COVID-19 Treatment Services

Nebraska Total Care will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.

For dates of service from February 4, 2020 through March 31, 2020 providers should use the ICD-10 diagnosis code:

  • B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere

For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:

  • U07.1 – 2019-nCov Confirmed by Lab Testing

As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers.  For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply.

Again, we thank you for your unwavering commitment to the care and well-being of our members, as well as to the communities we share. Please don’t hesitate to reach out to Provider Services at 1-844-385-2192 (TTY 711) with any questions you may have.