Commercial COVID-19 FAQ for providers
Get the latest information about our COVID-19 coverage.
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.
Mass General Brigham Health Plan resources
- COVID-19 Resource Center: View all our coronavirus resources, including OTC test coverage information for Commercial and My Care Family (MassHealth) members.
- Mass General Brigham Health Plan COVID-19 payment policy
Information from the CDC
The best source for credible news 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:
Frequently asked questions
Everything you need to know about caring for our commercial members during the pandemic.
Visit the MassHealth FAQ for information about MassHealth members
Table of Contents
- Vaccine information
- COVID-19 testing and treatment
- Relaxing prior authorization requirements
- Telemedicine and other technology
- Medications
- Credentialing and enrollment
- Administrative information
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.
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Vaccine information overview (Updated 5/19/2022)
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.
- Vaccine resources
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Testing and treatment overview
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.
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 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.
For information about COVID testing and treatment coverage for MassHealth members, please visit our Medicaid FAQ.
- Test site resources
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What are the current 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.
- 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 and forward)
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 and forward)
Mass General Brigham Health Plan follows ICD-10-CM Official Guidelines for Coding and Reporting and guidance from the Massachusetts Division of Insurance.
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What are the current covered COVID-19 specimen collection and lab codes? (Updated 02/16/2022)
Please reference our comprehensive COVID-19 payment policy for the specimen collection and lab codes that are covered when medically necessary and ordered by a provider.
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Telemedicine overview
To help prevent the spread of the coronavirus and support our provider partners during the public health emergency, we have expanded the scope of allowed telemedicine services and provider specialties.
In addition, to ensure continued access to care, we have removed cost sharing (copayments, deductibles, or coinsurance) for medically necessary COVID-19 telemedicine visits. As of January 1, 2021, cost sharing has resumed for non-COVID-19-related telemedicine visits with PCPs, specialists, and additional providers, such as urgent and routine care, and outpatient behavioral health services.
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How should I bill for telemedicine? (5/9/2023)
You can find complete information about billing for telemedicine in our COVID-19 payment policy.
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Does Mass General Brigham Health Plan pay for a doctor or non-physician provider to call or use other technology to communicate with a patient? Which codes should be used?
We have expanded access to telemedicine services during the COVID-19 epidemic.
For more information, please refer to our COVID-19 public health emergency telemedicine policy.
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Can I bill for a follow-up preventive visit in my office after I’ve delivered a preventive visit via telemedicine? (Updated 5/7/20)
If a preventive visit has been rendered and billed via telehealth, Mass General Brigham Health Plan does not reimburse separately for a follow-up preventive visit in your office. Vaccinations and vaccine administration are separately reimbursable.
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Does Mass General Brigham Health Plan cover drugs and therapies to treat COVID-19? (Updated 02/16/2022)
Please reference our COVID-19 payment policy for medications covered under the medical benefit.
For oral medications covered under the retail pharmacy benefit, please refer to the member's pharmacy benefit manager.
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If my patient needs a medication to treat COVID-19 that is not in the Mass General Brigham Health Plan formulary, will there be an expedited formulary exception review process?
As specific medications are developed to treat COVID-19, Mass General Brigham Health Plan follows Federal and/or State guidance for how it would be made available and for any applicable cost sharing requirements. There are currently some medications being utilized that are on our existing formulary without a prior authorization. Non-formulary prescriptions can be reviewed within 24 hours in cases of exigent circumstances. Please note COVID-19 on the request.
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Does Mass General Brigham Health Plan cover immunizations for members age 3+ at a retail pharmacy? (Updated 11/09/20)
Mass General Brigham Health Plan is committed to ensuring timely access to critical health care services for COVID-19 for our members. During the COVID-19 public health emergency, we will cover immunizations for members age 3+ at a retail pharmacy, in addition to a provider’s office. As always, we encourage members to consult their primary care provider or pediatrician regarding childhood immunizations.
Please note employers that are self-insured may not offer prescription drug coverage through Mass General Brigham Health Plan. Members should check the details of their coverage by contacting their employer, visiting the member portal, or using the Mass General Brigham Health Plan member app.
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How do I enroll new medical providers in my practice?
If you have an immediate need to credential or enroll a provider, please indicate that on your request. In addition, please indicate if this is a permanent or temporary placement at your practice.
Prior to submitting any request to enroll or credential a medical provider, please check your rosters via the Mass General Brigham Health Plan Provider portal to validate current provider enrollments to your group billing NPI.
Providers who have already been credentialed by Mass General Brigham Health Plan will not require any additional credentialing to provide services at a new location, however, they will need to be enrolled. To enroll a new provider to your group billing NPI:
- The fastest way to link an already credentialed provider to your practice is via the Mass General Brigham Health Plan Provider Portal.
- If you are not able to submit your enrollment via the Portal, please submit your HCAS form, which is available on the HCAS resource page, to healthplanPEC@mgb.org
Behavioral health providers should refer to the information on the Optum Provider portal.
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Are there additional credentialing or enrollment requirements for telemedicine services?
There are no additional credentialing or enrollment submissions required for a medical provider that is enrolled in the Mass General Brigham Health Plan network to provide telemedicine services. Please refer to our public health emergency telemedicine policy for details.
Behavioral health providers should refer to the information on the Optum Provider portal.
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Are you adhering to standard turnaround times and prompt pay standards? (Updated 4/15/20)
Mass General Brigham Health Plan is adhering to standard turnaround times and prompt pay standards for all claims processing. Standard claim editing applies and some claims may pend for manual review. Manually reviewed claims are also subject to standard turnaround times.
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How are you reimbursing out-of-network clinicians who provide COVID-19 testing or treatment services to Mass General Brigham Health Plan members? (Updated 5/26/20)
Mass General Brigham Health Plan is paying in accordance with DOI guidelines during the public health emergency. Providers are not permitted to balance bill members for any costs above the DOI-mandated rates. This applies to fully insured and most self-insured commercial plans.
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Does Mass General Brigham Health Plan cover hospital at home services? (updated 5/19/2023)
Yes, Mass General Brigham Health Plan reimburses approved facilities for the provision of Acute Hospital Care at Home services when medically necessary and provided by a CMS approved hospital.
Read our payment policy and provider FAQ for more information.
For more information
Visit our COVID-19 Resource Center to find resources for employers and our provider FAQ.
Where can I get updates on COVID-19?
The best source for credible news on COVID-19 is the CDC. You can check their website to find the latest updates and recommendations, including resources like:
- Frequently asked questions
- Information about the disease
- Guidance for businesses and employers
- Preventing COVID-19 spread in communities
The Massachusetts Department of Public Health is also a helpful resource for more of the latest updates.
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.