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Coronavirus Updates

March 2020 – Maryland Physicians Care (MPC) has been working in close partnership with Maryland Department of Health (MDH) in addition to other government authorities to serve and protect patients during the COVID-19 outbreak. MPC is dedicated to ensuring that our members and providers have the most up-to-date information to protect themselves and their families from COVID-19. MPC will implement all MDH HealthChoice Program requirements regarding COVID-19. Visit the MDH website for the latest Medicaid information during the COVID-19 outbreak. Check back often for updates.

Providers who will provide the COVID-19 vaccinations must report to Immunet according to Executive Order 21-01-05-01. Review the MDH Quick Reference Guide here. Find additional information on reporting to Immunet here.

For more information about discussing the vaccine with patients, please see MDH’s Vaccine Communications and Outreach Strategies in Primary Care toolkit.

Maryland GoVAX COVID-19 Vaccination Support Center

1-855-MDGOVAX / 1-855-634-6829
7 a.m. to 10 p.m. / 7 days a week

The Maryland Department of Health opened the Maryland GoVAX COVID-19 Vaccination Support Center to make COVID-19 vaccine appointments and information easily available for Marylanders without internet access. Marylanders who have internet access can visit covidlink.maryland.gov to connect with an advocate.

Provider COVID Vaccine Update

Coverage for COVID Vaccine and Administration

Vaccination products are being made available at no cost to all willing providers by the federal government. MPC will accept the products at zero cost and administration codes in accordance with MD Medicaid rates:

91300 – Pfizer vaccine product code
91301 – Moderna vaccine product code
0001A – Pfizer vaccine administration code; first dose, – Reimbursement MD FFS Rate
0002A – Pfizer vaccine administration code; second dose – Reimbursement MD FFS Rate
0011A – Moderna vaccine administration code; first dose – Reimbursement MD FFS Rate
0012A – Moderna vaccine administration code; second dose Reimbursement MD FFS Rate

Infusion Therapy – Hospital Providers

Infusion therapy done in a hospital setting MPC will require prior authorization for the administration M codes. MPC will accept the following product and administration codes for infusion therapy in accordance with MD Medicaid rates: (SEE HSCRC COVID Memo guidance)

Q0239 – Eli Lilly vaccine product code
M0239 – Eli Lilly administration code – MPC requires prior authorization, payment at MD Medicaid Rate
Q0243 – Regeneron vaccine product code
M0243 – Regeneron administration code – MPC requires prior authorization, payment at MD Medicaid rate

Federally Qualified Health Centers – COVID Vaccination and Administration

Effective February 1, 2021 MD Medicaid will reimburse FQHCs for administration of COVID vaccinations, when vaccine administration is the sole purpose of the patient’s visit. If the vaccination is administered during a somatic office visit, it will be reimbursed as part of the cost-based rate for that visit.

MD Medicaid will allow for the COVID vaccination and administration to be billed separately without an office visit and will reimburse for the vaccination at zero cost and the administration at the MD Medicaid Rate.

MPC will accept the following vaccination and administration codes from FQHCs in accordance with MD Medicaid rates:

0001A – Pfizer first dose
0002A – Pfizer second dose
0011A – Moderna first dose
0012A – Moderna second dose

Retail Pharmacy

The Maryland Department of Health has made the distribution of the COVID vaccination through retail pharmacies within Maryland Physicians Care pharmacy network. The vaccine may be available at certain Walgreens and CVS locations. Please visit the state’s website to locate vaccination sites. Coronavirus – Maryland Department of Health – Vaccine

Skilled Nursing Care

MDH revised guidelines for FFS nursing home admissions. Currently MPC continues to require notification of transfer from a hospital to nursing facility. Hospitals are not required to obtain Preadmission Screening and Resident Review (PASRR) approval prior to requesting a transfer to a skilled nursing facility, as indicated for certain individuals.

Coverage for Testing

Updated 4/24/20

New testing codes
MPC will accept the additional testing codes recently released and will reimburse in accordance with the MD Medicaid rates:

U0003- Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R

U0004- 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R

G2023: Specimen collection for SARS-CoV-2, any specimen source

G2024: Specimen collection for SARS-C0V-2 from an individual in a SNF or by a laboratory on behalf of a Home Health Agency, any specimen source

MPC will cover COVID-19 testing and screening services to members with no associated member cost share. To ensure that our members receive the care they need as quickly as possible, MPC will not require prior authorization for par and non-par providers.  The Maryland Department of Health (MDH) has issued guidance on the codes and rates for COVID-19 testing.   MPC will accept claims with the following codes to represent COVID-19 testing:

U0001 – Used specifically for CDC testing laboratories to test patients for SARS-CoV-2

U0002 – Allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19)

87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique

MPC will pay the MD Medicaid rates for these codes.  Any claims processed prior to MDH establishing its Medicaid rate will be paid at 30% of billed charges and later adjusted accordingly.

Coverage for Telehealth Visits

MPC covers telemedicine (audio and video) visits per the MDH guidance. Prior authorization is not required for any participating provider. Remote patient monitoring (RPM) still requires prior authorization.

Updated 5/12/20

MDH provided guidance regarding coverage of physician services via audio only telehealth during the COVID-19 State of Emergency. After review of the guidance, MPC has expanded the codes allowed to be billed using audio only telehealth.

The following CPT codes are billable to MPC for Physician services rendered via audio only telehealth using the UB modifier

  • 99110
  • 99211-15
  • 99391-96

Updated 5/7/20

On May 4, 2020, MDH issued guidance on Well-Child Visits and Preventive Care during the COVID-19 State of Emergency with specifics regarding the types of visits and coding acceptable via audio/video telehealth services. MPC will be following the MDH guidance regarding the coding and use of telehealth services for Well-Child visits. Please refer to the MDH notice for more information.

On April 27, MDH issued guidance to address questions regarding how hospitals should submit claims for services delivered via telehealth. MPC will be following the MDH guidance. Please refer to the MDH notice for more information.

Updated 3/27/20

Therapy Services

On March 27, MDH issued guidance regarding use of telehealth for Physical Therapy, Occupational Therapy, Speech/Language Pathology and Nutrition Counseling during the state of emergency. MPC will cover these services in accordance with MDH guidance. MPC requires the therapy modifier per the communication previously shared.

Per the MDH guidelines, therapy services provided via telehealth will also require the GT modifier in the second modifier position. Prior authorization for therapy services is required for all providers.

Please note that it is the provider’s responsibility to ensure services are delivered via the guidelines established by MDH.

Teledentistry Services

On March 30, MDH released guidance regarding Dentistry services via telehealth during the state of emergency. For MPC members age 21 and over, MPC’s Dental provider, DentaQuest will allow teledentistry services in accordance with the MDH guidelines, as part of MPC’s value added adult benefit coverage.

Updated on 3/25/20

On March 21, MDH issued further guidance to authorize the reimbursement of audio-only health care services for SOMATIC health care providers and to grant further flexibility regarding the use of HIPAA-compliant telehealth technology during the state of emergency. Providers MUST comply with the MDH medical record and member consent documentation requirements found on the MDH website COVID-19 transmittals. MPC will cover audio-only services during the state of emergency in accordance with the MDH guidance. Prior authorization is not required for any licensed physicians and CRNPs. Visit the MDH website for specific guidelines under Provider Updates. MDH will issue future guidance regarding the applicability to other provider types such as therapy providers not currently included in these provisions.

Diagnosis Coding for COVID-19

Updated 4/1/20

The ICD-10 code U07.1 for COVID-19 has been configured in MPC’s systems.

Personal Protective Equipment (PPE)

Updated 6/1/20

MDH revised guidelines for FFS nursing home admissions. Currently MPC continues to require notification of transfer from a hospital to nursing facility. Hospitals are not required to obtain Preadmission Screening and Resident Review (PASRR) approval prior to requesting a transfer to a skilled nursing facility, as indicated for certain individuals.

Balance Billing MPC Members is Strictly Prohibited

Balance billing MPC members or their family members for any portion of these costs is not acceptable and strictly prohibited. Provider(s) may only bill MPC for Medicaid program covered services only. Costs associated with the purchase of personal protective equipment (PPE) are not eligible for reimbursement per MDH guidance.

All Healthcare Providers Must Obtain Personal Protective Equipment (PPE)

Providers resuming elective and non-urgent medical procedures are expected to maintain at least one week’s supply of personal protective equipment (PPE) for themselves, staff, and as appropriate, for patients. For those providers who may be unable to provide PPE for themselves, staff, and patients where appropriate are expected to limit patient care to urgent and non-elective procedures and appointments.

MDH guidelines require all healthcare providers to be able to obtain personal protective equipment (PPE) from standard supply chains.

Personal Protective Equipment (PPE) Supplier List

Providers continue to have the ability to request MDH assistance with obtaining personal protective equipment (PPE) for non-elective medical procedures and urgent appointments. To request personal protective equipment (PPE) and other health related equipment except ventilators, providers must complete an Emergency Medical Material Request Form and send it to their local point of contact. This service is available for non-elective or urgent medical procedures only.

Prescription Medication Access

MPC will allow a 14-day emergency fill during the state of emergency excluding controlled substance medications.

Medications requiring prior authorization and other restrictions:

Medication Prior Authorization Required Exceptions
Chloroquine Yes Restricted to non-COVID-19 uses, exception existing medication
Hydroxychloroquine Yes Restricted to non-COVID-19 uses, exception existing medication
Ribavirin No Requires Hep C medication co-dispensing
Darunavir Yes Requires HIV diagnosis

MPC allows medication refills after 75% of the days’ supply is used.

MPC has established clinical criteria for the use of hydroxychloroquine and cholorquine (effective 4.21.2020) which can be found here. See Prior-Authorization Forms for Outpatient Pharmacy Medications Processed Through ESI.

There are no member copays for medications.

MDH PPS Medicaid Helpline Update

Updated 4/29/20

The Maryland Department of Health office of Pharmacy Services Fee-for-Service Medicaid Helpline has transitioned to a voicemail system. When callers dial 1-800-492-5231, option # 3, the system instructs them to leave a voicemail with their name, Medicaid ID number or Provider number, and contact information. Our staff will return their calls. The voicemail option is available Monday through Friday from 8 AM to 5 PM. We expect to see a higher than usual volume of inquiries due to this change.

General Health Plan Operations

Currently MPC is not experiencing any operational issues impacting members or providers. There may be opportunities to streamline processes by utilizing electronic systems instead of paper where possible.

Member and Provider Service phone lines are accessible. Provider Relations support remains available via telephone or email. To find your Provider Relations Representative, click here.

Utilization Management

MPC is following standard procedures related to prior authorization and notification for admissions. Please refer to the MPC website for prior authorization process instructions. MPC continues to recommend that requests be faxed in for prior authorization.

MPC / National Imaging Associates (NIA) for high end radiology and select pain management services offers an online tool to facilitate prior authorization for imaging. The site offers various tools to support the process including checking status of authorization. Please visit the site to register.

Claims Processing

MPC continues to process claims and provider payments with no interruptions in operations. Electronic submission should be used whenever possible to reduce the need for mailroom services. All standard claim filing guidelines apply. Participation in electronic funds transfer is recommended. Please visit the MPC website for additional information.

Appeals Processing

Member pre-service appeals:
MPC continues to process member pre-service with no change in process. Member pre-service appeals can be faxed to 866-831-0790. Please refer to the MPC website for additional information.

Provider claims appeals:
MPC continues to process provider appeals with no change in process. Claims appeals must be submitted in writing with appropriate medical records per the instructions on the MPC website.

Contact Us

Quick Reference Guide is located on our website with essential phone and fax numbers.

Last updated 4.30.2020.

Please refer to the Centers for Disease Control and Prevention (CDC)’s website for most current guidance.

The newest edition of MPC’s Provider Newsletter is now available!

click here to view

Know The Facts About Coronavirus (COVID-19)

Symptoms are flu-like, including: fever, coughing, and shortness of breath.

If you think you might have been exposed, contact your doctor immediately. You can also have a video visit with a doctor using the MyVirtualMPC app.

It is important to do everything you can to protect yourself from COVID-19.