​DHS COVID-19 PROVIDER RESOURCES // OMAP

Medical Assistance (MA) Program Coverage of 2019-Novel Coronavirus Testing and Related Services Frequently Asked Questions (FAQs)

Issued: March 24, 2020

The Department of Human Services (DHS) understands there are concerns about the 2019-novel coronavirus (COVID-19) and has developed these FAQs to address questions regarding MA coverage of testing and related treatment for COVID-19. 

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.  

What is coronavirus? 

Coronaviruses are a large family of viruses, some causing illness in people and others circulating among animals, including camels, cats and bats. 

The 2019 novel coronavirus (COVID-19) is a new virus that causes respiratory illness in people and can spread from person-to-person. This virus was first identified during an investigation into an outbreak in Wuhan, China. 

Will the MA Program pay for COVID-19 tests? 

Yes. The MA Program will pay for COVID-19 testing when a doctor or health care practitioner determines it is needed. There are no MA copayments for laboratory tests for COVID-19. Prior authorization is not required. 

The Centers for Medicare & Medicaid Services (CMS) developed two new Healthcare Common Procedure Coding System (HCPCS) codes for providers and laboratories to use when testing for COVID-19. Procedure code U0001 is only to be used when billing for the tests developed by the Centers for Disease Control and Prevention (CDC). Procedure code U0002 is to be used to bill for non-CDC laboratory tests for COVID-19. 

These procedure codes are currently available for use on the MA Program Fee Schedule. An MA bulletin with billing information will be issued to providers. 

Providers should follow Department of Health (DOH) guidance for evaluation, testing and reporting related to a beneficiary suspected of having COVID-19 available here.

What services will the MA Program cover to treat COVID-19? 

While there is no specific antiviral treatment for COVID-19, the MA Program covers a broad range of services that help relieve symptoms. Some of the services available are:

• X-rays and diagnostic testing
• Hospital Care (Inpatient and Outpatient)
• Emergency Ambulance Transportation
• Non-emergency transportation to MA covered appointments
• Home health services
• Nursing Facility Care
• Immunizations
• There is currently no vaccine for COVID-19. The influenza vaccine does not protect against coronavirus infection; however, an annual flu vaccine can help keep you healthy during the flu season.
• Prescription Drugs
• Over-the-Counter medications for fever relief and other medications related to the treatment of virus symptoms when prescribed by your doctor or health care practitioner.
• To ensure beneficiaries have a 30-day supply of their prescription drug, refills may be covered before the refill date. 

*** MA beneficiaries under age 21 are eligible for some services that are not covered for adults, such as overthe-counter cough and cold preparations.

Will medical care related to COVID-19 have to be prior authorized? 

Not all MA covered services have to be prior authorized. For those services that do, DHS will expedite reviews for services related to COVID-19 when possible. Services may be approved for longer periods of time when necessary to ensure uninterrupted services. 

What if a provider cannot see a patient? 

MA MCOs are making sure their provider networks can handle an increase in health care services related to COVID-19. If an MA MCO does not have enough health care providers in its network with the appropriate training and experience to meet the particular health care needs of its members, MA MCOs must cover services by providers who are out-of-network. MA beneficiaries who receive services through managed care should call their MCO Member Services line if they are having difficulty obtaining services. 

MA beneficiaries in the MA Fee-for-Service Program should call the Recipient Service Center at 1-800-537- 8862 if they are having difficulty obtaining services. 

Will the MA Program pay for doctor visits provided using telehealth? 

COVID-19 is a communicable disease and some beneficiaries may prefer to receive health care services using telehealth instead of in-person. Telehealth is two-way, real time interactive communication between the patient and the doctor or other practitioner. Some services may be available using telehealth. MA beneficiaries should contact their MA MCO to see what services may be available using telehealth. 

If I am an out-of-state provider wanting to provide services via telemedicine to MA patients do I need to enroll in the Medical Assistance program? 

You may need to enroll in the PA Medical Assistance Program. If you are providing services to a Medical Assistance beneficiary with Fee-for-Service (Access) you will need to enroll in order to be paid. If you are providing services to a Medical Assistance beneficiary that has health insurance through one of the Medical Assistance Physical Health HealthChoices managed care plans you could be reimbursed as an out-ofnetwork provider. You should contact the appropriate managed care plan for more information. 

If I am an out-of-state provider who would like to enroll in the Medical Assistance Program, can I provide telemedicine services before I am officially enrolled? 

Yes, you can provide services, but please submit an enrollment application as soon as possible and request an effective date equal to the first day you provided services to the PA Medical Assistance fee-for-service beneficiary or Physical Health HealthChoices enrollee. Once enrolled, you can submit claims for payment for the services provided via telemedicine. 

Will there be copayments for medical care related to COVID-19? 

Certain services, such as those provided to children under age 18, pregnant women, and individuals who reside in a facility as well as laboratory services and emergency services do not have a copayment. Any copayments for testing, screening, and office visits related to COVID-19 will be waived.

Is there a number I can call if I have questions or need assistance? 

MA Fee-for-Service

• Fee-for-Service Recipient Call Center: 1-800-537-8862, Select Option 1, then Option 2 
• Fee-for-Service Provider Service Center – 1800-537-8862, Select Option 2, then Option 2 

MA Managed Care 

• MA beneficiaries and providers who participate in MA managed care should call their MCO.

Other DHS important contact information is available here. 

Where can I find more information about COVID-19? 

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. 

Additional information is also available on the CDC website and through CMS.