HHS COVID-19 Uninsured Programs

In late April, CMS announced that they will cover uninsured patients suffering from COVID-19, or having been exposed and possibly suffering from the virus. Providers can be reimbursed for services provided on or after February 4, 2020. Due to the Coronavirus Aid, Relief and Economic Security (CARES) Act, providers can seek reimbursement for services provided to COVID-19 diagnosed or suspected infected individuals. The portal can be accessed by providers at https://coviduninsuredclaim.linkhealth.com/. There are instructions to walk you through getting reimbursed for these services. Checking eligibility on these patients prior to billing for them, is key; however, there are providers being reimbursed at this time for these patients.

To participate the provider needs to:

• Verify the patient has no health care coverage
• Confirm with HHS that the patient is uninsured
• Agree to not balance bill the patient

Reimbursement under this program includes:

• Specimen collection, diagnostic/antibody testing
• Testing related visits including
  • Office visits
  • Urgent care visits
  • Emergency room visits
  • Telehealth visits
• Treatment related:
  • Office visits (including telehealth)
  • Emergency room visits
  • Inpatient costs
  • Outpatient/observation costs
  • Skilled nursing facility (SNF) and long-term acute care (LTAC)
  • Home health
  • DME (oxygen, ventilator)
  • Emergency ambulance transportation
  • Non-emergent patient transfers via ambulance
  • FDA approved drugs as they become available
• FDA-approved vaccine (when it becomes available)

Treatment Codes
To be reimbursed for these services, COVID-19 must be the primary diagnosis code, with the only exception being pregnancy (O98.5-). Diagnosis code B97.29 should be used for services rendered or dates of discharge prior to April 1, 2020. On or after April 1, 2020 use U07.1. Procedure codes for all services will follow normal billing practices.

Testing Codes
For testing-related visits rendered in either an office, urgent care, emergency room or vi telehealth, one of the following diagnosis codes must be included:

• Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
• Z20.828 – Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
• Z11.69 – Encounter for screening for other viral diseases (asymptomatic)

For antibody testing and testing-related services rendered in either an office, urgent care, emergency room or via telehealth to be eligible for reimbursement, claims must include one of the following procedure codes:

• 86318 – immunoassay for infectious agent antibody, qualitative or semi-quantitative, single step method (reagent strip)
• 86328 – Immunoassay for infectious agent antibody(ies), qualitative or semi=quantitative, single step method (reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)
• 86769 – Antibody; severe acute respiratory syndrome coronavirus (SARS-CoV2 (coronavirus disease COVID-19)

Testing Codes – Independent Labs

For an independent lab to be eligible for reimbursement, one of the following diagnosis codes must be included:

• Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)
• Z20.82 – Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)
• Z11.59 – Encounter for screening for other viral diseases (asymptomatic)

Additional Reimbursement Codes

Single line item claims using the following procedure codes will also be eligible for reimbursement:

• COVID-19 Tests – U0001/U0002/U0003/U0004/87635
• Antibody Tests – 86318/86328/86769
• Specimen Collection – G2023/G2024

Getting Started

In order to participate in the program, you will need to sign up for Optum ID and Optum Account. If you already have an Optum ID you can visit the registration page. There are three steps to the registration process that can take up to 10 business days to complete. Once you are registered to provide these services, you need to attest that every patient you service meets the correct criteria.

Once you have seen the patient, you can then submit claims for reimbursement. Payer ID 95964 and the name COVID19 HRSA Uninsured Testing and Treatment Fund will be used for these claims. Each patient will be assigned a temporary Member ID after the provider submits a patient roster.

Electronic payment can be expected in 7-10 business days, no earlier than May 18, 2020.

If you need further assistance on this topic, please feel free to reach out to the TotalMD training department at 800-613-7597 extension 011.