HealthTeam Advantage is closely monitoring COVID-19 (Coronavirus) to ensure we continue providing the best care and service to our members, provider partners, and employees. We rely on the guidance from our medical directors, our parent company, Cone Health, the Centers for Disease Control and Prevention, and the NC Department of Health and Human Services.
Updates for our PPO and HMO Products
The following is effective March 16, 2020 through the end of declared Public Health Emergency (PHE). At that time, we will re-evaluate and communicate with our network.
COVID-19 Vaccine Information
Medicare Advantage Coverage and Reimbursement
- For Calendar Years (CYs) 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration for beneficiaries enrolled in Medicare Advantage plans will be made through the original fee-for-service Medicare program.
- This means that any COVID vaccine and the administration of the COVID-19 vaccine must be submitted to original Medicare, and NOT to HealthTeam Advantage until further notice.
For additional information, please call your provider concierge at 855-218-3334.
U0001 (CDC test) allowable of $35.91
U0002 (non-CDC test) allowable of $51.31
87635 (CPT for non-CDC test – confirmed that Quest and LabCorp will be using) allowable of $51.31
Modifiers Required: NONE
Date of Service: ANY until further notice
Place of Service: ANY
Member liability: ZERO
Telehealth Coverage Expanded**
Click here for the expanded covered codes.
Place of Service: 02 (The location where health services and health-related services are provided or received, through a telecommunication system.)
Modifiers required: NONE
Date of Service: 3/16/2020 through the end of the declared Public Health Emergency.
Member liability: ZERO
Methodology: Video and audio capabilities preferred (Skype and FaceTime accepted). Telephonic accepted if video unavailable.
* Wellness visits should include all required elements with the exception of a few components unobtainable through video services.
** This is in addition to our MDLive benefit which is available to our members free of charge via https://mdlive.com/hta
Network pharmacies can bypass the refill too soon edit by entering a submission clarification code (SCC) of 13 (i.e. override code). The SCC=13 is an override due to a state of emergency. By entering the code, the member is able to get the medication and the plan is able to do reporting on the number of prescriptions processed via the emergency declaration. The member will still be responsible for the applicable cost-share. In addition, many network pharmacies (i.e. Walgreens) are providing free delivery to their customers. Members will need to check with their pharmacy to see if home delivery is available.
The pharmacies were notified via a fax blast about the implementation of the override code. However, if a pharmacy processes a claim early, they will see the message below when the claim rejects:
ANDA;T2;RTS — Rx: 7581097 DT: 23-JAN-2020
DS: 90 RD: 23-MAR-2020; IF A PUBLIC HEALTH EMERGENCY, USE THE SCC OF 13 TO OVERRIDE THE 79 REJECT.
Claims Submission and Contact Information
- CS Modifier Required on All COVID-19 Testing Related Services
- COVID-19 Vaccine and Antibody Treatment Codes
- COVID-19 Vaccine Toolkit
- How/When to Bill U07.1 for COVID-19
- CDC’s Official Coding and Reporting Guidelines
- Medicare Telemedicine Fact Sheet
- Medicare Learning Network (MLN) Booklet on Telehealth Services
- Tips for keeping your practice in business during the COVID-19 pandemic
- Economic Relief Resources–North Carolina Medical Society
- Disaster Loan Applications–US Small Business Administration
- Coronavirus Small Business Guide–US Chamber of Commerce
Suspension of 2% Medicare Sequestration
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a bill designed to provide financial support and resources to individuals and businesses affected by the COVID-19 pandemic, was signed into law on March 27, 2020 and extended on December 27, 2020.
Under the Act, the 2% sequestration of Medicare payments was suspended effective May 1, 2020, through March 31, 2022.
Beginning April 1, 2022 through June 30, 2022 we implemented the 1% payment adjustment. Beginning July 1, 2022, the full 2% payment adjustment is effective.
HealthTeam Advantage has followed CMS regulations regarding the suspension and reinstatement of the sequestration as outlined above.
- NC Department of Health and Human Services
- Cone Health Coronavirus Information
- Centers for Disease Control and Prevention Coronavirus Information
- NC Poison Control
NC hotline (answers to general, non-emergency questions about novel coronavirus) 866-462-3821