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Provider Coronavirus Information

The Department of Community Health (DCH) has received requests for additional clarification of the telehealth guidance released 3/17/20 and further clarified in a message dated 3/18/20. In response to requests for clarification of service delivery locations and the term “distant site locations” DCH is issuing additional guidance to clarify these outstanding questions.

Qualified Providers

Qualified providers permitted to furnish Medicaid-reimbursed telehealth services during the Public Health Emergency include physicians and certain non-physician providers such as nurse practitioners, physician assistants and certified nurse midwives. Other practitioners enrolled in Georgia Medicaid such as certified nurse anesthetists, licensed clinical social workers, clinical psychologists and therapists (PT, ST and OT) may also deliver services within their scope of practice, consistent with Medicaid reimbursement rules, and in the category of service in which they are enrolled.

Service Delivery Location: Originating Site

The Coronavirus Preparedness and Response Supplemental Appropriations Act as signed into law by the President on March 6, 2020 allows states broad authority to waive limitations on settings where members are eligible to receive telehealth and where telehealth services can be delivered during the emergency. All members with access to video or telephone communication may receive services in their homes to reduce exposure to themselves and others. Under the emergency declaration and waivers, these services may be provided by professionals regardless of patient location. The services must meet established medical necessity criteria relevant to the procedure or treatment.

Service Delivery Location: Distant Site

Qualified providers deliver services from distant sites. During the COVID-19 state of emergency, providers may deliver medically necessary services in various settings including their homes or other settings in which the privacy and confidentiality of the member can be assured. Qualified providers should continue to follow all applicable licensure rules specific to their profession. Services delivered from distant sites will be billed using the provider billing address associated with the enrolled Medicaid practice or facility. Claims must be billed using the associated procedure code, GT modifier and place of service code 02 to indicate telehealth delivery.

Billing

Providers should reference the 3/18/20 banner message relating to COVID-19 and the Use ofTelehealth for additional requirements related to member consent and patient confidentiality. DCH will continue to review all categories of service, adding services and procedure codes that can be reimbursed through telehealth service delivery as identified. MMIS will be modified to include new codes following DCH review. The Department will post additional information as needed.

Verbal Consent

Consent to receive services must be provided verbally by the member and noted in the member’s file or medical record. Providers are not required to obtain a hard copy of the consent form as noted in the Telehealth Guidance manual.

If you have questions related to the waiver of originating or distant site requirements, please contact the DXC Technology Provider Contact Center at 1-800-766-4456 and/or your assigned Provider DXC Representative.

In response to the COVID-19 State of Emergency, Peach State Health Plan is following the guidance provided by the Department of Community Health (DCH) to temporarily waive certain policies related to coverage of Telehealth/Telemedicine services.

As a preemptive effort to protect both our provider partners and members, Peach State Health Plan is strongly encouraging the provider community to consider telehealth when treating and diagnosing patients.

What has changed?

Expansion of the Types of Origination Sites

  • Telehealth originating site limitations listed in the Georgia Medicaid Telehealth manual are being waived. The revised list of origination sites available for use are noted below.

Expansion of Telehealth Services to additional modalities

  • Telephone Communication
  • Use of Webcam or other audio and video technology
  • Video Cell Phone Communication

What are the requirements to utilize the added modalities?

  • Patients must initiate the service and provide consent to be treated virtually.
  • Consent must be documented in the medical record with date, time, and consenting/responsible party before initiation of the service.

How should I Bill for Telehealth Services?

  • Procedure codes should be used along with a telehealth Place of Service (POS) and or the GT modifier
  • The POS and or Modifier must be included on the claim
    • POS: 02
    • Modifier: GT

Other Important Reminders

  • All Services must be deemed Medically Necessary.
  • Authorizations are still required for services currently requiring an authorization.  Please refer to the Pre-Auth Check tool
  • Providers must comply with the provisions outlined in the Telehealth Manual posted on GAMMIS.
  • Providers must continue to comply with state telehealth laws and regulations, including professional licensure, scope of practice, standards of care, patient consent and other payment requirement for Medicaid members.

Revised/Expanded list of Originating sites

  • Physician and Practitioners Offices
  • Hospitals
  • Rural Health Clinics
  • Federally Qualified Health Clinics
  • Hospital-based or  CAH based Renal Dialysis Centers (Independent Renal Dialysis Facilities, are not eligible origination sites
  • Skilled Nursing Facilities
  • Local Education Authorities (LEA)
  • County Boards of Health
  • Community Mental Health Centers
  • A Mobile Stroke Unit (only for purpose of diagnosis, evaluation, or treatment of symptoms of acute stroke
  • The home of a Medicaid or Peach Care for Kids Member
  • Emergency Medical Service Ambulance
  • Pharmacy

Therapy Services covered for Physical, Speech and Occupational through Telehealth

  • Procedure codes for physical therapy, speech therapy and occupational therapy are being configured to allow telehealth delivery.  Please note that a complete list of codes can be found on pages 32 – 43 of the CIS Policy Manual.

Behavioral Health Services covered through Telehealth

  • Covered telehealth services are designated with a GT modifier on the DCH provider services manuals. Please refer to the DCH Provider website.
  • General categories of services with telehealth designation include:
    • Community Behavioral Health Rehabilitation Services
    • Psychological Services
    • Physician Services
    • Autism Services
    • Services must be delivered  within the scope of practice of the practitioner
    • Licensed Masters Providers must meet the Georgia Composite Board training guidelines.

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.

HCPCS and CPT Codes for COVID-19 Testing Services

  • Starting April 1st, 2020, providers performing the COVID-19 test can begin billing us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:
    • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”

Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
  • Adjudication of claims is currently planned for the first week of April 2020. 

We are complying with the rates published on 3/12/20 by CMS:

  • U0001 = $35.91
  • U0002 = $51.31
  • Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.

Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

Coronavirus disease 2019 (COVID-19) is an emerging illness.  Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.  At this time, most people in the United States will have little immediate risk of exposure to this virus.  New information, obtained daily, will further inform the risk assessment, treatment options and next steps.  We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance:

  • Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.
  • Instruct symptomatic patients with travel history to China or other infected areas to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
  • Health care personnel encountering symptomatic patients with travel history to China or other infected areas should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
  • Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.
  • Monitor and manage ill and exposed healthcare personnel.
  • Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible. 

Take Action:

  1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  2. Review your infection prevention and control policies and CDC's recommendations  for healthcare facilities for COVID-19.
  3. Know how to report a potential COVID-19case or exposure to facility infection control leads and public health officials.  Contact your local or state health department healthcare providers to notify local or state health department in the event of a person under investigation for COVID-19.
  4. Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

Other Resources: