Covid-19 Updates

May 19, 2022

FDA Limits Authorized Use of Janssen COVID-19 Vaccine

The U.S. Food and Drug Administration (FDA) on May 5, 2022, limited the authorized use of the Janssen COVID-19 vaccine to the following individuals: 

• Those who are 18 or older and for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate; or,
• Those 18 or older who elect to receive the Janssen COVID-19 vaccine because they would otherwise not receive a COVID-19 vaccine.

The FDA in its announcement cited the risk of thrombosis with thrombocytopenia syndrome (TTS), a syndrome of rare and potentially life-threatening blood clots in combination with low levels of blood platelets, with onset of symptoms approximately one to two weeks following administration of the Janssen COVID-19 vaccine. 

Additional information about this update is available from the FDA:

• Janssen COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers
• Fact Sheet for Recipients and Caregivers

Refer to our COVID-19 Vaccines page for additional vaccination-related information.

March 23, 2022

LTACH and SNF Streamlined Admission Process for COVID Patients Ending March 31, 2022

Effective April 1, 2022, we are resuming our standard admission process for long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) for all Blue Cross and Blue Shield of Alabama members.

We are not extending the streamlined admission process for LTACHs and SNFs for Blue Cross members with a specified COVID-19 diagnosis beyond March 31, 2022.

We will continue to monitor admission rates related to COVID-19 and consider changes to our admission policy accordingly.

Visit our COVID-19 Treatment page for other treatment information.

December 6, 2021

COVID-19 Vaccine Codes Added

We have updated our COVID-19 Vaccines page with newly added codes related to vaccines authorized for use. Refer to this webpage for a list of current vaccine codes and other vaccination-related information.

December 6, 2021

Claims Update for COVID-19 Vaccines and Monoclonal Antibodies

Effective January 1, 2022, providers who give COVID-19 vaccinations or administer monoclonal antibody treatment to patients enrolled in a Medicare Advantage plan, including Blue Advantage®, should submit claims to the Medicare Advantage plan.

Starting in 2022, Medicare Advantage Organizations (MAOs) and Medicare-Medicaid Plans (MMPs) must pay for the COVID-19 vaccine and its administration (including approved booster doses) without cost sharing for beneficiaries enrolled in their plans, which includes Blue Advantage.

This update also applies to the therapies and administration of monoclonal antibody treatments for patients enrolled in a Medicare Advantage Plan, including Blue Advantage.

September 1, 2021

Warnings About Use of Ivermectin to Treat COVID Patients

Effective August 26, 2021, Blue Cross and Blue Shield of Alabama implemented a prior authorization for ivermectin that requires a U.S. Food and Drug Administration (FDA) labeled or CMS-approved indication for coverage.

In recent weeks, the FDA, the World Health Organization (WHO) and other leading agencies have issued warnings about the use of ivermectin to treat patients with COVID-19.

Refer to the "Prescription Medication Updates" section on our COVID-19 Treatment page for links to information published by these agencies and a list of important things to consider about the use of ivermectin.

September 1, 2021

Resources: Monoclonal Antibodies for COVID-19

The use of monoclonal antibodies is increasing as a treatment to help reduce hospitalization and death in high-risk COVID-19 patients, as well as to prevent certain other patients who have been exposed from developing COVID-19.

Here are some important resources about the use of monoclonal antibodies as a treatment related to COVID-19:

• National Institutes of Health (NIH) Guidelines: Refer to the NIH’s Anti-SARS-CoV-2 Monoclonal Antibodies webpage for detailed information about guidance.
• Therapeutics Distribution Locations: The U.S. Department of Health and Human Services maintains a website to help locate treatment facilities where recent shipments of monoclonal antibodies have been delivered.
• Coding Information: Refer to our COVID-19 Treatment webpage for codes and other information related to these treatments.

September 1, 2021

Experts Recommend Pregnant Women Get COVID Vaccine

The Centers for Disease Control and Prevention (CDC) along with various Alabama healthcare organizations are strongly recommending that pregnant women get the COVID-19 vaccination.

“A new CDC analysis of current data from the v-safe pregnancy registry assessed vaccination early in pregnancy and did not find an increased risk of miscarriage among nearly 2,500 pregnant women who received an mRNA COVID-19 vaccine before 20 weeks of pregnancy,” the agency said in an August 11, 2021, statement.

The Alabama Perinatal Quality Collaborative issued a statement in August: “We urge those caring for pregnant and lactating women to counsel their patients on the benefits of vaccination. The literature supports the safety of vaccination in individuals, before, during, and after pregnancy.”

The Alabama Department of Public Health (ADPH) issued a recommendation on August 24, 2021, citing vaccination support from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

The ADPH “joins these organizations in strongly urging all pregnant individuals, along with recently pregnant, planning to become pregnant, breastfeeding and other eligible pregnant women to be vaccinated against COVID-19.”

August 20, 2021

Third-Dose Vaccine Codes Added for Pfizer, Moderna

We have updated our COVID-19 Vaccines page with codes for third-dose administration of the Pfizer-BioNTech and Moderna vaccines effective August 13, 2021.

On August 12, 2021, the U.S. Food and Drug Administration amended the emergency use authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines to allow an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.

On August 13, 2021, the Centers for Disease Control and Prevention endorsed the Advisory Committee on Immunization Practices’ recommendation for the use of an additional dose of the COVID-19 vaccine for people with moderately to severely compromised immune systems after an initial two-dose vaccine series.

Refer to our COVID-19 Vaccines page for a list of current vaccine codes and other vaccination-related information.

April 26, 2021

Federal Guidance on COVID-19 Vaccine Administration

The U.S. Department of Health and Human Services’ Office of Inspector General has issued an announcement about COVID-19 vaccination administration that includes the following guidance:

• The vaccine must be administered at no cost to recipients.
• Providers may not charge an office visit or other fee if the COVID-19 vaccine is the sole medical service provided.
• Providers may not seek any reimbursement, including through balance billing, from the vaccine recipient.

You can read the entire announcement at oig.hhs.gov/coronavirus by clicking the headline “Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance” dated April 15, 2021.

Visit our COVID-19 Vaccines page for additional vaccination information.

April 14, 2021

Promote COVID-19 Vaccinations – Help End the Pandemic

As the COVID-19 pandemic continues, vaccinations are a critical step in resolving this public health crisis by helping to prevent serious illness and limit the spread of the virus.

We invite you to play this one-minute video on your waiting room televisions, website or social media channels to help educate your patients about the importance of the vaccines. We ask that you join us in support of these critical vaccinations.

Visit our COVID-19 Vaccines page for additional vaccination information.

March 10, 2021

Janssen COVID-19 Vaccine Information Available

Our COVID-19 Vaccines page includes new information related to the Janssen vaccine that has received emergency use authorization from the U.S. Food and Drug Administration.

Important note about Blue Advantage^® members: Providers administering COVID-19 vaccines to Blue Advantage members must submit those claims to the CMS Medicare Administrative Contractor (MAC) for payment.

February 5, 2021

Important COVID-19 Message from our Medical Directors

COVID-19 continues to cause alarming rates of hospitalizations, severe illness, even death. Vaccines are critical to address this ongoing public health crisis. That’s why frontline healthcare workers – physicians, clinicians, nurses, pharmacists and others – have been given vaccination priority.

Please read this message from Blue Cross and Blue Shield of Alabama Medical Directors about the importance of healthcare workers getting vaccinated and, as the availability of vaccines increases, encouraging their patients to do the same.

Refer to our COVID-19 Vaccine page for a list of current vaccine codes and other vaccination-related information.

January 29, 2021

COVID-19 Testing for Surveillance Purposes Not Covered

As COVID-19 vaccines increasingly become available to the public in Alabama, we want to remind providers that testing for surveillance purposes is not covered, whether conducted separately or in conjunction with the vaccine administration. We do not cover COVID testing to determine vaccine effectiveness.

As stated on our COVID-19 Testing page, here are the coverage guidelines:

Covered

Medically Appropriate COVID-19 Testing – Testing to detect or diagnose COVID-19 in an individual when there is presence of a potential COVID-19 symptom or actual or suspected exposure to a person with COVID-19.

Non-Covered

Surveillance COVID-19 Testing – Testing for patients to return to work or school to rule out the possibility of COVID-19 in the absence of symptoms or exposure. Federal government guidance on this legislation issued June 23, 2020, states that group health plans and insurers are not required to pay for COVID-19 tests that are ordered for surveillance purposes. 

December 15, 2020

CPT Code 99072 Not Billable 

We do not reimburse providers for CPT code 99072, which is defined as: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.”

Code 99072 has been added to our List of Procedures and Services Not Separately Paid, which outlines CPT and HCPCS codes that are not separately payable services.

December 9, 2020

DME Update: Oxygen Therapy

In response to the ongoing COVID-19 public health emergency, the suspension of the oxygen saturation requirement for both certification and recertification has been extended through the end of the federal public health emergency.

Refer to our COVID-19 Treatment page for additional treatment information.

December 4, 2020

Important Telehealth Policy Update

In response to the ongoing COVID-19 pandemic, expanded telehealth services coverage for eligible Blue Cross members including Blue Advantage^® will continue through the end of the federal public health emergency. Continue to check our COVID-19 Provider Update Center for important announcements.

Because benefits can vary depending on a member’s plan, it’s important to always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details.

September 8, 2020

Avoid Common COVID-19 Billing Issues

During our response to the COVID-19 pandemic, we have not waived standard documentation or medical necessity policies. It is important that providers review medical record documentation and avoid the following common inappropriate billing scenarios: 

• Do not bill specimen collection HCPCS code G2023 with a Level 2 or higher evaluation and management (E/M) service. The specimen collection is included with the E/M service.
• Do not bill a Level 2 or higher E/M code if the patient is not seen by a billable practitioner.
• Do not submit a claim for a telehealth visit if:
  • the phone call is part of normal practice operations (scheduling, refill request with no changes),
  • the billing practitioner does not personally speak to the patient, or
  • the minimum medical necessity and documentation requirements are not met during the call.

September 8, 2020

COVID-19 Panel Testing 

As the demand continues for COVID-19 testing, we are advising providers that panel testing should be ordered only if it is medically necessary for the patient. Routinely performing respiratory panels is not appropriate in the absence of supportive clinical symptoms. In most cases, only a specific test to determine the presence of COVID-19 is needed.

At some point in the near future, medical necessity reviews may be used to determine if panel tests given to patients were needed. Providers who order panel tests should note in the medical record the reason for such a test.

Refer All Tests to In-Network Laboratories

All Blue Cross and Blue Shield of Alabama participating providers are required per their contract to refer to in-network laboratories. A list of in-network labs is available at AlabamaBlue.com/providers/FindALab.

Review our COVID-19 Testing page for additional information, including our guidance on surveillance vs. diagnostic testing coverage.

July 29, 2020

Attention Blue Advantage^® Providers: Use Appropriate Codes for Telehealth E/M Services

Providers must use correct codes to indicate whether audio and video equipment or audio only was used when performing evaluation and management (E/M) services via telehealth for Blue Advantage patients. Refer to our Telehealth Coverage Guidelines page for details.