Please note that the following information applies to Anthem’s Commercial health plans. Please review the Medicare specific site noted below for details about Medicare plans.

Commercial:  Provider News Home

Medicare:  Medicare Advantage Provider News Archives

 

Anthem is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.

 

To help address care providers’ questions, Anthem has developed the following updates and frequently asked questions.

 

Contents:

Update Summary

Frequently Asked Questions:

  • Anthem’s actions
  • COVID-19 testing
  • COVID-19 vaccines
  • Virtual, telehealth and telephonic care
  • Coding, billing, and claims
  • Other

 

Update Summary

 

COVID-19 testing and visits associated with COVID-19 testing

Anthem’s affiliated health plans will waive cost shares for our fully-insured employer, individual, Medicare and Medicaid plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits and services during the visit associated with the COVID-19 test, including telehealth visits.  Anthem looks for the CS modifier to identify visits and services leading to COVID-19 testing. This modifier should be used for evaluation and testing services in any place of service including a physician’s office, urgent care, ER or even drive-thru testing once available. While a test sample cannot be obtained through a telehealth visit, the telehealth provider can help members get to a provider who can do so. The waivers apply to members who have individual, employer-sponsored, Medicare and Medicaid plans. 

 

Telehealth (video + audio and telephonic/audio-only)

Until the NH Insurance Commissioner’s emergency order is rescinded, or the State of Emergency is terminated, Anthem will waive cost shares for medically necessary treatment delivered via telehealth related to COVID-19 by in-network providers.

 

For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021, unless a longer period is required by law.

 

For telehealth services not related to the treatment of COVID-19 from Anthem’s telehealth provider, LiveHealth Online, cost sharing will be waived from March 17, 2020, through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.

 

Effective from March 17, 2020, through September 30, 2020, unless a longer period is required by law, Anthem’s affiliated health plans waived member cost shares for telehealth visits for services not related to the treatment of COVID-19 from in-network providers, including visits for mental health or substance use disorders, for our fully-insured employer plans and individual plans.

 

For out-of-network providers, Anthem waived cost shares from March 17, 2020, through June 14, 2020. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

 

Telephonic-only care

Effective from March 19, 2020, through July 31, 2021, unless a longer period is required by law, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required by law. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans and Medicaid plans, where permissible. From March 19, 2020, through September 30, 2021, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for our Medicare Advantage plans.

 

Prescription coverage

In accordance with NH mandates, until the NH Insurance Commissioner’s order is rescinded, or the State of Emergency is terminated, Anthem will allow members to receive a one-time early refill of up to a 90-day supply of approved medications. The IngenioRx Home Delivery pharmacy offers free delivery and 90-day prescriptions can be submitted via ePrescribing. Alternatively, you can call us at 833-203-1742 or fax the prescription to 800-378-0323.

 

Frequently Asked Questions

 

Anthem’s actions

 

What is Anthem doing to prepare?

Anthem’s affiliated health plans are committed to help provide increased access to care, while eliminating costs and help alleviate the added stress on individuals, families and the nation’s healthcare system.

 

These actions are intended to support the protective measures taken across the country to help prevent the spread of COVID-19 and are central to the commitment of Anthem’s affiliated health plans to remove barriers for our members and support communities through this unprecedented time. 

 

Anthem’s affiliated health plans are committed to help our members gain timely access to care and services in a way that places the least burden on the healthcare system. Our actions should reduce barriers to seeing a physician, getting tested and maintaining adherence to medications for long-term health issues.

 

Anthem is waiving:

  • cost sharing for the treatment of COVID-19 from April 1, 2020, through January 31, 2021, for members of our fully-insured employer, individual, Medicare Advantage and Medicaid plans. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
  • cost sharing for COVID-19 diagnostic tests as deemed medically necessary by a healthcare clinician who has made an assessment of a patient, including serology or antibody tests, for members of our employer-sponsored, individual, Medicare and Medicaid plans. Cost share waiver extends to the end of the public health emergency.
  • cost sharing for visits and services during the visit to get the COVID-19 diagnostic test, beginning March 18, 2020, for members of our employer-sponsored, individual, Medicare and Medicaid plans. Cost share waiver extends to the end of the public health emergency.
  • cost sharing for telehealth in-network visits for COVID-19 treatment from March 17, 2020, through January 31, 2021, unless a longer period is required by law, including visits for behavioral health, for our fully-insured employer, individual plans, and where permissible, Medicaid. Medicare Advantage and Medicare GRS plans are waived through February 28, 2021.
  • cost sharing for telehealth services not related to the treatment of COVID-19 from Anthem's telehealth provider, LiveHealth Online, from March 17, 2020, through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.
  • cost sharing for telephonic-only in-network visits from March 19, 2020, through July 31, 2021, for fully-insured employer-sponsored, individual and Medicaid plans. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.
  • cost sharing for telephonic-only, in-network provider visits through September 30, 2021, for Medicare plans.
  • cost sharing for U.S Preventive Services Task Force (USPSTF) or CDC-approved vaccines as they become available.

 

The cost sharing waiver includes copays, coinsurance and deductibles.

 

For additional services, members will pay any cost shares their plan requires, unless otherwise determined by state law or regulation. Members can call the number on the back of their identification card to confirm coverage. Providers should continue to verify eligibility and benefits for all members prior to rendering services.

 

Waiver of certain member cost shares, and coverage for telephonic/audio-only telehealth, may be extended beyond dates indicated in this Provider Communications as may be required by NH Emergency Orders issued by the Governor or the New Hampshire Department of Insurance.

 

How is Anthem monitoring COVID-19?

Anthem is monitoring COVID-19 developments and what they mean for our associates and those we serve. We are fielding questions about the outbreak from our customers, members, providers and associates. Additionally, our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part to further support our stakeholders.

 

Anthem has a business continuity plan for serious communicable disease outbreaks, inclusive of pandemics, and will be ready to deploy the plan if necessary.

 

Anthem’s enterprise wide business continuity program includes recovery strategies for critical processes and supporting resources, automated 24/7 situational awareness monitoring for our footprint and critical support points, and Anthem’s Virtual Command Center for Emergency Management command, control and communication.

 

In addition, Anthem has established a team of experts to monitor, assess and help facilitate timely mitigation and response where we have influence as appropriate for the evolving novel coronavirus threat.

 

In case of mass pandemic, how can you ensure that your contracted providers can still provide services?

Anthem is committed to working with and supporting our contracted providers. Our benefits already state that if members do not have appropriate access to network physicians that we will authorize coverage for out-of-network physicians as medically necessary.

 

In addition, Anthem’s telehealth provider, LiveHealth Online, is another safe and effective way for members to see a physician to receive health guidance related to COVID-19 from home via a mobile device or computer with a webcam. 

 

COVID-19 testing

 

When member cost sharing has been waived (where permissible) by Anthem as outlined in this FAQ for COVID-19 testing and visits associated with COVID-19 testing, telehealth (video + audio) services, and in-network telephonic-only services, how does that impact provider reimbursement?

Anthem will process the claim as if there is no member cost sharing, as it does, for example, with preventive health services.

 

How is Anthem reimbursing participating hospitals that perform COVID-19 diagnostic testing in an emergency room or inpatient setting?

Reimbursement for COVID-19 testing performed in a participating hospital emergency room or inpatient setting is based on existing contractual rates inclusive of member cost share amounts waived by Anthem. As we announced on March 6, 2020, Anthem will waive cost shares for members of our fully insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test. 

 

How is Anthem reimbursing participating hospitals that are performing COVID-19 diagnostic testing in a drive-thru testing setting?

Based on standard AMA and HCPCS coding guidelines, for participating hospitals with a lab fee schedule, Anthem will recognize the codes 87635 and U0002, and will reimburse drive-thru COVID-19 tests according to the lab fee schedule inclusive of member cost share amounts waived by Anthem. Participating hospitals without lab fee schedules will follow the same lab testing reimbursement as defined in their facility agreement with Anthem inclusive of member cost share amounts waived by Anthem. As we announced on March 6, 2020, Anthem will waive cost shares for members of our fully-insured employer-sponsored, individual, Medicare, Medicaid and self-funded plan members—inclusive of copays, coinsurance and deductibles—for COVID-19 test and visits to get the COVID-19 test.

 

Does Anthem require a prior authorization on the focused test used to diagnose COVID-19?

No, prior authorization is not required for diagnostic services related to COVID-19 testing.

 

Does Anthem require use of a contracted provider for the COVID-19 lab test in order for waiver of the member’s cost share to apply?

Anthem will waive member cost shares for COVID-19 lab tests performed by participating and non-participating providers. This is applicable for our employer-sponsored, individual, Medicare and Medicaid plan members. 

 

What codes would be appropriate for COVID-19 lab testing?

Anthem is encouraging providers to bill with codes U0001, U0002, U0003, U0004, 86328, 86769, or 87635 based on the test provided.

 

COVID-19 vaccines

 

How is Anthem reimbursing U. S. Food and Drug Administration (FDA)-approved COVID-19 vaccines?

The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government.

Effective May 1, 2021, for members of our fully-insured employer and individual plans, as well as self-funded plans, Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines at a rate of $40 per administration. Anthem will cover the administration of COVID-19 vaccines with no cost share for in- and out-of-network providers, during the national public health emergency, and providers are not permitted under the federal mandate to balance-bill members.


For members of Medicare Advantage plans, CMS issued guidance (https://www.cms.gov/files/document/COVID-19-toolkit-issuers-MA-plans.pdf) that the COVID-19 vaccine administration should be billed by providers to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved. This will ensure that Medicare Advantage members will not have cost sharing for the administration of the vaccine.


For members of Medicaid plans, Medicaid state-specific rate and other state regulations may apply.


What CPT/HCPCS codes would be appropriate to consider for the administration of a COVID-19 vaccines?

CMS has provided coding guidelines related to COVID-19 vaccines: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

 

Virtual, telehealth and telephonic care

 

Will Anthem cover telephonic-only/audio-only services in addition to telehealth via video + audio?

Anthem does not cover telephonic-only services today (with limited state exceptions) but we are providing this coverage from March 19, 2020, through July 31, 2021, unless a longer period is required by law, to reflect the concerns we have heard from providers about the need to support continuity of care for Plan members during extended periods of social distancing. Anthem will cover telephonic-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law. Self-insured plan sponsors may opt out of this program.


What member cost shares will be waived by Anthem’s affiliated health plans for virtual care through internet video + audio or telephonic-only care?

For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through January 31, 2021, unless a longer period is required by law.

 

For telehealth services not related to the treatment of COVID-19 from Anthem’s telehealth provider, LiveHealth Online, cost sharing will be waived from March 17, 2020, through May 31, 2021, for our fully-insured employer, individual, and where permissible, Medicaid plans. Medicare Advantage members pay no member cost share for LiveHealth Online, regardless of national emergency.

 

Effective from March 17, 2020, to September 30, 2020, unless a longer period is required by law, Anthem’s affiliated health plans will waive member cost share for telehealth (video + audio) visits for services not related to the treatment of COVID-19, including visits for behavioral health, for our fully-insured employer plans and individual plans.

 

From March 17, 2020, through December 31, 2020, Anthem waived member cost shares for telehealth visits for services not related to the treatment of COVID-19 from in-network providers, including visits for mental health and substance use disorders, for our Medicare Advantage and Medicaid plans, where permissible. For out-of-network providers, Anthem waived cost shares from March 17, 2020, through June 14, 2020. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

 

Is Anthem’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telehealth?

As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability and stands ready to have physicians available to see the increase in patients, while maintaining reasonable wait times.

 

What is the reimbursement rate for telehealth and telephonic services?

As required by the State of New Hampshire, in-network telehealth and telephonic services must be paid at the same rate, whether a service is provided in-person or through telehealth or telephonically, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim. 

 

Can all contracted providers provide telehealth and telephonic services?

Yes. All Anthem contracted providers can provide telehealth and telephonic services if clinically appropriate.

   

What codes would be appropriate to consider for a telehealth or telephonic visit?

For telehealth rendered by a professional provider, report the CPT/HCPCS code with Place of Service “02” and also append either modifier 95 or GT.

 

For telehealth rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT.

 

For outpatient telephonic services rendered by a facility provider, report the CPT/HCPCS code with revenue code 780 and the word “AUDIO” in the Treatment Authorization Code field (UB04 field # 63). 

 

For telephonic services rendered by a professional provider, report the CPT/HCPCS code with Place of Service “02” and the word "AUDIO" populated in the Prior Authorization Number field (CMS1500 field # 23).

 

For telephonic services, providers may also choose to submit telephonic services telehealth claims with the correct time-based telephonic E&M services CPT code (99441, 99442, 99443, 98966, 98967, 98968) and the place of service code that depicts where the provider’s telephonic-only services occurred.

 

What codes would be appropriate to consider for telehealth (audio and video and telephonic/audio-only) for physical, occupational, and speech therapies?

Telehealth visits for the following physical, occupational and speech therapies for visits coded with place of service (POS) “02” and modifier 95 or GT would be appropriate for our fully-insured employer, individual, Medicare Advantage plans and Medicaid plans, where permissible:

 

  • Physical therapy (PT) evaluation codes 97161, 97162, 97163 and 97164
  • Occupational (OT) therapy evaluation codes 97165, 97166, 97167 and 97168
  • PT/OT treatment codes 97110, 97112, 97530 and 97535
  • Speech therapy (ST) evaluation codes 92521, 92522, 92523 and 92524
  • ST treatment codes 92507, 92526, 92606 and 92609

 

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139-97150, 97533 and 97537-97546.

 

What is the best way that providers can get information to Anthem’s members on Anthem’s alternative virtual care offerings?

Anthem.com and Anthem’s COVID-19 microsite (https://www.anthem.com/blog/member-news/how-to-protect/) are great resources for members with questions and are being updated regularly.

 

Anthem members have access to telehealth 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or download the LiveHealth Online app from the App Store or Google Play.

 

Anthem members also can call the Anthem 24/7 NurseLine at the number listed on their Anthem ID card to speak with a registered nurse about health questions.

 

Coding, billing, and claims

 

 

What diagnosis codes would be appropriate to consider for a patient with known or suspected COVID-19 for services where a member’s cost shares are waived?

The CDC has provided coding guidelines related to COVID-19: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

 

What modifier is appropriate to waive member cost sharing for COVID-19 testing and visits related to testing?

CMS has provided the Medicare guideline to use the CS modifier: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-10-mlnc-se. Anthem also looks for the CS modifier to identify claims related to evaluation for COVID-19 testing. This modifier should be used for COVID-19 evaluation and testing services in any place of service. 

 

Does Anthem expect any slowdown with claim adjudication because of COVID-19? 

We are not seeing any impacts to claims payment processing at this time. 

 

Should providers who are establishing temporary locations to provide healthcare services during the COVID-19 emergency notify Anthem of the new temporary address(es)?

Providers do not need to notify Anthem of temporary addresses for providing healthcare services during the COVID-19 emergency. Providers should continue to submit claims specifying the services provided using the provider’s primary service address along with current tax ID number.

 

Will Anthem allow Roster Billing for the COVID-19 vaccine?

Providers who currently submit electronic claims are encouraged to do so. The electronic process is the quickest way to get the claims to Anthem.

 

Yes, Anthem will accept Roster Billing from providers and state agencies that are offering mass vaccinations for their local communities. Providers may submit the COVID-19 Vaccination Roster Billing Form to Availity at https://www.availity.com/ by signing in and submitting the form electronically to the Anthem health plan.

 

How can a provider submit Anthem’s Roster Billing claim form?

In addition to Availity.com, providers and state agencies who wish to submit Roster Billing claims can submit paper forms:

Or


Anthem Blue Cross and Blue Shield

PO Box 27401

Richmond VA 23261

 

Is there a specific diagnosis code Anthem would look for on the COVID-19 Vaccination Roster Billing Form?

No.  However, to assist providers our COVID-19 Vaccination Roster Billing Form provides a default Z23 diagnosis code. 

 

Other

 

Do the guidelines contained in this FAQ apply to members enrolled in the Anthem affiliated health plans in states living in another BCBS Plan’s service area? 
Anthem’s guidelines apply to Anthem’s affiliated health plan’s membership (members with Anthem ID cards) wherever they reside, except where prohibited by law or local emergency guidelines. Each BCBS Plan may have different guidelines that apply to members of other Blue plans. Providers should continue to verify an individual’s eligibility and benefits prior to rendering services.

 

Do these guidelines apply to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan commonly referred to as the Federal Employee Program (FEP®)?

Where permissible, these guidelines apply to FEP members. For the most up-to-date information about the changes FEP is making, go to https://www.fepblue.org/coronavirus.

What financial assistance is available for care providers during the COVID-19 crisis?

The CARES Act provides financial relief to lessen the impact of the COVID-19 crisis. Included in the law are new resources to address the economic impact of COVID-19 on employers of all sizes. The Act expands existing federal loan programs, creates new tax credits, postpones employment tax payments, and includes additional tax relief. To help care providers navigate the resources available to them, Anthem has compiled information on programs we have learned about that could provide additional financial relief during this crisis. This information can be found in the Federal Resources Available for Care Providers and Employers in the Federal CARES Act article in Anthem Provider News. 

 

Are you aware of any limitations in coverage for treatment of an illness/virus/disease that is part of a pandemic?

Our standard health plan contracts do not have exclusions or limitations on coverage for services for the treatment of illnesses that result from a pandemic. 

 

Please call the Provider Call Center number on the back of the member’s ID card if you have questions or need additional information.

Please note that the above information applies to Anthem's Commercial health plans. Please review the Medicare specific site noted below for details about Medicare plans.

Commercial:  Provider News Home

Medicare:  Medicare Advantage Provider News Archives

532-0621-WP-NH

 



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