COVID-19 Updates for Providers
New! The Secretary of Health and Human Services extended the nationwide public health emergency due to COVID-19 through April 20, 2021.
The health of our plan members and the safety of those who deliver care are our top priorities. COVID-19 is a rapidly evolving public health emergency, and we’re working closely with national, state and local health organizations.
On this page, we will post COVID-19-related updates to our operational processes, as well as other relevant information that will be pertinent to your provision of care to Peoples Health patients during this time. We’re monitoring the COVID-19 public health emergency closely and updating this site with new information as it’s available. Be sure to check back frequently for updates.
Last updated: 4/2/2021 10 a.m.
LATEST COVID-19 NEWS
FDA-Authorized COVID-19 Vaccine Information
Per the Louisiana Department of Health, all Louisianans age 16 and older are now eligible for an FDA-authorized COVID-19 vaccine. For the most up-to-date listing of participating vaccine locations, visit the Louisiana Department of Health website.
Vaccinations at participating locations are BY APPOINTMENT ONLY; patients must contact the location to make an appointment. Patients who arrive without an appointment will not be vaccinated.
Below is additional general information about FDA-authorized COVID-19 vaccine billing and coding.
- Click here for more information from the FDA on emergency use authorization (EUA) of FDA-authorized COVID-19 vaccines.
- The cost of FDA-authorized COVID-19 vaccine serums will be paid for by the U.S. government. Eligible patients receiving the vaccine will not have any out-of-pocket costs either for the vaccine or the vaccine administration, including when two doses are required. Providers should not ask patients for vaccine payment upfront or after the vaccine is received.
- Charges for FDA-authorized COVID-19 vaccine administration should be billed to the CMS Medicare Administrative Contractor (MAC). The MAC will reimburse claims for Medicare patients with no cost share through 2021. For more information, visit the CMS COVID-19 Insurers Toolkit.
- Peoples Health will reimburse for the office visit that is conducted in conjunction with FDA-authorized COVID-19 vaccine administration.
- There is a limited supply of FDA-authorized COVID-19 vaccines available. The CDC and state health agencies are managing distribution and providing prioritization on which groups of people should get the vaccine first.
- Health care professionals should use published American Medical Association (AMA) CPT® codes when submitting FDA-authorized COVID-19 vaccine administration claims to Peoples Health under the patient’s medical benefit. CPT® is a registered trademark of the American Medical Association.
- COVID-19 vaccine resources:
Sequestration Adjustments
The suspension of sequestration payment adjustments has been extended. It is suspended for claims with dates of service from May 1, 2020, through March 31, 2021.
COVID-19 FDA-Authorized Testing and Testing-Related Services Cost-Sharing Waivers Extended
In accordance with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain COVID-19 cost-sharing waivers has also been extended:
- Cost-sharing is waived for FDA-authorized COVID-19 testing—including antibody testing— conducted through April 20, 2021; tests must be FDA-authorized to be covered without cost-sharing. FDA-authorized tests include tests approved for patient use through pre-market approval or emergency use pathways, and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. Tests must be ordered by a physician or appropriately licensed health care professional.
- Cost-sharing is waived for COVID-19 testing-related services provided through April 20, 2021, if the services are provided based on a suspected COVID-19 diagnosis
Telehealth Expansion Waivers - New End Date
In line with the federal government extending the end date for the COVID-19 public health emergency to April 20, 2021, the end date for certain telehealth expansion waivers has also been extended:
- Originating site restriction waiver has been extended through April 20, 2021.
- For physical therapy, occupational therapy and speech therapy services, Peoples Health will continue to expand telehealth coverage through April 20, 2021.
Also, please note that additional CPT and HCPCS codes are eligible for use for services conducted in a telehealth setting in 2021. There are also some codes that are temporarily eligible during the COVID-19 public health emergency. For more information, review the CMS fact sheet on the CY 2021 Physician Fee Schedule Final Rule.
FDA-Authorized Antibody Testing Cost-Sharing Coverage
Peoples Health patients are covered without cost-sharing for FDA-authorized COVID-19 antibody tests when ordered by a physician or appropriately licensed health care professional.
An antibody test may determine if a person has been exposed to COVID-19, while a COVID-19 diagnostic test determines if a person is currently infected. FDA-authorized tests include tests approved for patient use through premarket approval or emergency use pathways and tests that are developed and administered in accordance with FDA specifications or through state regulatory approval. According to the FDA, an antibody test should not be used to diagnose a current infection. Virus detection should be used to diagnose a current infection. Peoples Health strongly supports the need for reliable testing and encourages health care providers to use reliable FDA-approved tests.
FQHC and RHC Claim Guidelines
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) should use the following guidelines when submitting claims for distant site telehealth services, to ensure the claims accurately indicate the services were provided via telehealth:
- For telehealth services rendered from January 27, 2020, through June 30, 2020: Include modifier 95 and modifier CG
- For telehealth services rendered between July 1, 2020, and the end of the COVID-19 public health emergency: Use the RHC/FQHC-specific G code, G2025
Claims will be paid according to CMS reimbursement guidelines for each time period. Note: FQHCs and RHCs are required, per Medicare, to waive cost-sharing for COVID-19 services, including telehealth. RHCs and FQHCs may also include the modifier “CS” on the service line for these services.
Inpatient Claims Processing With Weighted Payments
CMS has released updated, diagnosis-related group values. For contracted providers, Peoples Health is processing claims using these updated values. Claims for non-contracted providers will be processed per Medicare pricing as appropriate.
Prior Authorization for Drugs
Electronic Funds Transfer (EFT)
Did you know you can enroll in EFT to receive claims payments from Peoples Health? To learn more about enrolling in EFT or to request an EFT enrollment form, email
phn.provider@peopleshealth.com or contact your provider representative. Note that to enroll in EFT, you must also be able to receive electronic remittance advice.
Pharmacy Updates
Peoples Health is closely monitoring the drug supply chain to determine if any coverage changes are necessary.
Home Health Agencies
Home health agencies can provide more services to patients using telehealth within the 30-day episode of care, so long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. We acknowledge that the use of such technology may result in changes to the frequency or types of in-person visits outlined on existing or new plans of care.