COVID-19 Treatment and Cost Share Guidance

Last update: January 8, 2021, 4:00 p.m. CT

We want care providers to focus on delivering care and providing support to our members. UnitedHealthcare is implementing a cost share waiver for COVID-19-related care and treatment. Some services or facility exclusions may apply. Implementation for self-funded customers may vary. We will adjudicate benefits in accordance with the member’s health plan.

UnitedHealthcare is waiving member cost sharing for COVID-19 treatment. Treatment coverage may vary by health plan. Please review each section below for details. If a member receives treatment under a COVID-19 admission or diagnosis code, we will waive cost sharing (copays, coinsurance and deductibles) for the following: 

  • Office visits
  • Urgent care visits
  • Emergency department visits
  • Observation stays
  • Inpatient hospital episodes 
  • Acute inpatient rehab
  • Long-term acute care
  • Skilled nursing facilities

Treatment coverage may vary by health plan.  Please review each section below for details:

Medicare Advantage

  • Waiver of cost share is effective from Feb. 4, 2020 through Jan. 31, 2021 for in-network and out-of-network visits, for inpatient and outpatient COVID-19 treatment.

Individual and Group Market fully insured health plans

  • Waiver of cost share is effective from Feb. 4, 2020 through Oct. 22, 2020 for in-network and out-of-network visits.
  • From Oct. 23, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network visits and for inpatient and outpatient COVID-19 treatment.
  • Waiver of cost share for COVID-19 inpatient treatment at in-network facilities from Jan. 1, 2021, through Jan. 31, 2021.
  • Starting Oct. 23, 2020, out-of-network coverage will be determined by the member’s benefit plan.
  • Implementation for self-funded customers may vary.

Medicaid 

  • Waiver of cost share is subject to state regulations.

Medicare Advantage Plans and Individual and Group Market Fully Insured Health Plans

Between Feb. 4, 2020 and Jan. 31, 2021, if a member receives treatment under a confirmed positive diagnosis of COVID-19 or has a COVID-19 admission, providers may bill with codes U07.1 and B97.29. As of Jan. 1, 2021, providers may also bill with code J12.82 through Jan. 31, 2021.

For Medicaid plans, state regulations apply. 

For a full list of associated codes and sequencing codes for COVID-19-related visits, see the ICD-10-CM Official Coding and Reporting Guidelines.

During the national public health emergency period, UnitedHealthcare will cover the investigational monoclonal antibodies the U. S. Food and Drug Administration (FDA) has granted Emergency Use Authorization (EUA) for the outpatient treatment of COVID-19.

Prior authorization

Prior authorization is not required for administration of these monoclonal antibodies, given the potential benefit of outpatient therapeutic intervention in high-risk patients with early mild to moderate COVID-19. Typical processes and member benefits, including those related to clinical trial participation, if applicable, will apply for outpatient visits.

Billing and reimbursement

For Individual and Group Market, Individual Exchange and Medicaid health plans, when COVID-19 monoclonal antibody doses are provided by the government without charge, providers should only bill for the administration. Health care providers should not include the monoclonal antibody codes on the claim when the product is provided for free. Implementation for self-funded customers may vary.

For Medicare health plans, COVID-19 monoclonal antibody infusion claims should be submitted to the Medicare Administrative Contractor (MAC), otherwise claims will be denied if submitted to UnitedHealthcare. 

Drug name

HCPCS code

Administration code

Bamlanivimab

Q0239

M0239

Casirivimab + Imdevimab

Q0243

M0243

 

For more information, visit the Center for Medicare & Medicaid Services (CMS) Monoclonal Antibody COVID-19 Infusion page.

Member coverage and cost share

For Individual and Group Market and Individual Exchange health plans, UnitedHealthcare will waive cost sharing for the administration of monoclonal antibody treatments for in-network providers in outpatient settings through Jan. 31, 2021. Out-of-network benefits will be adjudicated according to a member’s benefit plan. Implementation for self-funded customers may vary.

For Medicare health plans, the CMS Medicare Administrative Contractor will reimburse claims for Medicare beneficiaries with no cost share (copayment, coinsurance or deductible) through 2021.

Medicaid state-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s UnitedHealthcare Community Plan website, if applicable.

Resources

For more information on administration, high-risk patients and treatment availability, please review the following resources:

For members with a confirmed positive diagnosis of COVID-19, we will waive cost sharing (copays, coinsurance and deductibles) for all COVID-19-related care during inpatient treatment. Non-COVID-19-related services will be covered in accordance with the member’s benefit plan.

For members with a confirmed positive diagnosis of COVID-19, we will waive cost sharing (copays, coinsurance and deductibles) for COVID-19 office visits, including telehealth visits, initial office visits, post-inpatient transitional visits and other visits where COVID-19 is on the claim as a diagnosis. Office visits for conditions not related to COVID-19 are not waived for cost sharing, such as an existing condition or newly diagnosed conditions not related to COVID-19.

  • Individual and Group Market Fully Insured health plans
    From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare will waive cost sharing (copays, coinsurance and deductibles) for in-network and out-of-network emergency and medically necessary non-emergency ground ambulance transportation for COVID-19-related services. UnitedHealthcare will also waive cost sharing for ground transportation from facility to facility (acute to acute or acute to post-acute) for patients with a positive COVID-19 diagnosis.

Cost share will be waived for emergency ground transportation that results in an inpatient admission for COVID-19 treatment at an in-network facility from Jan 1, 2021, through Jan. 31, 2021.

  • Self-Funded Individual and Group Market health plans   
    We will work with self-funded customers who want us to implement a similar approach on their behalf. Member cost sharing will apply.
  • Medicare Advantage 
    Coverage and cost sharing will be adjudicated in accordance with the member’s benefit plan.
  • Medicaid
    Coverage and waiver of cost share is subject to state regulations. 

Resources

Care providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals, as well as travel advisories from the U.S. State Department.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 


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Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.