Provider Notice Issued 07/17/2020

Date:    July 17, 2020 

To:       Federally Qualified Health Centers

Re:      Lab Testing and Claim Submittal Related to COVID-19

This notice is intended to provide guidance to Federally Qualified Health Centers (FQHCs) for testing and encounter claims related to COVID-19. This billing guidance is effective with dates of service beginning March 18, 2020 and applies to claims for participants covered under both traditional Medicaid fee-for-service and Medicaid managed care plans.

Procedure code 99000 - Handling and/or Conveyance of Specimen for Transfer from the Office to a Laboratory is an allowable, billable code in the FQHC setting effective with dates of service beginning March 18, 2020.  The reimbursement rate is $23.46 when there is not a billable encounter. When there is a billable encounter, the clinic is allowed the encounter rate and the specimen collection fee will not be separately reimbursable.  For services rendered between February 4, 2020 and March 17, 2020, clinics may be eligible for claim reimbursement through the Health Resources and Services Administration (HRSA)  COVID-19 Uninsured Program. 

Billing for a patient who has fee-for-service Medicaid – FQHCs may bill via MEDI or 837P

●        Encounter billing – If a specimen is collected during a billable encounter (face-to-face with a physician, advanced practice nurse, or physician assistant), clinics should bill the encounter procedure code, T1015, the detail codes, and the specimen collection procedure code, 99000, as part of the encounter. The Department will reimburse the clinic the encounter rate. 

●        No billable encounter – If a patient presents for a specimen collection only, clinics must bill 99000 only. The Department will reimburse clinics $23.46. 

●    Clinics are not required to submit a new claim, if a specimen collection was provided during an encounter and the encounter has already been billed without the 99000 procedure code.

Billing for a patient enrolled in a HealthChoice Illinois Medicaid MCO 

●        If a patient is enrolled in a plan and the clinic is contracted with the plan, providers should refer to the plan’s billing instructions.

●        If a patient is enrolled in a plan and the clinic is not contracted with the patient’s plan, MCOs will cover medically necessary covered services provided by a non-network provider for a patient who is not on the clinic’s roster for the diagnosis and treatment of COVID-19. Providers must contact the individual plan for payment of the encounter or specimen collection only. 

Billing for an individual who has private insurance

●        Providers must bill the private insurance.

Billing for a non-insured individual

The Department is developing a portal for providers to bill the specimen collection for patients who do not have insurance. 

At this time, providers may utilize the MEDI system to verify if a patient has existing medical coverage through the Department. Providers can prepare data now to submit claims when the portal is operational; detailed instructions will follow when development is complete.

The Department will provide updated information in the near future. Providers who are not already enrolled to receive electronic notification of new releases from the Department are encouraged to subscribe.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service issues or to the applicable MMAI or HealthChoice Illinois managed care plan.

Kelly Cunningham

Interim Medicaid Administrator