Thank you for everything you’re doing for our members during the COVID-19 pandemic. Information is changing rapidly, so I’m sending you this letter with updates and changes on three topics.
COVID-19 pre-surgical asymptomatic screening
As you prepare to perform elective surgeries and procedures again, HMSA has decided to cover COVID-19 pre-surgical testing of asymptomatic patients with no cost share as of April 1, 2020. HMSA's decision to support the testing of patients heading into procedures, regardless of whether or not they're showing symptoms, was made to ensure the safety of hospital staff, other patients, and the community.
This temporary exception is for all fully insured commercial, Medicare Advantage, and QUEST Integration plans.
This exception covers COVID-19 RT-PCR testing (U0001, U0002, U0003, U0004, 87635) for asymptomatic patients before a surgery or procedure when rendered by a participating provider. Include one of the following ICD-10 diagnosis codes in the primary position on the claim:
- Z01.812 Encounter for preprocedural laboratory examination.
- Z01.818 Encounter for other preprocedural examination.
HMSA coverage will include the negotiated rate for the test and the cost share for all fully insured commercial, Medicare Advantage, and QUEST Integration members through June 30, 2020. At the end of the three-month exception period (June 30), we’ll review this decision and determine if the period needs to be extended.
HMSA is required by state and federal law to cover health care only when it’s medically necessary, as defined in the Hawaii Revised Statutes (HRS). SARS-CoV2 antibody testing (serology) isn’t medically necessary at this time and therefore isn’t a covered benefit.
A test is medically necessary under HRS 432 when it serves to diagnose or treat a medical condition such as an infection. Since the antibody isn’t approved or able to detect the active viral infection and that its intended primary purpose is to aid in public health efforts through community surveillance, it’s not a health plan benefit at this time.
HMSA pays for diagnostic tests for COVID-19 following guidance from the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the Hawaii Department of Health (DOH).
HMSA fully supports clinical advancements that improve the diagnosis, treatment, and prevention of COVID-19. However, while antibody testing may play an important public and occupational health role in the way we track COVID-19 cases and reopen the state and nation, antibody testing isn’t currently recognized by CDC, FDA, or DOH as a valid diagnostic test for detecting the virus that causes
We recognize that this is a rapidly changing environment and will continue to monitor the latest guidance from the CDC, FDA, and DOH to determine which tests are medically necessary. As the guidelines and recommendations evolve, we’ll continue to re-evaluate our policies.
Cost-share waiver effective and end dates
The cost-share waivers for COVID-19 were set to end at different times in the coming weeks. We have decided to extend the waivers through June 30, 2020. Here are the new end dates for the different waivers:.