COVID-19 Updates & Alerts for Providers

Questions and Answers for California Wellcare Providers

Due to the rapidly changing environment as a result of COVID-19, the information included in this section is intended to serve as a guide for COVID-19-related information. This information and guidance is in response to the current COVID-19 pandemic and is subject to change, and may be retired at a future date. Unless stated otherwise, special coverage and waivers stated herein expire when the public emergency period ends. This section shall be updated as new information and guidance becomes available; however, providers should continue to refer to the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and the Centers for Medicare & Medicaid Services (CMS) websites for the most up-to-date information.

Please refer to the sections below for current plan information regarding COVID-19 vaccines and guidance.

Updated March 6, 2023

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Information throughout the FAQs has been updated to reflect current guidance and information, including the following section:

COVID-19 GENERAL INFORMATION

COVID-19 Public Health Emergency Extended by Federal Government into 2023 (updated)

COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19

COVID-19 Alerts

COVID-19 Therapeutic and Vaccine FAQs

What you need to know about current treatment

Vaccine FAQs

Communications & Resources

Stay informed on the latest news and help for you and your patients

Resource FAQs

COVID-19 Trainings & Webinars

Notices about COVID-19-related trainings and webinar sessions

COVID-19 Training

COVID-19 General Information

What's covered, how to bill for treatment, telehealth guidance, and more

General FAQs

Historical Information

COVID-19 content that may be retired or no longer relevant to the public health emergency

Retired FAQs

COVID-19 Provider Alerts

Updated 12/26/22

Winter 2022/2023 - Help Patients and Others Stay Protected from COVID-19

New COVID-19 cases and hospitalizations are on the rise. Please remind your patients to get evaluated for treatment right away if they test positive for COVID-19 and have symptoms. When caught early and treated, a positive test for COVID-19 may not lead to serious health problems or even death.

There are many treatment options available and at no cost that can help keep patients healthy.

Encourage Patients to Follow these 4 Steps

1. Get Tested: Call the statewide COVID-19 hotline at 833-422-4255 or go to California All to find free COVID-19 testing at no cost.

2. Act Fast: Seek COVID-19 treatment if you have symptoms. COVID-19 treatments must be taken within 5-7 days from when symptoms begin.

Individuals with insurance, can contact their health care provider, urgent care center or visit a Test-to-Treat location.
Those without insurance can connect to a telehealth provider at no cost. Visit Sesame Care or call 833-686-5051 to make a phone or video appointment.
Call 833-422-4255 for help to find treatment regardless of insurance status.

3. Isolate: Stay away from others for at least 5 full days. Use the California Department of Public Health personal testing and isolation calculator to help determine how long you should isolate.

4. Tell People: Notify people you recently interacted with that they may have been exposed. Call, text, email, or notify them anonymously through the Tell Your Contacts website.

More available resources

California All is dedicated to all you need to know about COVID-19, such as facts about treatment, when and how to find treatment.
California Department of Public Health (CDPH) has information about COVID-19 and treatment, booster doses, masking updates and much more.
Top 5 Tips to Prevent Winter Viruses
Health Advisory to Providers: Reminder to Lower Barriers to Prescribing COVID-19 Therapeutics to Mitigate Impact of COVID-19.

Updated 12/9/22

A joint letter (PDF) issued by the California Department of Public Health (CDPH) in partnership with the American Academy of Pediatrics in California, California Academy of Family Physicians, California Immunization Coalition, and California Medical Association asks providers of pediatric services to continue to help improve immunization rates for flu and COVID-19 vaccinations.

Steps you and your staff can take to make a difference

Right now respiratory infections are on the rise. Talk to parents or a child’s legal guardian about the need to vaccinate during:

Calls to schedule office visits
Well-child check-ups
Acute care visits
Walk-in hours

Low vaccination rates among children

First COVID-19 dose: About 58% of children ages 5–17 and about 10% of children younger than age 5 years have received their first COVID-19 vaccination. Although children in these ages usually experience only mild symptoms, over 122,000 have been hospitalized and over 1500 have died in the United States.
Flu vaccination: About 31% of children in California have received their flu vaccination according to statistics from early November.

More information

Learn about other strategies and more resources to help with pediatric vaccination rates by viewing the joint letter (PDF).

Updated 6/3/22

The Los Angeles County Department of Public Health (LAC DPH) updated their Isolation and Quarantine Orders on June 1, 2022 that affects the general public. The update is supported by the California Department of Public Health’s (CDPH's) Isolation and Quarantine of the General Public.

LAC DPH versus CDC isolation requirements

LAC DPH isolation and quarantine requirements for COVID-19 vary from those recommended by the Centers for Disease Control and Prevention (CDC) in some areas. The major differences for an infected person and close contact include:

Infected person - A person infected with a case of COVID-19 must have a negative COVID-19 test collected on or after Day 5 to end isolation on Day 6–Day 10. If the case does not test or if their test remains positive, they are required to continue to isolate at least through Day 10.
- Infected persons should check with their employer for other restrictions or exclusions from work or other settings that may be required.
- See Isolation Instructions for Persons with COVID-19.
Close contact in the general public - Any person who shared the same indoor airspace with someone with COVID-19 for a total of 15 minutes or more over a 24-hour period while the case was infectious.
- Quarantine is not necessary as long as they remain asymptomatic, get tested between Day 3-Day 5, and wear a mask through Day 10 of their last exposure with the infectious case.
- See Close Contacts-General Public.

LAC DPH quarantine guidelines

Health care providers can also refer to the LAC DPH isolation and quarantine guidelines that give more details about managing cases and contacts with quick links to patient resources.

More resources

Updated 7/25/22:

The California Department of Public Health (CDPH) and OptumServe are upgrading 146 Test to Treat sites across the state over the next couple of weeks. A Test to Treat locator map can help you direct patients to local service sites if they are unable to schedule an office visit but are experiencing COVID-19 symptoms.

How OptumServe test to treat sites can help

Californians can recover quicker from COVID-19 and may be able to prevent inpatient hospital stays by visiting a OptumServe Test to Treat site within five days that COVID-19 symptoms begin. Services are offered at no cost and include telehealth, if needed.

Persons who test positive for COVID-19 are seen by a provider and, if they qualify, can get prescription antiviral pills, Paxlovid or Lagevrio at the same time. The generic names are nirmatrelvir/ritonavir and molnupiravir, respectively.

COVID- 19 vaccines and boosters are preferred

COVID-19 vaccines and boosters are still the preferred choice to prevent the virus. Patients can make vaccination appointments by visiting myturn.ca.gov or calling 833-422-4255.

Visit Vaccinate All 58 to learn more about safe and effective vaccines available for all Californians ages 5 and up.

Added 3/31/22

Healthcare Ready is doing a study about procurement and donation coordination strategies among community health centers (CHCs) during a disaster.

Join the study now!

Anyone working in supply chain, supply ordering, or procurement for CHCs is welcome to participate in the study. This could be supply chain managers, operations managers, procurement specialists, and facility managers.

To participate, send an email with the times you are available for a 30-minute call to research@healthcareready.org. Or, for those who prefer to send written responses, please fill out this online survey.

Bring your experience to help answer questions

Talks with CHCs across the country will revolve around past experiences, challenges and leading practices with government-health care-mass care and donation coordination.

The study is looking for answers about how procurement strategies are adapted during disasters; the influence of donations from public or private donors on supply procurement and coordination; and, how group purchasing can aid health centers.

Get involved with project goals to promote better practices

Those involved in this project will work to:

Improve donation coordination between CHCs and donors.
Search for regional opportunities for supply sourcing and strategies.
Identify leading strategies that promote supply chain resilience during disasters.
Share findings from the study to help CHCs build more resilient supply chain practices within their own operations.

Added 3/28/2022

Important update! The Health Resources & Services Administration’s Uninsured Program is no longer accepting claims or will stop accepting COVID-19 claims on these dates due to insufficient funds.

Date and Time

Description

March 22, 2022, at 11:59 PM Eastern time.

COVID-19 testing or treatment claims. A confirmation receipt of your claim submission does not mean the claim will be paid.

For more information, see HRSA COVID-19 Uninsured Program Claims Submission Deadline FAQs.

April 5, 2022, at 11:59 PM Eastern time

COVID-19 vaccination claims.

For more information, see the COVID-19 Coverage Assistance Fund Claims Submission Deadline FAQs.

Note: Claims that have already been submitted will be paid subject to available funds.

Added 2/15/22:

COVID-19 can be serious for kids. Your strong recommendation has a big impact on parents' decision to get their children vaccinated.

Over 65% of California's children ages 5-11 have not gotten their first dose of the Pfizer-BioNTech (Pfizer) COVID-19 vaccine.

Hardest hit are children living in Q1 (less healthy) areas.
Unvaccinated children are 11 times more likely to be hospitalized and have a four times greater risk of death from COVID-19 than the flu.
Data shows ages 5-11 are more likely to be vaccinated by a medical practice than the general population.

A large part of California's success rate to get kids vaccinated against COVID-19 and its variants will depend on your help. Please expand outreach or patient access to COVID-19 vaccines in your local community.

Eligibility for younger kids may expand again soon

Pfizer submitted a request to amend the Emergency Use Authorization of their COVID-19 vaccine to include children ages 6 months through 4 years.

Resources with more information

Added 5/25/21

On March 30, we started contacting your patients with information about scheduling COVID-19 vaccine appointments.

What your patients can expect and when

Providers are encouraged to share the following information with their Wellcare patients so they know how we are contacting them and what to expect as part of this outreach.

WellCare outreach to your patients includes:

Method	Frequency
Text	A series of text messages, once every two weeks
Email	One email
Phone	Live calls by Wellcare staff to educate and connect members to vaccine appointments
Interactive voice response	Recorded message when patients call the Wellcare Member Services Department

Myturn.ca.gov

California residents can go directly to myturn.ca.gov to schedule an appointment. Information is available in 12 languages. Residents who do not have access to myturn.ca.gov, or those who do not have an email address or a mobile phone, can contact the California COVID-19 hotline at 833-422-4255 for assistance:

Monday-Friday 8 a.m. to 8 p.m.
Saturday-Sunday 8 a.m. to 5 p.m.

Added 4/12/21

The "Let's Get to ImmUnity" campaign will address questions, concerns with COVID-19 vaccinations specific to the Black and African American communities

The California Department of Public Health (CDPH) is rolling out a tailored outreach for Black and African American communities across the state. This latest element of the "Let's Get to ImmUnity" public education campaign is part of the state's overall Vaccinate ALL 58 effort.

Engaging people where they live to raise awareness about COVID-19 vaccines

In addition to traditional communications, the campaign will meet people where they are via community engagement efforts throughout the state. These efforts will begin in Oakland. The campaign will partner with small businesses and community leaders serving the local Black and African American community. The goal is to increase awareness about the safety and efficacy of the vaccines and mobilize community members to get vaccinated.

Support for equitable vaccine administration across the state

Community engagement efforts will expand to Black and African American communities across the state as the campaign continues and will remain focused on increasing vaccine equity. The "Let's Get to ImmUnity" campaign is placing additional focus on geographic areas in the bottom quarter of the Healthy Places Index (HPI), mirroring the state's announcement last month to increase vaccine supply in these communities. The public education campaign is an important part in the state's five-part plan for equitable vaccine administration.

Stay informed about the latest COVID-19 information at https://www.cdph.ca.gov from CDPH.

Updated 3/12/21

In January 2021, the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations (HHS/OIG/OI) issued a health care fraud alert, regarding COVID-19 vaccines. This alert describes how scammers are perpetrating COVID-19-related schemes to beneficiaries, including those enrolled in Medicare. Schemes include telemarketing calls, social media platforms and door-to-door visits. Also, fraudsters are offering COVID-19 tests, HHS grants and prescription cards in exchange for personal details.

Scammers can use personal information collected through these schemes to fraudulently bill federal health care programs and commit medical identity thefts. The services offered are unapproved and illegitimate and may cause harm to the beneficiaries.

Please visit the health care fraud alert for a list of common schemes, and report any suspected COVID-19 health care fraud online or by calling 1-800-HHS-TIPS (800-447-8477).

Dear Provider,

We are actively monitoring the rapidly evolving developments with the COVID-19 vaccines and their distribution. We will share necessary updates with you as soon as they are available.

Download COVID-19 Vaccines: What You Need to Know for key details and information to help you and your staff understand the vaccine strategy.

See all California Medicare Provider Bulletins.

COVID-19 Trainings & Webinars

March 2, 2023

The COVID-19 Test to Treat Equity ECHO (Extension for Community Healthcare Outcomes) webinar series is designed to add to your knowledge about COVID-19 treatment at no cost.

The webinars offer 1.0 CME credit to attend, participate and complete a program evaluation.

When:
California statewide webinars are held the 2nd Wednesday of each month. Presentations are given by expert faculty, which include a moderated Q&A panel discussion with subject matter experts.

Wednesdays, 12–1 p.m. Pacific time	Topic
March 8	Natural History and Pathophysiology of COVID-19
April 12	Practical Aspects & Operational Details
May 10	Overview of Post-COVID Conditions

How to join:
Register at bit.ly/ECHOWebinar

Join smaller group Q&A sessions
Get involved with clinical discussions and technical support in a small group guided by a panel of experts. This program helps test to treat programs work within communities to reduce health disparities and increase access to a diagnosis and early treatment for COVID-19.

Region	Day each month	Time
Northern California Test & Treat ECHO Register here	1st Wednesday	12–1 p.m. Pacific time
Southern California Test & Treat ECHO Register here	3rd Wednesday	12–1 p.m. Pacific time

Additional information

Watch a recording of the January 2023 overview about COVID-19 outpatient therapeutics.
View the 2023 March ECHO flyer with more information about CME credits.

COVID-19 Therapeutic and Vaccine FAQS - What you need to know about current treatment

Is there provider support for questions about COVID-19 testing and treatment?

All California health care providers can get confidential consultation support through the COVID-19 Therapeutics Warmline managed by the University of California, San Francisco (USCF) National Clinical Consultation Center (NCCC). Providers of any experience level can speak with a clinician or pharmacist:

Call 866-268-4233 (866-COVID-CA). Monday – Friday, 6 a.m.–5 p.m. After- hours voice mail messages are returned the next business day.
This support is in real-time and at no cost.
No protected health information (PHI) is collected.

What resources are available about COVID-19 outpatient therapeutics?

Videos and resources are available from the Department of Health and Human Services’ Administration for Strategic Preparedness & Response (ASPR). The website covers the following topics and more:

Compare COVID-19 Therapeutics and Patient Requirements
Find, Order and Report COVID-19 Therapeutics
Learn About COVID-19 Therapeutics
Share Resources with Patients and Other Health Care Providers

The following videos are available through ASPR and cover:

ASPR and the COVID Response
Overview: COVID-19 Therapeutics
COVID-19 Therapeutics Distribution
Separate videos about therapeutics for: Paxlovid, Lagevrio, and Veklury

Note: The U.S. Food and Drug Administration (FDA) announced on January 26, 2023, that Evusheld is no longer authorized for emergency use in the United States against developing variants of the COVID-19 virus.

Additional resources

The Office of Communications for the California Department of Public Health (CDPH) has different material to download and print - from graphics and hand-outs to social messaging in English and Spanish. The goal is to educate patients and encourage use of COVID-19 therapeutics to treat symptoms before they become severe.

How to dispel misinformation about treatments

See the CDPH COVID-19 Therapeutics Myths and Facts sheet (PDF). It covers questions such as:

I don't need medication for mild-to-moderate illness.
I’m not high risk.
Treatments have serious side effects.
Rebound caused by treatments is common and can be dangerous.

Where can I get information for my patients about the COVID-19 Test to Treat Program?

More information about the Test to Treat Program can be found on the CDPH website. Patients who have COVID-19 symptoms can be seen by a health care provider and get treatment at a Test to Treat site during the same visit, if needed.

This is available to adults and children over age 12.
Uninsured individuals can access testing and treatment services at no cost at OptumServe locations.

Wellcare is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a health care provider, you play an integral role with COVID-19 vaccinations. We want to update you on important new information about vaccine coverage. For regular and frequent updates on the vaccine information and distribution in California, visit Vaccinate ALL 58.

Important! Enroll to get your California Immunization Information System (IIS) ID

During the Public Health Emergency, COVID-19 vaccines are being provided by state and federal governments at no cost to providers. The California Department of Public Health (CDPH) is overseeing the registration for the COVID-19 vaccination program in California. Program enrollment is currently focused on small physician practices who routinely vaccinate their patients as well as providers that are prioritized for vaccine allocation by local health departments.

Step 1: Get your IIS ID

Enroll in your local registry to receive your Immunization Information System (IIS) ID for enrollment in CalVax. County-specific information is below.

County	Website
San Joaquin	www.myhealthyfutures.org
Other Counties	www.cairweb.org/join-cair

Step 2: Enroll in myCAvax

myCAVax was enhanced with new functions based on user feedback. Some changes affect waste event creation, vaccine marketplace old and expired posts, location application, and enrollment.

Make sure you meet all the requirements before enrolling. Use the Provider Enrollment Worksheet to gather information needed ahead of time to complete enrollment in myCAvax.

Refer to the Readiness Checklist: Quick Start Guide (PDF) for additional steps to help providers onboard to the COVID-19 Vaccination Program.

More information that can help you share clear and accurate information about COVID-19 vaccines and address common questions from patients can be found in Communication Resources for Healthcare Providers and Staff from the Centers for Disease Control and Prevention (CDC).

Who is eligible for the COVID-19 vaccine?

Every Californian age 6 months and older is eligible for a COVID-19 vaccine. On June 16, 2022, the U.S. Food and Drug Administration (FDA) granted emergency use authorization for:

2-dose Moderna COVID-19 vaccine primary series to individuals 6 months through 5 years.
- Authorized to give a third primary series dose to individuals 6 months through 5 years with certain kinds of immunocompromise.

3-dose Pfizer COVID-19 vaccine primary series to individuals 6 months through 4 years.

Additional resources:

Vaccinate All 58 for information about the vaccine, incentive programs, how the vaccine works, vaccination progress data, questions and answers, and more.
California Department of Public Health (CDPH) for updated COVID-19 vaccine eligibility guidelines.
Centers for Disease Control and Prevention (CDC) offers clinical and professional resources.

Is there a current COVID-19 vaccination schedule?

The CDC developed COVID-19 immunization schedules that give guidance based on age and medical conditions including dosage for the different COVID-19 vaccines and interval wait periods between doses. There is also information for special situations when vaccinating children. Considerations for scheduling COVID-19 vaccinations include age transitions and interchangeability between Moderna and Pfizer COVID-19 vaccines:

Children should receive age-appropriate vaccine products based on their age on the day of the vaccination, regardless of their size or weight. If a person moves from a younger to an older age group during the primary series or booster dose(s), they should receive the vaccine dosage for the older age group for all subsequent doses.
If a child receives a dose of the age-appropriate product from both Moderna and Pfizer, both doses should be counted if the recommended interval between doses was met.
- Ages 6 months through 4 years can receive a third dose of either a monovalent Moderna vaccine or bivalent Pfizer vaccine administered at least 8 weeks after the second dose to complete the series.
COVID-19 vaccines and other vaccines may now be administered without regard to timing.
Simultaneous administration of COVID-19 vaccines and other vaccines can be done on the same day, as well as co-administration within 14 days.
Doses administered after the recommended intervals are valid.

What is the latest update about COVID-19 primary and booster shots?

The booster or additional dose of the COVID-19 vaccine is available at no cost to members. It will follow the same guidance as the initial two doses. For more information, see "How will the COVID-19 vaccine be covered for members?" further down in this section.

Pfizer and Moderna Bivalent mRNA COVID-19 booster doses

On December 8, 2022, the FDA amended the EUAs of the bivalent Moderna and Pfizer COVID-19 vaccines to include children down to ages 6 months.

Moderna: Children ages 6 month through 5 years can get a single dose bivalent booster two months after completing a primary series of the monovalent Moderna COVID-19 vaccine.
Pfizer: Children ages 6 months through 4 years can receive the Pfizer bivalent COVID-19 vaccine for their third dose in their primary series after receiving two doses of the monovalent COVID-19 vaccine.
- At this time, children ages 6 months through 4 years who have already received their three doses of the primary monovalent Pfizer COVID-19 vaccine series are not eligible for a booster dose of the bivalent vaccine.

Important notes:

Only use remaining supplies of the adult-dose monovalent Pfizer and Moderna COVID-19 vaccines for primary series doses but not for adult boosters.
Reschedule any COVID-19 booster appointments until you have supplies of the bivalent Pfizer or Moderna available.
Check vial labels to make sure the correct product is given since cap and label colors, including outdated language, can cause confusion.

Resources:

Pfizer, Moderna monovalent mRNA and Johnson & Johnson COVID-19 vaccines

The CDC COVID-19 vaccination product summary recommendations dated June 29, 2022, listed below has been updated to reflect the recent FDA change in authorization that monovalent mRNA Pfizer and Moderna COVID-19 vaccines are not recommended as booster doses for ages 12 and older:

Product	Age group	Dosage
Type: Monovalent mRNA vaccine - primary series and booster for ages under 12
Moderna (Blue vial cap with magenta-bordered label)	6 months through 5 years	Any dose in the primary series. Booster doses are not recommended for this age group.
Moderna (Blue vial cap with purple-bordered label)	6 through 11	Any dose in the primary series.
Moderna (Red vial cap with blue-bordered label)	12 and older	Any dose in the primary series.
Moderna (Red vial cap with blue-bordered label)	18 and older	Any dose in the primary series (0.5 mL)
Pfizer-BioNTech (Maroon vial cap with maroon-bordered label)	6 months through 4 years	Any dose in the primary series. Booster doses are not recommended for this age group.
Pfizer-BioNTech (Orange vial cap with orange-bordered label)	5 through 11	Any dose in the primary series and booster doses.
Pfizer-BioNTech (Purple vial cap with purple-bordered label)	12 and older	Any dose in the primary series.
Pfizer-BioNTech (Gray vial cap with a gray-bordered label)	12 and older	Any dose in the primary series.

Product	Age group	Dosage
Type: Viral vector vaccine
Janssen (Blue cap)	18 and older	Primary and booster doses.

The FDA has authorized limited use of the Johnson & Johnson COVID-19 vaccine due to a serious but rare blood clotting disorder.

The Johnson & Johnson vaccine may be considered for people ages 18 and older who:

Had a severe reaction after an mRNA vaccine dose or who have a severe allergy to an ingredient of the Pfizer or Moderna COVID-19 vaccines.
Are unable to access the preferred Pfizer or Moderna COVID-19 mRNA vaccines.
Would otherwise remain unvaccinated for COVID-19.

Additional Resources:

CDC: Moderna COVID-19 Vaccines Preparation and Administration Summary
CDC: Pfizer-BioNTech COVID-19 Vaccines Preparation and Administration Summary
Fact Sheet for Healthcare Providers Administering Vaccine
Guidance for people who received a COVID-19 vaccine outside of the Unites States.
COVID-19 Vaccine Eligibility Chart - shows when a COVID-19 vaccine should be given based on age or health conditions starting at 6 months.
CDPH - Why Get Vaccinated?
FDA Fact Sheets:
- HealthCare Providers Administering the Vaccine
- Recipients and Caregivers with information about the use of the Pfizer COVID-19 vaccine in adolescents, including the benefits and risks.

Are the COVID-19 vaccines safe for pregnant or lactating people?

On September 29, 2021, the CDC issued a health advisory recommending COVID-19 vaccination among people who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future

As of September 18, 2021, only 31.0% of pregnant people were fully vaccinated before or during their pregnancy. (See Vaccinations Among Pregnant People.)

The CDC strongly urges COVID-19 vaccination either before or during pregnancy as soon as possible. The benefits of vaccination outweigh known or potential risks, such as:

Severe illness and death.
An increased risk for adverse pregnancy and neonatal outcomes (including preterm birth and admission of their neonate(s) to an intensive care unit).
Stillbirth.

Recommendations on where to start

Your efforts should specifically:

Address populations with lower vaccination coverage.
Use approaches to reduce racial and ethnic disparities, such as tailored, culturally responsive, and linguistically appropriate communication of vaccination benefits.
Have pregnant people continue to follow all recommended prevention measures.
Advise pregnant people to seek care immediately for any symptoms of COVID-19.

Where can people get information about vaccine availability - My Turn?

If you are not providing the COVID-19 vaccine to your patients, refer them to Find out if it's your turn.

You can also refer patients to their county public health department. A listing of local health departments by county is available through CDPH. Patients may also call 211 or 311 for information about the COVID-19 vaccines. These are non-emergency numbers that are state- and city-supported and can help direct callers to COVID-19 vaccine services in their area.

Where can I find the latest guidance for the COVID-19 vaccine?

Visit the Centers for Medicare and Medicaid Services (CMS) website.

What are the codes to report and bill the COVID-19 vaccines?

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT^®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published; however, they will not be billable or payable until the specific vaccine receives official EUA approval.

Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name
91300	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	Pfizer-BioNTech COVID-19 Vaccine
0001A	ADM SARSCOV2 VAC 30MCG/0.3ML 1ST	Pfizer	Pfizer-BioNTech COVID-19 Vaccine Administration – First Dose
0002A	ADM SARSCOV2 VAC 30MCG/0.3ML 2ND	Pfizer	Pfizer-BioNTech COVID-19 Vaccine Administration – Second Dose
0003A (eff. August 12, 2021)	ADM SARSCOV2 VAC 30MCG/0.3ML 3RD	Pfizer	Pfizer-BioNTech COVID-19 Vaccine Administration – Third Dose
0004A* (eff. September 22, 2021 – TBD)	ADM SARSCOV2 30MCG/0.3ML BST	Pfizer	Pfizer-BioNTech COVID-19 Vaccine Administration – Booster
91305 (eff. January 3, 2022)	SARSCOV2 VAC 30 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap)
0051A (eff. January 3, 2022)	ADM SARSCV2 30MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration – First dose
0052A (eff. January 3, 2022)	ADM SARSCV2 30MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration – Second dose
0053A (eff. January 3, 2022)	ADM SARSCV2 30MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration – Third dose
0054A* (eff. January 3, 2022)	ADM SARSCV2 30MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration – Booster
91307 (eff. October 29, 2021)	SARSCOV2 10MCG/0.2ML TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric
0071A (eff. October 29, 2021)	ADM SARSCOV2 VAC 10MCG/0.2ML TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration – First Dose
0072A (eff. October 29, 2021)	ADM SARSCOV2 VAC 10MCG/0.2ML TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration – Second Dose
0073A (eff. January 3, 2022)	ADM SARSCOV2 VAC 10 MCG/0.2ML TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration – Third Dose
0074A (eff. May 17, 2022)	ADM SARSCOV2 VAC 10MCG/0.2ML TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration – Single booster dose
91308 (eff. June 17, 2022)	SARSCOV2 3MCG/0.2ML TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric ages 6 months–4 years
0081A (eff. June 17, 2022)	ADM SARSCOV2 VAC 3MCG/0.2ML TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration ages 6 months–4 years
0082A (eff. June 17, 2022)	ADM SARSCOV2 VAC 3MCG/0.2ML TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration ages 6 months–4 years
0083A (eff. June 17, 2022)	ADM SARSCOV2 VAC 3MCG/0.2ML TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pediatric Administration ages 6 months–4 years
91312 (eff. August 31, 2022)	SARSCOV2 VAC 30MCG/0.3ML TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine – Booster
0124A (eff. August 31, 2022)	ADM SARSCV2 30MCG/0.3ML TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Administration – Booster
91315 (eff. August 31, 2022)	SARSCOV2 VAC 10MCG/0.2ML TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine – Booster ages 5 years – 11 years
0154A (eff. August 31, 2022)	ADM SARSCV2 10MCG/0.2ML TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Administration – Booster ages 5 years – 11 years
91317 (eff December 8, 2022)	SARSCOV2 VAC BVL 3MCG/0.2ML	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product ages 6 months through 4 years (Maroon cap)
0173A (eff December 8, 2022)	ADM SARSCV2 BVL 3MCG/0.2ML 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (ages 6 months through 4 years) (Maroon cap) Administration - Third Dose
91301	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	Moderna COVID-19 Vaccine
0011A	ADM SARSCOV2 VAC 100MCG/0.5ML 1ST	Moderna	Moderna COVID-19 Vaccine Administration – First Dose
0012A	ADM SARSCOV2 VAC 100MCG/0.5ML 2ND	Moderna	Moderna COVID-19 Vaccine Administration – Second Dose
0013A (eff. August 12, 2021)	ADM SARSCOV2 VAC 100MCG/0.5ML 3RD	Moderna	Moderna COVID-19 Vaccine Administration – Third Dose
91306* (eff. October 20, 2021 – TBD)	SARSCOV2 VAC 50MCG/0.25ML IM	Moderna	Moderna COVID-19 Vaccine (Low Dose)
0064A* (eff. October 20, 2021 – TBD)	ADM SARSCOV2 50MCG/0.25ML BST	Moderna	Moderna COVID-19 Vaccine (Low Dose) Administration – Booster
0091A (eff. June 17, 2022)	ADM SARSCOV2 50MCG/0.5ML 1ST	Moderna	Moderna COVID-19 Vaccine Administration – Pediatric ages 6–11
0092A (eff. June 17, 2022)	ADM SARSCOV2 50MCG/0.5ML 2ND	Moderna	Moderna COVID-19 Vaccine Administration – Pediatric ages 6–11
0093A (eff. June 17, 2022)	ADM SARSCOV2 50MCG/0.5ML 3RD	Moderna	Moderna COVID-19 Vaccine Administration – Pediatric ages 6–11
0113A (eff. June 17, 2022)	AMD SARSCOV2 25MCG/0.25ML 3RD	Moderna	Moderna COVID-19 Vaccine Administration – Pediatric ages 6–11
91309 (eff. June 17, 2022)	SARSCOV2 VAC 50MCG/0.5ML IM	Moderna	Moderna COVID-19 Vaccine – Booster
0094A (eff. March 29, 2022 – rev. July 2, 2022)	ADM SARSCOV2 50MCG/0.5ML BST	Moderna	Moderna COVID-19 Vaccine Administration – Booster
91311 (eff. June 17, 2022)	SARSCOV2 25 MCG/0.25 ML IM	Moderna	Moderna COVID-19 Vaccine
0111A (eff. June 17, 2022)	IMM ADMN SARSCOV2 25 MCG/0.25 ML First dose	Moderna	Moderna COVID-19 Vaccine Administration – First Dose
0112A (eff. June 17, 2022)	IMM ADMN SARSCOV2 25 MCG/0.25 ML Second dose	Moderna	Moderna COVID-19 Vaccine Administration – Second Dose
91313 (eff. August 31, 2022)	SARS-COV2 50MCG/0.5 ML IM	Moderna	Moderna COVID-19 Vaccine – Bivalent Booster
0134A (eff. August 31, 2022)	ADM SARSCOV2 VAC 50MCG/0.5ML BST	Moderna	Moderna COVID-19 Vaccine Administraton – Bivalent Booster
91314 (eff. August 31, 2022)	SARS-COV2 25MCG/0.25 ML IM	Moderna	Moderna COVID-19 Vaccine – Bivalent Booster ages 6 years – 11 years
0144A (eff. August 31, 2022)	ADM SARSCOV2 VAC 25MCG/0.25ML BST	Moderna	Moderna COVID-19 Vaccine Administration – Bivalent Booster ages 6 years – 11 years
91316 (eff December 8, 2022)	SARSCOV2 VAC BVL 10MCG/0.2M	Moderna	Moderna COVID-19 Vaccine, Bivalent Product ages 6 months through 5 years (Dark pink cap and a label with a yellow box)
0164A (eff December 8, 2022)	ADM SRSCV2 BVL 10MCG/0.2ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent ages 6 months through 5 years (Dark pink cap and label with a yellow box) Administration – Booster Dose
91304 (eff. July 13, 2022)	SARS-COV2 5MCG/0.5ML IM	Novavax	Novavax COVID-19 Vaccine ages 18+
0041A (eff. July 13, 2022)	ADM SARSCOV2 5MCG/0.5ML First dose	Novavax	Novavax COVID-19 Vaccine Administration ages 18+ – First Dose
0041B (eff. July 13, 2022)	ADM SARSCOV2 5MCG/0.5ML Second dose	Novavax	Novavax COVID-19 Vaccine Administration ages 18+ – Second Dose
0044A (eff. October 19, 2022)	ADM SARSCOV2 5MCG/0.5ML BST	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration - Booster
91303	SARSCOV2 VAC AD26 .5ML IM	Janssen	Janssen COVID-19 Vaccine
0031A	ADM SARSCOV2 VAC AD26 .5ML	Janssen	Janssen COVID-19 Vaccine Administration
0034A (eff. October 20, 2021 – TBD)	ADM SARSCOV2 VAC AD26 .5ML B	Janssen	Janssen CVOID-19 Vaccine Administration – Booster

*As of August 31, 2022, these monovalent vaccine formulations cannot be used as a booster

What are the reporting requirements for the COVID-19 vaccine?

Providers must record details of the vaccination into their system of record within 24 hours, and into the applicable public health system within 72 hours.

How can I help prepare for the COVID-19 vaccine?

CMS toolkits - Providers can use this set of toolkits to help administer the vaccine.
CMA toolkit - Physician practices can use the California Medical Association toolkit for answers to their frequently asked questions such as vaccine priority, vaccine administrators and addressing patient concerns.
CDC toolkit - The COVID-19 Vaccination Communication Toolkit is designed to help medical centers, clinics, pharmacies and clinicians to promote vaccination among healthcare provider staff. These materials can help educate and build confidence in COVID-19 vaccination, raise awareness about the benefits of vaccination, and address common questions and concerns.
Immunization Action Coalition (IAC) - Provides clinics with resources and tools that cover the different COVID-19 vaccine products available, address vaccine hesitancy, help educate patients on the vaccines, and more.

How will the COVID-19 vaccine be covered for members?

Similar to other preventive immunizations, the COVID-19 vaccines are offered at no cost to members. In addition:

For Calendar Years (CYs) 2020 and 2021, payment for the COVID-19 vaccine and its administration for Medicare Advantage plan members will be made through the original fee-for-service Medicare program. The vaccine itself is available from the federal government free of charge.
For CY 2022, CMS will no longer directly reimburse providers for COVID-19 vaccines including their administration. Vaccine related claims should be billed like other Medicare covered vaccines. Send claims to the delegated at-risk provider groups of Wellcare.

What resources are available to help with reminders about the second dose of the vaccine, and reporting vaccine side effects?

Providers should refer to the Talking to Your Patients About the COVID-19 Vaccine section below for helpful information on how to engage and talk to your patients about the vaccine.

Second-dose vaccine reminders

Providers can offer patients VaxText^SM, a free text messaging service that patients can opt in to receive convenient text message reminders to get their second dose of the COVID-19 vaccine. Vaccine recipients can text ENROLL to 1-833-VaxText (829-8398) to start getting their weekly second dose reminders.

Visit the CDC website for more information.

Reporting vaccine side effects

Patients can report any side effects from the vaccine directly to the CDC using V-safe^SM smartphone-based tool. Patients may be contacted by someone from CDC to check on them and get more information, depending on the answers provided. V-safe will also remind patients to get their second COVID-19 vaccine dose if needed. For more information, visit the CDC website.

Providers are a key part in the adoption and administration of the COVID-19 vaccines to the American public. Patients look to their health care professionals for medical guidance and assurance. As your partners in health care, we want to share some tips for effectively setting expectations and addressing questions from your patients.

Engage in effective COVID-19 vaccine conversations

Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

Start with empathy and understanding

Acknowledge the disruption COVID-19 has caused in all our lives.
Provide an opportunity to recognize common concerns that can be addressed by a vaccine.

Assume patients want to be vaccinated but may not know what to expect

Consider providing the following general information to patients about the timeline for COVID-19 vaccines.
Encourage patients to continue taking steps to protect themselves from COVID-19.

Give your strong recommendation

Let your patients know if you plan to recommend COVID-19 vaccination for them.
Share the importance of COVID-19 vaccines to protect patients' health as well as the health of those around them.
If you have received a COVID-19 vaccine, talk about it with them.
Reassure your patients that the vaccine is safe.

Listen to and respond to questions

If a patient has concerns or questions, this doesn't mean they won't accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it.

Keep the conversation open

After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
Encourage patients to take at least one action like:
- Scheduling another appointment.
- Reading any additional information you provide them about COVID-19 vaccination.
- Encourage others to get their COVID-19 vaccine.
Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.

Revised mask guidelines for vaccinated and unvaccinated people

Effective March 1, 2022, California no longer requires masks in indoor public settings but they are still strongly recommended. For more information about masks, visit COVID19.CA.GOV.

After March 12, 2022, the universal masking requirement for K-12 and childcare settings was terminated, although CDPH strongly recommends that individuals in these settings continue to mask in indoor settings when the universal masking requirement lifts. For more information about universal masking requirements, visit the California Department of Public Health.

Masks are still required whether a person is vaccinated or unvaccinated in:

high transmission settings like public transit
emergency shelters
health care settings
correctional facilities
homeless shelters
long-term care facilities

Local health departments and businesses can still require more stringent policies if they choose.

Resources to help you build vaccines confidence with your patients

View videos developed in collaboration with the CDC, U.S. Department of Health and Human Services (HHS), National Institute of Allergy and Infectious Diseases (NIAID), and top health and medical institutions that cover a range of topics to help physicians and health care providers build vaccine confidence in their patients and address questions about COVID-19 vaccines. Additional video resources are available in the COVID-19 Resource Center.
Access the video series through the California Medical Association (CMA) or directly on YouTube.
The California Department of Public Health (CDPH) recently launched two new 30-second TV advertisements. Entitled "This Moment" and "Cambiar," the ads empower and inspire Californians, especially those in the most vulnerable populations, to get vaccinated. This is part of the state’s "Let’s Get to ImmUnity" public education campaign. "This Moment" is available in the COVID-19 Resource Center.

Answering patient questions about the vaccine

Your patients will likely have a lot of questions about the vaccine, and as their health care provider, they will turn to you for answers. Refer members to frequently asked questions about the vaccines at Coronavirus COVID-19 Medicare Members.

COVID-19 General Information - What's covered, how to bill for treatment, telehealth guidance, and more

Where can I obtain information and guidance on COVID-19?

We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the coronavirus disease 2019 (COVID-19) and care for your patients.

Guidance:

Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.
Get more information about variants to COVID-19, such as the Delta variant.
Become familiar with post-COVID conditions (also called long COVID) that can have different types and combinations of health problems for different lengths of time.
Be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
Refer to the Centers for Disease Control and Prevention (CDC) criteria for a patient under investigation for COVID-19. Notify local and/or state health departments in the event of a patient under investigation for COVID-19. Maintain a log of all health care personnel who provide care to a patient under investigation.
Monitor and manage ill and exposed healthcare personnel.
Safely triage and manage patients with respiratory illness, including COVID-19.
Refer to the California Department of Public Health (CDPH) for recent guidance on resuming preventive care.

Take Action:

Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
Refer to the CDC and the World Health Organization (WHO) for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
Visit the California Department of Public Health (CDPH) for information about COVID-19 and the latest guidance from public health officials.

Where is other information and guidance on COVID-19 is available?

All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities may recommend delaying elective inpatient and outpatient surgical and procedural cases. The referring or treating provider must have determined and noted in the relevant record that when considering COVID-19 implications during this public health emergency period, a longer waiting time will not have a detrimental impact on the health of the member.
Telehealth services during this emergency period may be used to determine medical necessity for someone to come into the office, emergency room or urgent care center. Refer to Telehealth Guidance below for more information.
Visit the California Medical Association (CMA) website to view videos from a 12-part webinar series, Telehealth Series for Small and Medium Sized Practices, that cover all aspects of implementing telehealth in a medical practice. Topics reviewed include selecting a platform, reimbursement rules and patient interactions.

Updated March 6, 2023

Effective February 11, 2023, Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 Public Health Emergency for a final time with a 90-day notice. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through May 11, 2023. Any change after May 11, 2023 will be updated on this page.

In accordance with this extension, WellCare has updated its information and guidance for COVID-19-related information posted on this page.

Please note, the dates for the COVID-19 Federal Public Health Emergency extension may or may not align with California regulatory requirements or guidance.

Does Wellcare allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, Wellcare encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for covered services.

During the course of this declaration of emergency, Wellcare's coverage for telehealth services will follow guidance released by CMS, which includes telecommunications involving audio and video technology and audio only technology.

Services that cannot be appropriately delivered remotely are not eligible for telehealth coverage and reimbursement.
Capitated physician groups are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined previously. Claims processing risk will follow the in-person location place of service where the service would have been delivered in lieu of telehealth.

In addition to telehealth services offered through our network of providers, Wellcare has expanded access to telehealth services through third parties. Updated information on those vendor arrangements can be found in the Telehealth Platforms for Providers section below or at COVID-19 Updates and Alerts for Providers under Communications and Resources.

What are the guidelines for telehealth services specific to risk adjustment?

Providers should follow the guidance in the communication from the Centers for Medicare and Medicaid Services (CMS) dated April 10, 2020, regarding the Applicability of diagnoses from telehealth services for risk adjustment (PDF).

How do I bill for telehealth services during this declaration of emergency period?

Providers should bill and will be reimbursed for Medicare telehealth services as required by CMS
Use the normal Place of Service code (11, 23, etc.) with the appropriate telehealth modifiers, as identified by CMS

Updated CMS guidance for telehealth coverage can be found at:

Examples of benefits or services not appropriate for telehealth delivery:

Below are some examples (not exhaustive) of benefits or services that would not be appropriate for delivery via a telehealth modality.

Performed in an operating room or while the patient is under anesthesia
Requiring direct visualization or instrumentation of bodily structures
Involving sampling of tissue or insertion/removal of medical device
Requiring the in-person presence of the patient for any reason

What do I do if my Medicare telehealth claim did not price at full rate parity for the CPT code?

During the course of this declaration of emergency, Medicare telehealth claims need to reflect the normal POS (11, 23, etc.) and the applicable telehealth modifier for the claim to price at parity.

Claims for such CPT codes previously billed with POS 02 or POS 10 (effective April 4, 2022) must be re-billed as corrected claims in order to receive rate parity.

Are there member cost shares for Medicare network provider telehealth services?

For Medicare members, covered telehealth services delivered March 17, 2020 through May 31, 2021 will be offered at zero member cost share. For dates of service on or after June 1, 2021, only COVID-19 screening and testing related telehealth will be offered at zero member cost share in accordance with federal requirements. Effective with June 1, 2021 dates of service, all other non-COVID telehealth services will be subject to the cost sharing provisions of a member’s benefit plan. Members will continue to retain telehealth benefits included in their Wellcare coverage contract or policy, as well as any temporary extended telehealth benefit coverage mandated during the public health emergency period.

This applies to:

Telehealth services covered and provided by capitated physician groups.

Capitated Physician Groups:

Capitated physician groups are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above, including the waiver of member cost share. Eligible waived cost shares, as stated above, for capitated physician groups’ paid telehealth services will be reimbursed by the health plan.We are now processing reimbursement requests from capitated groups for dates of service from January 1, 2021 through December 31, 2021, if reimbursable above. Contact your provider network representative if you need submission information.

What is Wellcare's strategy to support telehealth services for providers and members?

Wellcare is committed to supporting your relationship with your patients. We continuously encourage members to first take advantage of the telehealth services provided by their primary care provider before considering Wellcare's contracted vendors.

What additional telehealth options are available to my patients?

Wellcare offers additional telehealth services through Teladoc^®to enhance access to care for your patients. These services supplement, but do not replace, the personal care you provide to your patients.

Providers can also refer to Telehealth Platforms for Providers for a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

What support will Teladoc provide to me if my patients use them?

Teladoc supports the PCP and their relationship with their patient. Teladoc services include:

Visit summaries sent to the PCP for close communication and continuity of care, at the member's request.
Referring patients back to the assigned PCP for follow-up appointments.
Prescribing of non-scheduled, non-lifestyle medications.
Availability of the member's medical records through the Teladoc application.

Is Wellcare requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Wellcare's participating physician groups (PPGs) are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Is Wellcare waiving cost-share requirements for screening and testing?

Wellcare benefit plans cover screening and testing for COVID-19. Wellcare is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Waived cost share for capitated physician groups' paid screening/testing services will be reimbursed by the health plan. We are now processing reimbursement requests from capitated groups for dates of service January 1, 2021 through December 31, 2021. Contact your provider network representative if you need submission information.

Where is COVID-19 testing available?

LabCorp, Quest Diagnostics™ and Bio Reference and several commercial and hospital based laboratories are currently offering testing for COVID-19. Providers are encouraged to visit the following sites for more information on registration and specimen collection requirements:

LabCorp - Physicians who send laboratory testing to LabCorp, will require an active account. Please contact LabCorp at 1-800-859-6046 and speak to a customer service representative to set up account.
Quest Diagnostics - or call 1-866-697-8378. Providers can open an account.
BioReference - Providers do not need to sign up. Tests can be sent through courier or FedEx depending on your area. Providers can open an account or contact BioReference via telephone at 1-833-684-0508 or 1-800-229-5227.
Twenty-two public health labs in California are testing samples for COVID-19. Providers can refer members for testing to their county public health department. Additional information can also be found at the California Department of Public Health.
Providers can confirm with community hospitals to determine if they are offering testing for COVID-19.

Testing can be ordered only by physicians or other authorized health care providers.

Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

The Lab Patient Service Centers will not be collecting specimens for COVID-19 testing. DO NOT refer patients to Lab Patient Service Centers. Please contact specific labs for instructions for specimen collection and transport, and to obtain specimen collection supplies.

What are the screening and testing guidelines for COVID-19?

CDPH has issued updated testing guidance to follow starting October 29, 2021. Diagnostic testing should be considered for all individuals with symptoms or exposure to COVID-19. Health plans are required to cover testing pursuant to federal requirements.

Key points of guidance:

Fully vaccinated individuals do not need to undergo diagnostic screening testing in non-health care settings including workplace and schools.
For individuals who are not fully vaccinated and are in high-risk workplace settings, diagnostic screening testing is still recommended even if it is not required.
Acute health care and long-term care facilities:
- Diagnostic screening testing of asymptomatic unvaccinated or incompletely vaccinated healthcare personnel (HCP) shall be tested based on frequency specified for their work schedule with either antigen or molecular testing (See AFL 21-27 or 21-28). Exempt unvaccinated or incompletely vaccinated HCP must observe all other infection control requirements and are not exempted from the testing requirement even if they have a medical contraindication to vaccination. This includes using masks.
- Individuals who have recovered from a COVID-19 infection more than 90 days prior, or had a previous positive antibody test for COVID-19, must still follow the testing requirements.

For more details, refer to the CDPH updated guidelines.

Additional resources for testing guidelines:

Refer to the Centers for Disease Control and Prevention (CDC) updated guidelines for testing patients suspected of having the COVID-19 infection.
- Providers are encouraged to reference the CDC website for the most current guidance.
Testing locations and guidance can be found on the Vaccinate ALL 58 site.

What billing codes should be used to bill for COVID-19 testing?

Starting April 1, 2020, providers performing the COVID-19 test can begin billing their participating physician group (PPG) for services for dates of service February 4, 2020 and after, using the following newly created HCPCS and CPT codes:

Specimen Collection

HCPC G2023- Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source.
HCPC G2024- Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source.
HCPC C9803- Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]).
CPTs 99000, 99001, or 99211when billed with a COVID-19 related diagnosis code.

Active Virus Testing

Effective for dates of service April 10, 2020, and continuing during the course of this declaration of emergency, Wellcare benefit plans cover medically necessary FDA-approved serologic (antibody) testing ordered by physicians or other authorized health care providers, using AMA approved CPT codes and based on CDC guidance for appropriate use of FDA-approved or authorized (Emergency Use Authorization, EUA) antibody tests. Additional clinical guidelines for serologic testing coverage may be communicated at a later date.

Providers performing medically necessary FDA-approved COVID-19 antibody tests can bill their PPG for services using the following CPT codes:

CPT 86328 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), (Coronavirus disease [COVID-19]), (For severe acute respiratory syndrome, coronavirus 2 [SARS-CoV-2] [Coronavirus, disease {COVID-19}] antibody testing using multiple-step method, use 86769).
CPT 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using single step method, use 86328).
CPT 0224U (effective June 25, 2020) Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed.
CPT 86408 (effective August 10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen.
CPT 86409 (effective Augustn10, 2020) Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer.
CPT 86413 (effective September 8, 2020)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.

CDC Antibody Testing Guidance:

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived.

Wellcare will absorb the costs for waived copayments for COVID-19 screening and testing to support our network providers.

In addition to cost-share requirements, authorization requirements will be waived for any claim that is received with these specified codes.

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

For complete and up-to-date diagnosis coding for COVID-19, visit the CDC National Center for Health Statistics website.

The following diagnosis codes can be used to bill for screening and testing services related to COVID-19.

Z11.52 (effective January 1, 2021) - Encounter for screening for COVID-19.
Z20.822 (effective January 1, 2021) - Contact with and (suspected) exposure to COVID-19.
Z20.828 (through December 31, 2020) - Contact with and (suspected) exposure to other viral communicable diseases.
Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out.

Is there more information available on COVID-19 billing?

For additional information on coding, refer to the following links from the American Medical Association (AMA):

What is the deadline to file claims?

The deadline to file Medicare claims for dates of service March 5, 2020 through July 25, 2020, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is Wellcare waiving cost-share requirements for COVID-19 related therapeutics?

Coverage for Medicare members will follow existing program guidelines.

Is Wellcare waiving cost-share requirements for COVID-19 related inpatient treatment?

Wellcare will waive member cost sharing for COVID-19 related treatments for Medicare members through May 31, 2021. For dates of service or admissions on or after June 1, 2021, the respective treatment cost sharing provisions of a member’s benefit plan will apply. Eligible waived cost shares, as stated above, for capitated physician groups’ paid COVID-19 related treatments will be reimbursed by the health plan. We are now processing reimbursement requests from capitated groups for dates of service January 1, 2021, through December 31, 2021, if reimbursable above. Contact your provider network representative if you need submission information.

Is Wellcare waiving prior authorizations for COVID-19 related inpatient treatments?

For admissions and/or dates of service prior to June 1, 2021, Wellcare's delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare members. Inpatient admission notification is still required as soon as possible to the member's assigned delegated participating physician group (PPG), if available. After June 1, 2021, normal prior authorization guidelines will apply.

What COVID-19 ICD-10 diagnoses codes are approved for use in treatment?

U07.1: 2019-nCoV - Confirmed by lab testing (effective April 1, 2020)
M35.81: Multisystem Inflammatory Syndrome (MIS) (effective January 1, 2021)
B97.29: Confirmed cases - other coronavirus as the cause of diseases classified elsewhere (prior to April 1, 2020)

Does Wellcare cover monoclonal antibody infusion treatment for COVID-19?

For dates of service prior to June 1, 2021, COVID-19 monoclonal antibody treatments available under an FDA Emergency Use Authorization (EUA) are covered benefits with no cost share or prior authorization required. The medications are available from the federal government at no cost to providers. After June 1, 2021, normal cost shares and prior authorization guidelines, if any, will apply.

The following codes have been published; however, they are not billable or payable until after the specific treatment received official EUA approval.

Current monoclonal antibody treatments with FDA EUA's

Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name
Q0249 (eff. June 24, 2021)	Tocilizumab for COVID-19	Genentech	Injection, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg
M0249 (eff. June 24, 2021)	Adm Tocilizu COVID-19 1st	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose
M0250 (eff. June 24, 2021)	Adm Tocilizu COVID-19 2nd	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (ages 2 years and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose
Q0220 (eff Dec 8, 2021)	Tixagevimab & Cilgavimab (EVUSHELD), 300mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg
Q0221 (eff Feb 24, 2022)	Tixagevimab & Cilgavimab (EVUSHELD), 600mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
M0220 (eff Dec 8, 2021)	Tixagevimab & Cilgavimab (EVUSHELD) Admin	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring
M0221 (eff Dec 8, 2021)	Tixagevimab & Cilgavimab (EVUSHELD) Admin Home	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

Prior treatments with FDA Emergency Use Authorization revoked

Code	CPT Short Descriptor	Labeler Name	Vaccine/Procedure Name
Q0239* (FDA’s EUA ended April 16, 2021)	bamlanivimab-xxxx	Eli Lilly	Injection, bamlanivimab, 700 mg
M0239 (FDA’s EUA ended April 16, 2021)	bamlanivimab-xxxx infusion	Eli Lilly	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Q0240 (eff. July 30, 2021; FDA’s EUA ended Jan 24, 2022)	Casirivi and imdevi 600 mg	Regeneron	Injection, casirivimab and imdevimab, 600 mg
M0240 (eff. July 30, 2021; FDA’s EUA ended Jan 24, 2022)	Casiri and imdev repeat	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
M0241 (eff. July 30, 2021; FDA’s EUA ended Jan 24, 2022)	Casiri and imdev repeat hm	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence. This includes a beneficiary’s home, subsequent repeat doses
Q0243* (FDA’s EUA ended Jan 24, 2022)	casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 2400 mg
Q0244 (eff. June 3, 2021; FDA’s EUA ended Jan 24, 2022)	casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 1200 mg
M0243 (FDA’s EUA ended Jan 24, 2022)	casirivi and imdevi infusion	Regeneron	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring
M0244 (eff May 6, 2021; FDA’s EUA ended Jan 24, 2022)	casirivi and imdevi infusion home	Regeneron	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence
Q0245* (FDA’s EUA ended Jan 24, 2022)	bamlanivimab and etesevimab	Eli Lilly	Injection, bamlanivimab and etesevimab, 2100 mg
M0245 (FDA’s EUA ended Jan 24, 2022)	bamlan and etesev infusion	Eli Lilly	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
M0246 (FDA’s EUA ended Jan 24, 2022)	bamlan and etesev infusion home	Eli Lilly	Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence
Q0247 (eff. May 26 2021 – ended April 5, 2022**)	Sotrovimab	GSK	Injection, sotrovimab, 500 mg
M0247 (eff. May 26 2021 – ended April 5, 2022**)	Sotrovimab infusion	GSK	Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
M0248 (eff. May 26 2021 – ended April 5, 2022**)	Sotrovimab inf, home admin	GSK	Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence
Q0222 (eff Feb 11, 2022; FDA’s EUA ended Nov 30, 2022)	Bebtelovimab 175 mg	Eli Lilly	Injection, bebtelovimab, 175 mg
M0222 (eff Feb 11, 2022; FDA’s EUA ended Nov 30, 2022)	Bebtelovimab injection admin	Eli Lilly	Intravenous injection, bebtelovimab, includes injection and post administration monitoring
M0223 (eff Feb 11, 2022; FDA’s EUA ended Nov 30, 2022)	Bebtelovimab injection admin, home	Eli Lilly	Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

*medication code not payable

Effective January 1, 2022, the medication and infusion's administration fee is billable to the appropriate payor based on Wellcare’s existing division of financial responsibility with the capitated physician group/IPA. Medication that is available free from the federal government is not reimbursable. Prior to 2022, the medication and infusion's administration fee is billable to CMS directly for both Original Medicare and Medicare Advantage members.

What if my office or facility is impacted by COVID-19?

If your office or facility is impacted by COVID-19 and this affects your ability or capacity to provide services and access to members, please contact your participating physician group (PPG) immediately. Wellcare contracted PPGs must notify their Wellcare designated network representative of any changes in access to their provider panel.

As a reminder, providers are responsible to provide coverage to their patients, and to communicate this to patients via appropriate signage, messaging and communications. We encourage the use of telehealth services to promote physical distancing while supporting the needs of your patients, whenever possible. The use of urgent care or emergency room/department services to provide routine coverage for your office is not appropriate, unless the use of emergency room/department services are medically necessary.

If you close your office, or if you switch to only providing virtual appointments, take the following action:

Contact your PPG immediately.
Notify your patients who have upcoming appointments about your office changes and provide. documentation of how your patients were notified to your PPG.
Inform your patients about available coverage options for your office, including voicemail instructions and/or message for patients, posters and member outreach.

What is Wellcare doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Wellcare has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented within Wellcare's history, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Wellcare regularly reviews and updates its emergency business continuity protocols. As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations. In particular:

Wellcare's Provider Network Management (PNM) and Provider Relations personnel remain available to providers, with no current impact in their ability to assist with provider issues.
- However, on-site meetings are being replaced with telephonic and other forms of support.
Our key operational units will continue to provide updates to PNM leadership if and when challenges arise.
We have created the following website link, "COVID-19 Updates and Alerts for Providers," to view regular updates.

Communications and Resources - Stay informed on the latest news and help for you and your patients

Does the Department of Healthcare Services (DHCS) have any resources available for providing care during COVID-19?

Providers are encouraged to reference the following resources distributed by the DHCS to managed care plans (MCPs) to assist with providing care during the COVID-19 crisis:

What resources are available from DHCS to assist with the COVID-19 epidemic's immediate and long-term impacts on the mental health?

Providers can refer to the DHCS notice on suicide and prevention screening and resources (PDF) to assist with providing immediate and long-term care for patients resulting from the COVID-19 crisis.

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact their participating physician group (PPG) for questions or assistance.

Is coping assistance offered to members impacted by COVID-19?

Wellcare members impacted by COVID-19 may contact their participating physician group (PPG) for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19.

Wellcare encourages PPGs to educate contracted providers on disaster-responsive, trauma-informed care. This education or training should include the crucial roles of:

Ensuring physical and emotional safety of patients
Building trust between providers and patients
Recognizing and responding to the signs and symptoms of stress on physical and mental health
Promoting patient-centered, evidence-based care
Ensuring provider and patient collaboration in treatment planning
Sensitivity to the racial, ethnic, cultural, and gender identity of patients
Supporting provider resilience

PPGs should ensure their providers and care management teams learn the signs of and assess for stress-related morbidity, and create responsive treatment plans, including supplementing usual care with measures that help regulate the stress response system, such as:

Additional resources on how to mitigate the stress-related health outcomes anticipated with the COVID-19 emergency can be found at ACEs Aware.

Adverse Childhood Experiences (ACEs) resources and information for Medi-Cal can be found at California Department of Health Care Services Trauma Screenings and Trauma-Informed Care Provider Trainings.

Does Wellcare have a list of recommended telehealth platforms for providers?

Wellcare has researched a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

Wellcare is not affiliated with, and does not endorse, any of the solution platforms represented below. Wellcare has reviewed these platforms and summarized their capabilities on behalf of our providers, but we do not have any direct experience with any of these platforms and we cannot guarantee their performance. Your decision to utilize any of these platforms is based on your individual sole discretion as it relates to the needs of your individual practice.

Below is a summary of telehealth platforms you may find helpful in selecting a solution that best meets your practice needs.

Name	Description
Amwell	Amwell's Private Practice platform is available to California physicians at a discounted rate for the next 12 months. This telehealth solution can be branded for each practice and enables physicians to see their own patients and operate under their own payer contracts. Practice management capabilities include a branded telehealth practice with clinical workflows, online physician enrollment and scheduling appointments with your patients, collecting patient payments at the time of visit, and reporting and visit summaries to assist with clinical documentation.
Doxy.me	See your patients from anywhere via a personalized virtual exam room. Click doxy.me/YourDrsName to join them for a video call. You do not need to download software or create an account. Use a browser on a computer or mobile device with a camera and microphone. Practice management capabilities include in-session, live chat-box with current patient and/or next patient(s) in queue, and patient check-in.
VSee	Secure, low-bandwidth HD video. Encrypted with military-grade 256-bit AES encryption. VSee Messenger allows providers to securely video chat with patients in their homes. In-session snapshots can be securely sent through individual or group chats. Practice management capabilities include real-time screen share, live annotation, mark-up lab results, CT scans, e-documents, and electronic health record (EHR) integration.
eVisit	A user-friendly exam room equips providers with the tools needed to chart, prescribe and take notes. eVisit commits telehealth expertise and technology to fight against COVID-19 with VirtualED™ - a COVID-19-specific workflow that can be implemented quickly at no cost until July 31, 2020. Practice management capabilities include seamless EHR integration, custom patient eligibility and claims solutions. Specializes in increasing provider telehealth footprint to better meet the unique needs of the market. Improves outcomes and revenue with minimal overhead.
Innovaccer	COVID-19 management supports automated assessments, remote patient monitoring, education, and treatment. Practice management capabilities include leveraging artificial intelligence to eliminate coding gaps to drive quality performance, a data activation platform that promotes value-based care, and a private virtual examination room with secure audio/visual features to allow for the seamless and effortless rendering of care to patients.
Updox	Includes a dedicated virtual exam room to triage COVID-19 patients. No need to download software or create an account. Just use a browser on a computer or mobile device with a camera and microphone. Patients do not need to be pre-registered. Practice management capabilities include document completion, appointment scheduling, and appointment reminders via email and SMS.

Your Patients Can Get a Ride to Their COVID-19 Vaccine

How can members arrange a ride?

Call Access2Care at 1-866-653-0975 once COVID-19 vaccine appointment is scheduled.

Rides to and from mass public vaccination sites are not eligible.
Drivers are not able to wait with the member in line to get the vaccine.

Return rides

Return rides for all reservations will be scheduled for one hour after the set appointment time for the vaccine. If the member is ready earlier, or the appointment is taking longer than an hour they can call Access2Care at 1-866-653-0975 to schedule a return ride.

Advance notice plan requirements

Prior authorization is not required. Refer to the chart below for advance notice requirements.

Service type	Service examples	Advance notice
Non-emergency medical transportation	Gurneys Wheelchair vans Litter vans	Call Access2Care at 1-866-653-0975, 72 hours in advance
Non-medical transportation	Taxis Sedans Rideshare Other type of public/private transports	Call Access2Care at 1-866-653-0975, 72 hours in advance

This benefit has some restrictions and limitations. Please check the Member's Summary of Benefits or Evidence of Coverage or contact us.

Historical Information

Since March, Wellcare has waived prior authorizations, co-pays, and other costs related to COVID-19 testing, screening and medically necessary treatment.

We have also waived prescription refill limits and allowed members to refill prescriptions prior to their refill date during this course of declaration of emergency.

As seniors face increased social and economic barriers to care amid this pandemic, we are now offering a number of expanded benefits to help our eligible members address issues such as out-of-pocket medical costs, food insecurity, and medication assistance.

Effective July 1, 2020 through December 31, 2020, expanded benefits will include:

$0 Member Liability Extension: We are waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states.

Beginning July 1, 2020, providers should waive the member liability for the eligible primary and behavioral health care claims at the point of service, and forego the collection of the member cost share. This is a benefit change for our members and our claims system will be configured to administer these adjusted benefits. We recognize that providers have different reimbursement/accounting arrangements with us, and the costs associated with this benefit change will follow the accounting processes as outlined in the provider's contract with Wellcare.

What resources are available for providers to request and/or order Personal Protective Equipment (PPE)?

We understand that access to necessary PPE and other important supplies during the COVID-19 crisis has been challenging. If you need access to appropriate PPE and/or other supplies to provide care to your patients, we encourage you to reach out to the following resources for assistance.

Designated Local Public Health Department by County

Resource requests for health care providers and facilities are handled through the designated Public Health Department for your county.

New requests are:

Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
Upon receipt by the RDMHC, the request is then sent to the California Department of Public Health (CDPH) Medical and Health Coordination Center (MHCC) for proper tracking and fulfillment by both the State Operations Center (SOC) and the Emergency Medical Services Agency (EMSA).

Facilities currently facing a shortage of respirators, N95 masks or other supplies, should contact their MHOAC.

Direct Relief^®

Direct Relief provides clinics and health care centers throughout the United States and globally with access to no-cost pharmaceuticals, medical supplies and other resources to care for the world's most vulnerable people.

To learn more about Direct Relief and how to become a network partner, visit the Direct Relief website.

Western Drug Medical Supply

Western Drug Medical Supply is a leading provider of home medical equipment and supplies in Southern California. They have a large volume of masks procured and have volunteered to donate to providers located in Southern California who need them. Providers should reach out to Western Drug directly or at 1-800-891-3661.

COVID-19 Updates & Alerts for Providers

Questions and Answers for California Wellcare Providers

Updated March 6, 2023

COVID-19 Alerts

COVID-19 Therapeutic and Vaccine FAQs

Communications & Resources

COVID-19 Trainings & Webinars

COVID-19 General Information

Historical Information

COVID-19 Provider Alerts

Winter 2022/2023: Help Patients and Others Stay Protected from COVID-19

Help Protect Your Pediatric Patient with Flu and COVID-19 Vaccinations

Los Angeles County Health Officer Update to Isolation and Quarantine Orders

COVID-19 Test to Treat Sites Streamline Care Across the State

Calling All Community Health Centers: Help Improve Donation Coordination and Supply Chain Resilience to Prepare for Disasters

HRSA’s Uninsured Program No Longer Accepting Claims for COVID-19 Testing and Treatment

Important Role of Medical Practices in Pediatric COVID-19 Vaccination

We Can Help Your Patients Get Vaccinated Against COVID-19

CDPH COVID-19 Vaccine Outreach to Black and African American Communities

Attention: Fraud Alert about COVID-19

COVID-19 Vaccines: What You Need to Know

COVID-19 Trainings & Webinars

Added 3/2/2023 - Join the Webinars: Learn How to Set Up Test & Treat Programs for Your Clinic or Community

COVID-19 Therapeutic and Vaccine FAQS - What you need to know about current treatment

COVID-19 Therapeutics

Is there provider support for questions about COVID-19 testing and treatment?

What resources are available about COVID-19 outpatient therapeutics?

Additional resources

How to dispel misinformation about treatments

Where can I get information for my patients about the COVID-19 Test to Treat Program?

COVID-19 Vaccines

Step 2: Enroll in myCAvax

Who is eligible for the COVID-19 vaccine?

Is there a current COVID-19 vaccination schedule?

What is the latest update about COVID-19 primary and booster shots?

Pfizer, Moderna monovalent mRNA and Johnson & Johnson COVID-19 vaccines

Are the COVID-19 vaccines safe for pregnant or lactating people?

Where can people get information about vaccine availability - My Turn?

Where can I find the latest guidance for the COVID-19 vaccine?

What are the codes to report and bill the COVID-19 vaccines?

What are the reporting requirements for the COVID-19 vaccine?

How can I help prepare for the COVID-19 vaccine?

How will the COVID-19 vaccine be covered for members?

What resources are available to help with reminders about the second dose of the vaccine, and reporting vaccine side effects?

Talking to Your Patients About the COVID-19 Vaccine

Engage in effective COVID-19 vaccine conversations

Revised mask guidelines for vaccinated and unvaccinated people

Resources to help you build vaccines confidence with your patients

Answering patient questions about the vaccine

COVID-19 General Information - What's covered, how to bill for treatment, telehealth guidance, and more

Information and Guidance on COVID-19

Where can I obtain information and guidance on COVID-19?

Where is other information and guidance on COVID-19 is available?

COVID-19 Public Health Emergency Extended By Federal Government Into 2023

Telehealth Guidance and Support

Does Wellcare allow access to telehealth services to increase access to care? And what is the reimbursement rate?

What are the guidelines for telehealth services specific to risk adjustment?

How do I bill for telehealth services during this declaration of emergency period?

What do I do if my Medicare telehealth claim did not price at full rate parity for the CPT code?

Are there member cost shares for Medicare network provider telehealth services?

What is Wellcare's strategy to support telehealth services for providers and members?

What additional telehealth options are available to my patients?

What support will Teladoc provide to me if my patients use them?

COVID-19 Testing and Screening, Billing and Treatment Information

Is Wellcare requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Is Wellcare waiving cost-share requirements for screening and testing?

Where is COVID-19 testing available?

What are the screening and testing guidelines for COVID-19?

What billing codes should be used to bill for COVID-19 testing?

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

Is there more information available on COVID-19 billing?

What is the deadline to file claims?

Can providers balance bill members for fees related to screening and testing for COVID-19?

Is Wellcare waiving cost-share requirements for COVID-19 related therapeutics?

Is Wellcare waiving cost-share requirements for COVID-19 related inpatient treatment?

Is Wellcare waiving prior authorizations for COVID-19 related inpatient treatments?

What COVID-19 ICD-10 diagnoses codes are approved for use in treatment?

Does Wellcare cover monoclonal antibody infusion treatment for COVID-19?

Reporting COVID-19 Impacts to Offices and Facilities

What if my office or facility is impacted by COVID-19?