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UPDATED: COVID-19 UPDATE: Temporary Suspension of Polymerase Chain Reaction (PCR) Testing Payment Policy

Date: 05/27/20

Based on CDC guidance for evaluating and testing for COVID-19, Superior HealthPlan is temporarily suspending the PCR Testing payment policy (TX.PP.150) implemented effective January 1, 2020.

The PCR testing policy (CPT procedural codes 87631, 87632 and 87633) is suspended effective immediately so that these tests can be appropriately utilized per the CDC guidance. Reimbursement of eligible claims for medically necessary PCR testing  will be allowed for dates of service 02/04/2020 through 07/31/2020*.  The suspension of this Policy includes no restrictions on place of service. 

This interim departure from the PCR testing policy guidelines is applicable to providers that serve Medicaid (STAR, STAR Kids, STAR Health and STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Allwell from Superior HealthPlan (Medicare Advantage - HMO and HMO SNP) and Ambetter from Superior HealthPlan (Health Insurance Marketplace) members.

Please contact your Superior HealthPlan Account Manager with any questions related to this notice.

In response to provider feedback related to Superior HealthPlan’s proposed Physician Office Lab Testing (POLT) payment policy, we are proceeding with an alternative option to ensure medically necessary lab services are delivered in the appropriate setting. Superior will implement a Polymerase Chain Reaction (PCR) Testing payment policy effective January 1, 2020. 

PCR Respiratory Viral Panels (RVP) detect the RNA/DNA of multiple types of respiratory viruses in a single test, often through nasal, nasopharyngeal or oropharyngeal swab. RVPs may be indicated if the results will guide clinical decision-making for an immunocompromised or otherwise high-risk member. RVPs may also be covered if a member is critically ill and is in a health-care setting that cares for critically ill patients. 

The PCR testing payment policy limits reimbursement of the PCR testing procedural codes (CPT 87631, 87632 and 87633) to inpatient hospital, observation and hospital emergency room place of service. Effective with policy implementation, RVPs are no longer reimbursable in an office setting.

This payment policy will be applicable to providers that serve Medicaid (STAR, STAR Kids, STAR Health and STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Allwell from Superior HealthPlan (Medicare Advantage - HMO and HMO SNP) and Ambetter from Superior HealthPlan (Health Insurance Marketplace) members.

For policy details, please review the Polymerase Chain Reaction (PCR) Testing Policy on Superior’s Clinical and Payment Policy webpage

For any questions, please reach out to your local Superior HealthPlan Account Manager.

*Please note: Previously, the end date for this guidance was April 30, 2020. Per HHS, guidance dates that previously expired at the end of April have been extended through July 31, 2020.