Provider Information on COVID-19 Testing for the Uninsured

Medicaid provides coverage for some COVID-19 related services for people without insurance

Per the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, Louisiana Medicaid covers COVID-19 testing and testing-related services for uninsured individuals. Coverage is provided through a temporary Medicaid eligibility group.

Coverage for the Uninsured Eligibility Group was expanded to include vaccines and vaccine administration by the American Rescue Plan Act, effective March 11, 2021.

Who qualifies?

  • Providers must be a Medicaid enrolled provider to get paid for COVID-19 testing, testing-related services, vaccines and vaccine administration by Medicaid. They must be enrolled before the service is provided.
  • Uninsured individuals must be a Louisiana resident and cannot be undocumented, incarcerated or have other forms of medical insurance.

Which services are allowed?

Louisiana Medicaid will cover COVID-19 testing, testing-related services, vaccines and vaccine administration for uninsured individuals who qualify using the simplified application process.

Louisiana Medicaid covers commercial COVID-19 testing, vaccines and vaccine administration without restrictions or prior authorization. Reimbursement is provided at Medicare rates and this coverage is provided with no copay. A separate COVID-19 Laboratory Testing fee schedule is available at:

https://www.lamedicaid.com/Provweb1/fee_schedules/COVID-19_Fee.htm  

This fee schedule contains information specific to the procedure codes, types of service, reimbursement, and effective dates of service for covered laboratory testing related to COVID-19. It will be updated as needed throughout the COVID-19 event.

PHYSICIAN OR OTHER LICENSED PRACTITIONER SERVICES

Procedure code

Description

99201-99205

New patient visit

99211-99215

Established patient visit

T1015

FQHC/RHC visit

99281-99285

Emergency department visit

99050-99051

After hours care

 

Under CMS guidance, testing-related services are services that are directly related to the administration of a COVID-19 test or to determining the need for such a product, if needed.

How to Bill? 

The provider must self-attest on the uninsured individual’s application to Medicaid that they will not bill the federal government (through other funding for COVID-19 testing or vaccines provided through the U.S. Department of Health and Human Services) for the same service. 

If one of the COVID-19 testing-related services is performed via telehealth, modifier 95 and POS 02 are required.

To be payable, claims must be coded with at least one of the following ICD-10 diagnosis codes to indicate that they are COVID-19 related.

ICD-10 code

Description

Z03.818

Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

Z20.828

Contact with and (suspected) exposure to other viral communicable diseases (actual exposure to COVID-19)

Z11.59

Encounter for screening for other viral diseases

U07.1

COVID-19 (code only when there is a confirmed diagnosis). Available for services only after April 1, 2020

 

How do patients apply for coverage?

Uninsured individuals must apply for coverage using a simplified paper application specifically for Medicaid coverage of COVID-19 testing, testing-related services and vaccines.

The application – called the Application for Medicaid Coverage of COVID-19 Uninsured Eligibility Group – is available online here.

Medicaid encourages providers to help uninsured individuals complete the application. Medicaid has created a Provider Checklist to help determine if the unique COVID-19 benefit coverage is appropriate for the patient. The application must be submitted to Medicaid prior to billing and receiving payment. 

Providers can submit the paper application to any of these methods:

  • Email: coviduninsured@la.gov 
  • Fax: 1-866-852-0415
  • Mail: COVID Uninsured Applications
    • P.O. Box 64808
    • Baton Rouge, LA 70806

Individuals can also call 1-888-544-7996 to apply over the phone. Only one application per individual is required, and eligibility will last until the end of the emergency period.

A Medicaid card will not be provided to this eligibility group.

How do I know if someone is covered?

Coverage is determined by the decision letter or “UNINSURED GROUP FOR COVID-19” seen in MEVS.

Where can I find more information?

This webpage is only intended as a quick overview for providers. Medicaid has created a comprehensive guide on COVID-19 uninsured coverage that includes additional details on qualifications and coverage. The guide also includes a list of frequently asked questions, the Provider Checklist to help providers determine if this coverage is appropriate for your uninsured patients and a copy of the application for the patient. The guide is found online here.