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    Important: Claims billed electronically between 03/31/2023 and 04/20/2023 with CPT codes G2023 and G2024 may have rejected. This is because the original CMS code termination date was 03/31/2023. CMS has revised the termination date from 03/31/2023 to 05/11/2023 (to coincide with the end of the COVID-19 Public Health Emergency). This update was noted in the COVID-19 Payment Policy.

    While the official termination date of these codes of 05/11/23 is now in place, providers may need to resubmit claims that were originally submitted and rejected between 03/31/23 and 04/20/23. We apologize for any inconvenience. If you have any questions, please feel free to contact healthplanprovrelations@mgb.org.

    Our COVID-19 coverage policies

    If a topic isn't addressed here: Please reference our COVID-19 payment policy or follow our standard policies and procedures as outlined in our medical policies, payment policies, authorization guidelines, provider resources, or your contract. 

    Vaccine information

    Mass General Brigham Health Plan covers the administration of all COVID-19 vaccines that receive emergency use authorization (EUA) or full approval from the Food and Drug Administration (FDA), at no cost to our members. Please reference our COVID-19 payment policy for more details

    Please note that all vaccine providers administering a dose of COVID-19 vaccine in the Commonwealth must report administration to the Massachusetts Immunization Information System within 24 hours.

    Resources:

    doctor-in-face-mask-giving-vaccine-to-little-boy-who-came-to-the-picture-id1298103455

    COVID-19 testing and treatment

    Read our COVID-19 payment policy.

    In accordance with MA Chapter 260 of the Acts of 2020, we have removed copayments, deductibles, or coinsurance for medically necessary COVID-19 testing and treatment. This applies to inpatient and outpatient services at in- or out-of-network providers, including urgent care centers, emergency departments, hospitals, and other facilities. 

    Please note that employers offering self-insured plans may have different cost sharing for these services. 

    Medicare Advantage coverage

    In addition, Mass General Brigham Health Plan aligns with the Centers for Medicare and Medicaid Services (CMS) guidance for coverage and payment for the evaluation, testing, and treatment for COVID-19 for Medicare Advantage members.

    Members can log into the Member portal or call the customer service number on the back of their card for information about their plan benefits.

    Commercial and MassHealth testing coverage (updated 5/9/2023)
    Mass General Brigham Health Plan continues to follow current CDC and state public health department guidelines for testing coverage. Our members are covered without cost sharing for COVID-19 testing, when it is medically necessary and ordered by a PCP or treating provider. FDA-approved testing is also covered for commercial and Medicaid members when a person:

    • Has been identified as a close contact by a public health entity for a known or suspected exposure to COVID-19.
    • Works in an industry with increased exposure to the virus like health care, restaurant, hospitality, and retail industries.

    Testing is not covered for third party administrative reasons — including but not limited to pre-employment or return to work, public health, return to school, and travel screenings.

    Test site resources:

    • Covered diagnosis codes for COVID-19 evaluation and treatment (Updated 2/11/2022)

      Diagnosis Codes for Evaluation for suspected Covid-19

      • Z11.52: Encounter for Screening for Covid-19 through 6/30/2023.
      • Z20.822: Contact with and suspected exposure to Covid-19.

      Diagnosis Codes for Treatment of Covid-19

      • U07.1: COVID-19
      • J12.82: Pneumonia due to coronavirus disease 2019
      • M35.89 billed with B94.8/U09.9:
        • M35.89: Other specified systemic involvement of connective tissue
        • B94.8: Sequelae of other specified infectious and parasitic diseases (for dates of service through 9/30/2021)
        • U09.9: Post COVID-19 condition, unspecified (for dates of service from 10/1/2021 through 6/30/2023)

       

      If Multisystem Inflammatory Syndrome (MIS) develops as a result of a previous COVID-19 infection, assign codes M35.81 billed with B94.8/U09.9

      • M35.81: Multisystem Inflammatory Syndrome
      • B94.8: Sequelae of other specified infectious and parasitic diseases. (for dates of service through 9/30/2021)
      • U09.9: Post COVID-19 condition, unspecified (for dates of service from 10/1/2021 through 6/30/2023)

      Mass General Brigham Health Plan follows ICD-10-CM Official Guidelines for Coding and Reporting and guidance from the Massachusetts Division of Insurance.

    For more information

    The best source for information on COVID-19 is the CDC (Centers for Disease Control and Prevention). You can check their website to find the latest updates and recommendations, including resources like:

    Contact us

    Mass General Brigham COVID-19 hotline for MGB clinicians and patients: 617-724-7000 

    Mass General Brigham Health Plan staff is available at 855-444-4647, Monday to Friday (8:00 AM to 5:00 PM EST, closed 12:00 to 12:45 PM).

    For urgent prior authorization requests outside of regular business hours (including weekends and holidays), please contact us at 855-444-4647, and follow the prompts.