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Provider Information on COVID-19 Coverage

Updated July 2, 2020

Blue Cross and Blue Shield of Illinois (BCBSIL) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We’ve taken steps to lower costs and provide our members easier access to care related to COVID-19.

Testing and Treatment Coverage
We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance. The waiver applies to cost-share associated with COVID-19 treatment with providers, including facilities, from April 1 to Aug. 31, 2020, so long as the treatment is provided and consistent with the terms of the member’s benefit plan. We will reassess this waiver as events warrant.

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles for treatment of COVID-19, based on their employer’s election to participate in this benefit.  

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through Aug. 31, 2020

Medicare Supplement members do not have network restrictions unless otherwise noted on their plans. Members should always call the number on their ID card for answers to their specific benefit questions. See our FAQs for Providers  for more details.

Check Member Eligibility and Benefits
Use the Availity® Provider Portal  or your preferred vendor for eligibility and benefit verifications.

Claims for COVID-19 Testing
If you test a member when it's medically appropriate and in accordance with generally consistent medical standards, submit the claim to us using the appropriate code. Member cost-share will be waived. COVID-19 testing should be authorized by the U.S. Food and Drug Administration (FDA), which includes Emergency Use Authorization (EUA).

COVID-19 Lab Codes

  • 0202U (infectious disease - bacterial or viral respiratory tract infection, pathogen-specific nucleic acid - DNA or RNA, 22 targets including severe acute respiratory syndrome coronavirus 2 - SARS-CoV-2, qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected)
  • 87635 (American Medical Association (AMA) code for SARS-2-CoV-2 lab test)
  • C9803 (Hospital outpatient clinic visit specimen collection for SARS-2-CoV-2)
  • G2023 (Specimen collection for SARS-CoV-2)
  • G2024 (Specimen collection for SARS-CoV-2 from an individual in a skilled nursing facility or by a laboratory)
  • U0001 (CDC testing laboratories to test patients for SARS-CoV-2)
  • U0002 (Non-CDC lab test)
  • U0003 (nucleic acid, amplified probe technique for SARS-2-CoV-2, making use of high throughput technologies)
  • U0004 (any technique, making use of high throughput technologies)

COVID-19 Diagnosis Codes

  • U07.1 (COVID-19 acute respiratory disease)
  • B97.29
  • B34.2
  • Z03.818 (possible exposure to COVID-19)
  • Z20.828 (actual exposure to COVID-19)

Modifier CS
For services furnished on March 18, 2020, through June 30. 2020, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing-related services.

COVID-19 Antibody Testing
Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with EUA during the public health emergency.  

Antibody Testing Requirements
Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care professional. We encourage members to consult with their health care provider to determine the best test clinically indicated for their condition. Refer to the current FDA position on antibody testing .

At-Home Antibody Tests
We cover at-home collection methods for antibody testing if the tests are FDA-authorized and are clinically indicated for the member. We encourage members to consult with their health care provider to determine whether the test is medically appropriate for their condition.

COVID-19 Antibody Testing Codes

  • 86318 (revised to indicate immunoassay for infectious agent antibodies; single-step method)
  • 86328 (new for COVID-19; single-step method)
  • 86769 (new for COVID-19; multi-step method)

For more detail on COVID-19 coding and guidance, refer to the American Medical Association  website or the Centers for Disease Control and Prevention .

Out-of-Network Providers
If you are not an in-network provider, we will reimburse you for the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website.

Telehealth
BCBSIL has further expanded its access to telehealth in response to COVID-19. Refer to our March 28 announcement for details. We are also temporarily lifting cost-sharing for medically necessary health services delivered by an in-network provider via telehealth for eligible fully insured members. Benefits may be different for our members covered under certain employer-funded health plans. BCBSIL will continue to evaluate the telehealth program and make adjustments to best serve our members. All new developments for providers will be posted to our News and Updates.

Pharmacy
For members who have BCBSIL pharmacy benefits administered through Prime Therapeutics, BCBSIL will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Note on Medicare members: Members of these plans can get 90-day fills through mail order.

  • Blue Cross Group Medicare Advantage (PPO)℠
  • Blue Cross Group Medicare Advantage Open Access (PPO)℠
  • Blue Cross Group MedicareRx (PDP)℠
  • Blue Cross Medicare Advantage (HMO)℠
  • Blue Cross Medicare Advantage (PPO)℠
  • Blue Cross MedicareRx (PDP)

What is the risk of COVID-19?
According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19. 

We’ve developed a flier about COVID-19  that you may share with your patients.

More Information
Because this is a rapidly evolving situation, you should continue to use CDC guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. Also watch BCBSIL’s News and Updates for announcements, such as updates to our COVID-19 Provider FAQs  and other information and related resources.

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Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.