Provider Update: The End of the COVID-19 Public Health Emergency (PHE) 

Most things stay the same with your health plan, but you may see a few changes.

Here is what you need to know.

Due to the end of the COVID-19 federal public health emergency (PHE) on May 11, 2023, we have updated our Telehealth Billing Guide for Providers.

Refer to this document and our Telehealth and Remote Access Telemedicine policy on ProviderAccess for post-PHE guidance. These documents as well as other related information are located on our Telehealth and Remote Access Telemedicine webpage on ProviderAccess.

Certain benefits for your Blue Cross and Blue Shield of Alabama patients may change as a result of the PHE ending. Always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details for your patients.

You can continue to reference our COVID-19 Provider Update Center on ProviderAccess. The COVID-19 banner link will be removed from the top of the ProviderAccess homepage, but links to this section as well as the Telehealth and Remote Access Telemedicine Policy webpage are available by selecting the Resources tab and looking under Policies & Guidelines.

Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association.

As of May 12, 2023, normal cost-sharing applies for COVID-19 diagnostic testing, testing related services and telehealth.* We will no longer cover OTC COVID-19 home tests. Members may purchase OTC tests with their HSA/FSA accounts. The government will continue to provide vaccines/boosters and treatments (i.e., Paxlovid) at zero cost sharing until their supplies run out. Once the supplies run out, the cost will transition to the private market.

Preventive/Immunization benefits will apply to FDA-approved (including EUA) COVID-19 vaccines/boosters. ACIP and the CDC have already updated the 2023 recommendations to include COVID-19 vaccines/boosters.

*Telehealth services billed by a provider with a POS code 02 are based on the Medicare fee schedule for telehealth services provided in a facility. The Medicare fee schedule for telehealth services in a facility (POS code 02) is reimbursed at a lower amount than telehealth services provided in the patient’s home (POS code 10).

The federally declared public health emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023. This will result in changes in coverage and cost-sharing requirements for members of Arkansas Blue Cross and Blue Shield’s and Health Advantage’s fully insured health plans, as described below.

Please note: Coverage and cost-sharing changes for members of self-funded health plans administered by BlueAdvantage Administrators of Arkansas or Health Advantage are determined by the employers or plan sponsors who fund those self-funded plans. If you have questions about coverage for such plans, please call the number on the back of the health plan member’s ID card.

Member cost-sharing for COVID-19-related services
On May 11, 2023, federal mandates for coverage (without member cost-sharing) of certain healthcare services will end. Affected services rendered May 12, 2023, and thereafter will be subject to member cost-sharing requirements of the member’s plan (copays/deductibles/coinsurance, etc.). This resumption of member cost-sharing requirements for covered services includes:

• Clinical encounters associated with COVID-19, including
  • office visits
  • urgent care clinic visits
  • emergency department visits
  • telemedicine visits
  • lab evaluations performed in conjunction with any of the above-listed types of clinical encounters
• Diagnostic lab testing for COVID-19 performed in a medical setting – including eligible specimen collection
• Pharmacy-based diagnostic lab testing for COVID-19 performed by pharmacists – including eligible specimen collection
• All U.S. Food and Drug Administration-approved therapeutic agents used to treat COVID-19 – e.g., Veklury

This resumption of member cost-sharing requirements will not include (meaning that members will not be subject to cost-sharing):

• ƒ The cost of COVID-19 vaccines that have been approved by the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).
• Charges for administration of ACIP-approved COVID-19 vaccines – which are covered as preventive services and therefore do not require cost-sharing for most members.

Coverage for at-home COVID-19 test kits Coverage for such tests will end May 11, 2023. Specimen collection codes Healthcare Common Procedure Coding System (HCPCS) specimen collection codes G2023 and G2024 will no longer be covered after May 11, 2023, and claims containing those codes will be denied. Monoclonal antibodies There currently are no monoclonal antibody treatments approved for COVID-19. Accordingly, any related services rendered May 12, 2023, and thereafter will not be covered. High-throughput testing The following HCPCS codes no longer will be covered after May 11, 2023, for any provider at any place
of service:

• U0003
• U0004
• U0005

Out-of-network COVID-19 testing
After May 11, 2023, there will be no coverage for COVID-19 tests performed by entities that are not contracted participants in our health plans’ provider networks. Fee schedule pricing will be applied to covered lab codes only.

Prior authorization/medical management
Laboratory services for which prior authorization requirements were suspended due to the public health emergency will be subject to such prior authorization requirements beginning May 12, 2023.