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PEIA Policy for COVID-19 - Updated


PEIA Policy for COVID-19
3/10/2020(updated 3/19/2020)
Coronavirus 2019 (COVID-19) is a respiratory illness caused by a novel corona virus designated SARS-CoV-2.  The outbreak of COVID-19 originated in Wuhan City, Hubei Province, China.  With thousands of confirmed cases being reported in a rapidly growing number of countries worldwide and the number of national cases growing, the West Virginia Public Employees Insurance Agency (PEIA) is establishing this policy to support the health and safety of our members.
Diagnosis and Testing
Effective with date of service 3/01/2020 and after, PEIA will cover COVID-19 testing at a network provider, at 100% of the contracted allowance, for members who meet CDC guidelines for testing.  This will apply to PEIA PPB plans A, B, C and D.  This means the members will have no deductible or coinsurance for the actual test.  Deductibles, copayments, and coinsurance will also be waived for any physician or facility services incurred in the process of being tested. 
Treatment of any members, who test positive for the virus, will be covered at normal benefit levels.
Temporary Expansion of Telemedicine Benefit
For the next 60 days, PEIA is going to allow office visits and psychotherapy, for established patients, to be performed directly between the providers and patients via video conference or telephonically. 
PEIA is waiving the requirement of an Originating Site for these services but are limiting the office evaluation and management codes to 99211, 99212, and 99213.  Higher intensity codes 99214 and 99215 will still only be allowed for face to face visits.
PEIA would prefer the E&M codes billed for telemedicine service be billed with modifier GT or 95.
This real time interaction must be between the licensed provider and the patient.  Communication with office staff cannot be billed under an Evaluation and Management code.
This is in addition to our current Telehealth Policy which can be found at
Pre-Certification, Preauthorization and Prior Approvals
Because many elective procedures are being delayed, PEIA is going to automatically expand the time frame for any current approvals to 12/31/2020.  This means if a current pre-certification, preauthorization or prior approval is in place for a procedure scheduled for April 1, 2020 and that procedure is delayed, there is no need to call to reauthorize that procedure.  The current authorization will still be valid.
Early Refills for Medications
During the current State of Emergency, PEIA is allowing early refills of medications.  A pharmacy may contact the CVS Caremark Help Desk at 1-800-364-6331 or the member may contact CVS Caremark at 1-844-260-5894, to request an early refill.
If pharmacies are experiencing restricted orders from their wholesalers and are unable to fill ninety-day supplies of maintenance medications, they may contact the CVS Caremark Help Desk to request an override to allow a thirty-day supply.
Other Important Information
The CDC is periodically updating who should be tested.  Please refer to the following link for the latest updates.
If you believe you have been exposed to or have symptoms consistent with COVID-19, please call your local health department, primary care provider or iSelectMD for further instructions.
West Virginia has set up a hotline for its citizens and providers for up to date and accurate information regarding COVID-19.   The hotline is toll-free and operators are available 24/7 at 1-800-887-4304. 
In addition, Optum, part of UnitedHealth Group, is opening its Emotional-Support Help Line. Professionally trained, mental health staff are there to support people who may be suffering from fear or stress created by COVID-19. Optum’s Emotional-Support Help Line number is 866-342-6892 and will be open 24 hours a day, seven days a week. The service is free of charge and open to all PEIA members. 

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