Coronavirus (COVID-19) Updates for Providers
Last updated 05/09/22: Additional changes have been made to the over-the-counter COVID-19 testing for CarePartners of Connecticut
During the COVID-19 Public Health Emergency (PHE), CarePartners of Connecticut has adapted policies and business operations to support members in receiving care and to aid providers in their efforts to provide patients with safe access to the care they need.
As states lift PHE orders, CarePartners of Connecticut is returning to pre-pandemic operations and policies. Refer to the resources below for the most up-to-date information about CarePartners of Connecticut's policies and coverage.
The policies below will be revisited on a continuing basis.
Note: Providers should follow these guidelines for the dates of services listed during the COVID-19 PHE. For all other billing guidelines, refer to the Professional Services and Facilities Payment Policy and the benefit-specific payment policies located in the Provider Resource Center.
The federal government has purchased the vaccine and is supplying it to vaccinators. Providers will receive the vaccines from the state and/or federal health agencies.
CarePartners of Connecticut complies with federal and state guidelines for vaccines. Refer to the Connecticut Department of Public Health for information on vaccines.
Consistent with federal requirements, CarePartners of Connecticut is waiving cost sharing for the administration of COVID-19 vaccines.
CarePartners of Connecticut is not requiring referrals or prior authorizations for the administration of the COVID-19 vaccination, this includes the COVID-19 vaccine being administered by out-of-network (OON) providers during the PHE.
CarePartners of Connecticut Plan is reimbursing for administration of the vaccines and services associated with vaccine administration for all products. The reimbursement rate includes vaccine administration, public health reporting, and patient outreach, education, and counseling.
While CarePartners of Connecticut encourages the use of in-network providers, we will reimburse in- and out-of-network providers for the administration of the vaccine.
Refer to the COVID-19 Vaccine and Testing Codes list for details for billing information.
COVID-19 Testing and Treatment
- CarePartners of Connecticut will pay 100% of the allowed amount for medically necessary testing (including, but not limited to radiology and lab tests). Click here for a list of procedure codes.
- CarePartners of Connecticut covers in-person polymerase chain reaction (PCR), antigen and antibody laboratory testing for COVID-19 consistent with federal and state guidance at no cost to our members. These tests must be medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines. Providers should not collect any cost share from members.
- As of April 4, 2022, anyone with Medicare Part B coverage, including those enrolled in a Medicare Advantage plan are covered under Medicare. CarePartners of Connecticut continues to offer coverage for at-home tests in addition to the Medicare coverage and is available through Dec. 31, 2022. Our member website includes detailed instructions on how to purchase the tests with no up-front out-of-pocket cost at participating in-network pharmacies or how to submit for reimbursement.
- COVID-19 PCR tests that are laboratory processed and either conducted in person or at home must be ordered or referred by a provider to be covered benefits. CarePartners of Connecticut will not cover or reimburse for these tests for members when self-ordered, including when using an online self-completed questionnaire.
- Testing is not covered for general workplace health and safety, public health surveillance or other purposes not primarily intended for a member's individual COVID-19 diagnosis or treatment. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered.
- Diagnostic testing required by a provider for surgical or other medical procedures is medically necessary and covered, including if pregnant or expectant parents required to test prior to admittance to a delivery facility.
- Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers. As always, coverage is only available to health plan members.
Members are encouraged to see in-network providers, whenever possible. However, these policies apply to in-network and out-of-network (OON) providers:
- Provider Reimbursement: CarePartners of Connecticut will reimburse providers for treatment according to covered benefits in our plans for those members positively diagnosed with COVID-19.
- Monoclonal Antibodies: CarePartners of Connecticut covers medically necessary monoclonal antibody treatment in outpatient settings, without prior authorization as per the Food & Drug Administration’s (FDA) EUA criteria, for the treatment of mild to moderate COVID-19 in adult and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Refer to monoclonal antibody treatment information from the CMS and CDC for details on limitations of authorized use and instructions for healthcare providers. Member claims should be submitted to CarePartners of Connecticut.
- Paxlovid and Molnupiravir: The FDA has authorized EUA for Pfizer's Paxlovid (nirmatrelvir/ritonavir) and Merck's Molnupiravir for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy will have no cost share. Prescriber and pharmacy access is limited.
Refer to the Temporary COVID-19 Telehealth Payment Policy for the following:
- Telehealth guidelines for in-network providers
- Telehealth billing guidelines
- Temporary COVID-19 Telehealth/Telemedicine Code Lists
CarePartners of Connecticut will continue to evaluate market conditions and will inform the network in advance of an end date or further changes to this temporary policy.
Billing and Reimbursement Guidelines
CPT Code 99072 is designed for providers to report expenses incurred during a PHE, including PPE, cleaning supplies and additional clinical staff time. This code is non-reimbursable for CarePartners of Connecticut.
- Certified registered nurse anesthetists (CRNA) are not required to include the supervising physician information on claims. Note: CarePartners of Connecticut will continue to compensate for medically necessary CRNA services.
- Anesthesia claims should be billed with the appropriate procedure code, modifier and applicable time units, as described in the Anesthesia Payment Policy.
- CarePartners of Connecticut defers to providers to determine whether physician supervision is required under the laws of the state in which they practice and/or hospital policies.
CMS has extended the suspension of the sequestration payment reduction through March 31, 2022 and will phase back in with a 1% sequester cut from April through June 2022. The 2% cut goes back inteo effect on July 1, 2022. As such, consistent with this CMS requirement, CarePartners of Connecticut suspended the reimbursement reductions for Medicare Advantage hospital rates and professional rates for the same time period for acute care hospitals, clinicians, physicians and PCPs.
- CarePartners of Connecticut allows early refills of a medication prescription prior to the expiration date, including specialty pharmaceuticals. Controlled substance drugs are excluded from this policy.
- Maintenance medications may be refilled for up to a 90-day supply, assuming the days supply is available based on the unused portion of the prescription.
Tips for Prescribers
For information for members on Warfarin that require international normalized ratio (INR) testing, click here.
Register for Provider Update
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