Update on Cost Sharing & Prior Auth Requirements for COVID Treatment and Telehealth Services
Date: 11/05/21
In May we communicated updates to our prior authorization (PA) requirements for Telehealth services and COVID treatment. We just obtained clarification on the Medicare PA requirements for Telehealth services and have updated the table below that breaks down the services, and effective date of the change. The changes are in red in the Medicare (Allwell) Telehealth column.
Code/Mod/POS | *Medicaid | Marketplace | Medicare |
Telehealth | |||
Q3014 | Not Covered by AHCCCS | No PA Required | PA Required 6/1/21 for non par providers |
Any CPT/HCPCS billed w/ POS 02 | NA | No PA Required | PA Required 6/1/21 for non par providers |
G2010-G2012 | AHCCCS only covers when Medicare is primary; No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
Mod 95, GT, GQ Regardless of POS | NA | No PA Required | PA Required 6/1/21 for non par providers |
99421-99423 | No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
98970-98972 | No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
G2250-G2252 | AHCCCS considers these informational only codes and not payable | No PA Required | PA Required 6/1/21 for non par providers |
99441-99443 | No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
REV 780 Regardless of POS/Mod | PA Required 6/1/21 | No PA Required | PA Required 6/1/21 for non par providers |
98966-98968 | No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
Telehealth - FQHC/RHC G0071 | No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
RHC billing G2025 1/27/20 - 6/30/20: Mod CG required RHC billing G2025 7/1/20 - 7/20/21: No Mod required FQHC billing G2025 1/27/20 – 6/30/20: Mod 95 required FQHC billing G2025 7/1/20 – 7/20/21: No mod required | AHCCCS only covers when Medicare is primary; No PA Required | No PA Required | PA Required 6/1/21 for non par providers |
Description/Code/Mod/POS/DX | Medicaid | Marketplace | Medicare |
COVID Treatment | |||
Multisystem inflammatory syndrome (MIS) M35.81 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Treatment billed w/ U07.1 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Treatment billed w/ B97.29 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Monoclonal Infusion (Regeneron) Q0243 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Monoclonal Infusion (Regeneron) M0243 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Monoclonal Infusion (Eli Lily) Q0245 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Monoclonal Infusion (Eli Lily) M0245 | No PA Required | PA Required 7/1/21 | PA Required 6/1/21 |
Intravenous infusion,(Regeneron) M0244 | Not currently covered by AHCCCS | PA Required 7/1/21 | PA Required 6/1/21 |
Intravenous infusion (Eli Lily) M0246 | No currently covered by AHCCCS | PA Required 7/1/21 | PA Required 6/1/21 |
Member Cost Share Resumption
- Providers resumed collecting Medicare member liability at the point of service for all telehealth services on June 1, 2021 onward, in accordance with the member’s plan benefits.
- Providers resumed collecting Marketplace/Commercial member liability at the point of service on July 1, 2021 onward, in accordance with the member’s plan benefits.
If you have questions regarding the information contained in this update, please contact our Provider Customer Service Center at 1-866-796-0542 or your assigned Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.