Provider Reimbursement Available for COVID-19 Testing for the Uninsured

Monday, July 6, 2020

The South Carolina Department of Health and Human Services (SCDHHS) today announced it will begin accepting applications for a limited-benefit Medicaid coverage group newly authorized to provide reimbursement for coronavirus disease 2019 (COVID-19) testing for those without healthcare coverage. Services and individuals covered by the new COVID-19 Limited Benefit Program are limited to COVID-19 testing and diagnostic services. Instructions for providers are available below. Additional SCDHHS COVID-19-related policy changes and resources for providers are available at www.scdhhs.gov/COVID19.The Families First Coronavirus Response Act (FFCRA), which was signed into law on March 18, 2020, authorized the optional Medicaid coverage detailed in this bulletin, as well as a provider reimbursement program for COVID-19 testing and treatment through the Health Resources & Services Administration (HRSA).Recent guidance from the Centers for Medicare and Medicaid Services (CMS) indicates that CMS regards Medicaid as the primary payer for services, before the HRSA grant. More information for providers about reimbursement available through the HRSA grant is available at www.hrsa.gov/CovidUninsuredClaim.In order to be eligible for the new COVID-19 Limited Benefit Program, an individual must:

  • Be uninsured;
  • Be a resident of South Carolina;
  • Provide a Social Security number; and,
  • Have a qualifying citizenship or immigration status.

In order to receive reimbursement through the COVID-19 Limited Benefit Program, a provider must be enrolled as a Healthy Connections Medicaid provider AND the test must be rendered to an individual who has applied for and is approved for the new program. SCDHHS will reimburse enrolled providers for this new group for dates of service retroactive to March 18, 2020.Coverage for those who qualify for the COVID-19 Limited Benefit Program includes:

  • Services listed on the COVID-19 Testing Fee Scheduleand
  • An office visit (CPT codes 99201-99215 and 99381-99396) or encounter (HCPCS code T1015) related to COVID-19 testing. These office visits and encounters must be billed with a “CS” modifier.

Applications for coverage for the COVID-19 Limited Benefit Program are available here and at www.scdhhs.gov/COVID19.Providers who are not enrolled in Healthy Connections Medicaid can find information on how to enroll as a Healthy Connections Medicaid provider on the provider section of SCDHHS’ website.COVID-19 testing is a covered benefit for current Healthy Connections Medicaid members, including those enrolled in Family Planning, and current Healthy Connections Medicaid members do not need to apply for the new program.CMS has provided additional guidance related to reimbursement options created by the FFCRA, which is available here on its COVID-19 website. SCDHHS will communicate additional guidance regarding changes to the Healthy Connections Medicaid program through future Medicaid bulletins as needed. Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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