Skip to Main Content

Coronavirus Updates

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. 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.

Please review all available provider guidance, actions and resources listed below.

  • Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
  • Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
  • Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
  • 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.
  • Be familiar with the intended scope of available testing and recommendations from the FDA.    

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

  • Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.  
  • However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
  • Instruct symptomatic patients 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 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. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

New Telehealth Policies Expand Coverage for Healthcare Services

Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) (updated 05/29/2020) to help providers navigate telemedicine and telehealth reimbursement.

For more information, please refer to the guidelines below.

Superior is closely monitoring and following all guidance from the State and the Centers for Medicare and Medicaid as it is released, to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).

COVID-19 Testing Services

  • Providers performing the COVID-19 test can bill us for testing 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 – For Medicare & Marketplace only. 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.

  • These codes should not be used for serologic tests that detect COVID-19 antibodies.
  • 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 and diagnosis codes. (TX CHIP does not waive the copayment for any claim billed with these codes, we do not apply a copay for the testing codes and we waive the copay for all office visits. A copay may still apply to a hospital or non emergent ER claim billed with one of those lab codes.)
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes. Medicaid does not apply a cost share for these services specifically but depending on the location and diagnosis on the claim, a cost share may be applied to other services on the claim.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. Medicaid does not require authorization for these services specifically but depending on the location and diagnosis on the claim, an authorization may be required for other services on the claim.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

High-Throughput Technology Testing Services: Marketplace and Medicare Only

  • Providers performing high production COVID-19 diagnostic testing via high-throughput technology can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes:
    • HCPCS U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
    • Please note: U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
    • HCPCS U0004 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
    • Please note: U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
  • Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these codes to indicate high production testing.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

COVID-19 Specimen Transfers Medicare and Marketplace Only

  • For specimen transfer related claims, the following codes can be used:
    • G2023 - Spec Clct for SARS-COV-2 COVID 19 ANY SPEC SRC
    • G2024 - SP CLCT SARS-COV2 COVID19 FRM SNF/LAB ANY SPEC
    • C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. This is effective for services provided on or after March 1, 2020.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

COVID-19 Screening Services

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.
  • If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:
    • Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
    • Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation
  • This applies to services that occurred as of February 4, 2020.
  • Providers billing with these codes will not be limited by provider type.

COVID-19 Treatment Services

  • We will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.
  •  For dates of service from February 4, 2020 through March 31, 2020 providers should use the ICD-10 diagnosis code:
    •  B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere
  •  For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:
    •  U07.1 – 2019-nCov Confirmed by Lab Testing
  • As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers. For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply, where applicable.

Reimbursement Rates for COVID-19 Services for All Provider Types (where services are covered)

  • We are complying with the rates published by CMS for the following codes
    • U0001 = $35.91
    • U0002 = $51.31
    • U0003 = $100.00 (Medicare/Marketplace only)
    • U0004 = $100.00 (Medicare/Marketplace only)
    • G2023 = $23.46 (Medicare/Marketplace only)
    • G2024 = $25.46 (Medicare/Marketplace only)
  • Commercial products will reimburse COVID-19 services in accordance with our negotiated commercial contract rates.
  • We will follow these CMS published rates except where state-specific Medicaid rate guidance should supersede.
  • Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

For member information, please reference the Coronavirus Updates for Members webpage.

Latest News

For any questions, please contact your Account Manager or call Provider Services at 1-877-391-5921.