DHS COVID-19 PROVIDER RESOURCES // OMAP
Medical Assistance Bulletin 09-20-05: COVID-19 Testing and Related Treatment Exempt
from MA Copayment Requirements
Effective: March 1, 2020; Issued: May 1, 2020
Important Reminder: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every five years. Providers should log into PROMISe™ to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Enrollment (revalidation) applications may be found at https://www.dhs.pa.gov/providers/Providers/Pages/PROMISeEnrollment.aspx.
Purpose
The purpose of this bulletin is to advise providers that COVID-19 testing and testing-related
services and treatment are exempt from copayment requirements, effective with dates of
service on and after March 1, 2020.
Scope
This bulletin applies to enrolled providers who render services to beneficiaries in the MA Feefor-Service (FFS) and managed care delivery systems.
Background
On March 6, 2020, Governor Tom Wolf issued a public health emergency declaration in
response to the presence of COVID-19 in Pennsylvania. On March 13, 2020, COVID-19 was
declared a nationwide emergency under the Stafford Act retroactive to January 27, 2020.
The Centers for Medicare & Medicaid Services (CMS) has said that states may waive
copayments for Medicaid services related to COVID-19 testing and treatment.
Discussion
The Department suspended copayments effective with dates of service on and after March 1,
2020, for testing services (including in vitro diagnostic products), testing-related services, and
treatments for COVID-19, including vaccines, specialized equipment and therapies (including
drugs).
MA copayments are also suspended for the following drugs/drug categories, as they may be
used in the treatment of COVID-19:
- Acetaminophen
- Antidiarrheals
- Antiemetics
- Antihistamines (Second Generation)
- Anti-infectives
• Asthma/COPD
- Ophthalmic Antihistamines/Decongestants
- Ophthalmic Lubricants
- Oral NSAIDs
Procedure
Effective with dates of service on and after March 1, 2020, COVID-19 testing and testing-related
services and treatment are exempt from MA copayment requirements. MA providers may not
collect copayments for services necessary to test for or treat COVID-19 and the amount of the
copayment will not be deducted from the amount paid to the provider.
To ensure proper payment, MA providers testing and/or treating beneficiaries for COVID-19
must include a COVID-19 diagnosis code on their MA FFS claims as described in provider
Quick Tips “ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19)”, issued on March
27, 2020 and “ICD-10-CM Official Coding Guidelines Related to COVID-19”, issued on March
17, 2020.
Providers who render services in the managed care delivery system should submit claims
according to the billing procedures of the applicable MA Managed Care Organization.
This guidance will remain in effect for the duration of the Governor's disaster declaration relating
to the COVID-19 virus. The Department may re-issue these guidelines as appropriate.
Information on MA Program coverage related to COVID-19, to include an FAQ document, can
be found on the Department of Human Services website here.
The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides
regular updates. Click here for the most up to date information regarding COVID-19.
Comments and Questions