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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.

Telehealth

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

 

COVID Treatment

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.