Reinstatement of Prior Auth Requirements for COVID Treatment and Telehealth Services
Date: 05/27/21
Arizona Complete Health (AzCH) is updating its prior authorization (PA) requirements for Telehealth services and COVID treatment. The table below breaks down the services, and effective date of the change for Medicaid (AzCH-Complete Care Plan), Marketplace (Ambetter) and Medicare (Allwell).
The impact to Medicaid is minimal. These changes primarily impact Marketplace and Medicare. We do apologize because we anticipate some Medicare claims for DOS after 6/1 may be paid and later reversed if the claim is received prior to our system being updated. We are also in the process of updating our online Pre-Auth Check Tool. To minimize impact to your organization please make sure your team requests PA as outlined in the table below.
Code/Mod/POS | *Medicaid | Marketplace | Medicare |
|---|---|---|---|
Q3014 | Not Covered by AHCCCS | No PA Required | PA Required 6/1/21 |
Any CPT/HCPCS billed w/ POS 02 | NA | No PA Required | PA Required 6/1/21 |
G2010-G2012 | AHCCCS only covers when Medicare is primary; No PA Required | No PA Required | PA Required 6/1/21 |
Mod 95, GT, GQ Regardless of POS | NA | No PA Required | PA Required 6/1/21 |
99421-99423 | No PA Required | No PA Required | PA Required 6/1/21 |
98970-98972 | No PA Required | No PA Required | PA Required 6/1/21 |
G2250-G2252 | AHCCCS considers these informational only codes and not payable | No PA Required | PA Required 6/1/21 |
99441-99443 | No PA Required | No PA Required | PA Required 6/1/21 |
REV 780 Regardless of POS/Mod | PA Required 6/1/21 | No PA Required | PA Required 6/1/21 |
98966-98968 | No PA Required | No PA Required | PA Required 6/1/21 |
Telehealth - FQHC/RHC G0071 | No PA Required | No PA Required | PA Required 6/1/21 |
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 |
Description/Code/Mod/POS/DX | Medicaid | Marketplace | Medicare |
|---|---|---|---|
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 should resume 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 should resume 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 feel free to contact our Provider Customer Service Center at 1-866-796-0542. If you need your assigned Provider Engagement Specialist contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.