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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 May 11, 2022

22-016D

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

COVID-19 VACCINE FAQS

  • COVID-19 Vaccines (updated)

COVID-19 GENERAL INFORMATION

  • COVID-19 Public Health Emergency Extended By Federal Government Into 2022 (updated)
  • COVID-19 Testing and Screening, Billing and Treatment Information  (updated)


COVID-19 Alerts

Recent and time-sensitive news concerning COVID-19


COVID-19 Vaccine FAQs

What you need to know about the vaccines

Communications & Resources

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

COVID-19 Trainings & Webinars

Notices about COVID-19-related trainings and webinar sessions

COVID-19 General Information

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


Historical Information

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

COVID-19 Provider Alerts

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.
  • 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

Added 5/20/22 

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 molnupiravir) at the same time.

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 This PDF document will open in a new window. 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

None currently scheduled. Please check back later for the latest upcoming Trainings & Webinars.

COVID-19 Vaccine FAQS - What you need to know about the vaccines

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 ages 5 and up is eligible for a COVID-19 vaccine. See "Can kids get a COVID-19 vaccine?" for more details about vaccinating ages 5-11.

Refer to Vaccinate All 58 for information about the vaccine, incentive programs, how the vaccine works, vaccination progress data, questions and answers, and more.

You can also refer to the CDPH website for updated COVID-19 vaccine eligibility guidelines.

Has the FDA approved any of the emergency use COVID-19 vaccines?

On August 23, 2021, the U.S. Food and Drug Administration issued a news release that announced approval of the Pfizer-BioNTech COVID-19 Vaccine for people ages 16 and older.

 Updated 5/11/22

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

The booster or additional dose of the COVID-19 vaccine will be 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, Moderna and Johnson & Johnson COVID-19 vaccines

The most current COVID-19 vaccination recommendations by the Centers for Disease Control and Prevention (CDC) for a third primary dose, which includes immunocompromised individuals, and preferred COVID-19 vaccine booster shots are listed in the table below:

If you received…

Additional primary dose

Booster doses

Which booster can you get

Pfizer-BioNtech (Pfizer) two-dose primary series

  • Ages 5 and older who are moderately to severely immunocompromised
  • 28 days after 2nd shot
  • Ages 12 and older
  • At least 5 months after completing the primary series
  • Pfizer or Moderna are preferred*
  • Teens 12–17 may only get a Pfizer booster.

Moderna two-dose primary series

  • Ages 18 and older who are moderately to severely immunocompromised
  • 28 days after 2nd shot
  • Ages 18 and older
  • At least 5 months after completing the primary series
  • Pfizer or Moderna are preferred*

Johnson & Johnson* single dose primary series

  • No additional primary shot
  • Ages 18 and older
  • At least 2 months after the primary dose
  • Pfizer or Moderna are preferred*

*Johnson and Johnson COVID-19 vaccine - ages 18 and older

On May 5, 2022, the FDA placed 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

Can kids get the COVID-19 vaccine?

Parents can go to myturn to schedule an appointment for the Pfizer vaccine or the flu shot, or call the hotline at 833-422-4255 to find a nearby vaccination site. The flu shot can be given at the same time as a COVID-19 vaccine.

Pfizer pediatric vaccine

Providers should use the CDPH communication released on November 12, 2021 about pediatric services summarizing Pfizer pediatric (ages 5–11 years) COVID-19 vaccine clinical information. The summary includes information about:

  • Background and composition
  • ACIP* recommendations for vaccine USE
  • Vaccine information fact sheet
  • Dosage and administration
  • Reactogenicity and adverse events
  • Ordering and billing
  • Resources

*ACIP - Advisory Committee on Immunization Practices

Ages 5–11

Starting November 3, 2021, newly eligible children ages 5–11 can now get the Pfizer COVID-19 vaccine. It will be administered as a two-dose primary series occurring three weeks apart. The dosage will be 10 mcg lower than the Pfizer COVID-19 vaccine given to children ages 12 and older.

View the press releases below for more information:

Ages 12 and older

On May 10, 2021, the Food and Drug Administration (FDA) issued a news release that amended the Emergency Use Authorization (EUA) for the Pfizer/BioNTech COVID-19 vaccine to include adolescents ages 12 through 15. The FDA assures the public and medical community that the available data meets their rigorous standards to support the emergency use of this vaccine for these ages. (Note: The EAU was originally issued on December 11, 2020 for administration in people ages 16 and older.)

Moderna and Johnson & Johnson/Janssen vaccines

The Moderna COVID-19 vaccine and Johnson & Johnson/Janssen vaccines are available to people ages 18 and older.

Additional resources:

Co-administer vaccines during pediatric well-child visits

Providers are encouraged to use the Pfizer/BioNTech COVID-19 vaccine visit to meet the well-child visit requirement. The Centers for Disease Control & Prevention (CDC) updated their recommendations that co-administration of the COVID-19 vaccine with other vaccines is no longer discouraged.

  • 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.

This important step ensures children and adolescents ages 5 and older who see their physician for a COVID-19 vaccine are able to catch-up on other immunizations they may have missed during the pandemic.

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 - TBD) SARSCOV2 VAC 10MCG TRS-SUCR Pfizer Pfizer-BioNTech COVID-19 Pediatric Vaccine
0071A (eff. October 29, 2021 - TBD) ADM SARSCV2 10MCG TRS-SUCR 1 Pfizer Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration - First dose
0072A (eff. October 29, 2021 - TBD) ADM SARSCV2 10MCG TRS-SUCR 2 Pfizer Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration - Second dose
0073A (eff. January 3, 2022) ADM SARSCV2 10MCG TRS-SUCR 3 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange 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
91303 SARSCOV2 VAC AD26
.5ML IM
Janssen Janssen COVID-19 Vaccine
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
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 COVID-19 Vaccine Administration - 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 VaxTextSM, 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-safeSM 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:

  1. Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
  2. 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.
  3. 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 5/11/22

Effective January 16, 2022, Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through July 15, 2022 unless ended sooner or extended by HHS.

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:

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

  • HCPC U0001- For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPC U0002- For all other commercially available tests: 2019-nCoV Real-Time RT-PCR Diagnostic Panel. (It is not yet clear if the Centers for Medicare & Medicaid Services (CMS) will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.
  • CPT 87635 - (effective March 13, 2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. The industry standard for reporting of novel coronavirus tests across the nation's health care system.
  • HCPC U0003-(effective April 14, 2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
  • HCPC U0004 - (effective April 14, 2020): 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
  • CPT 0202U - (effective May 20,2020): Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 0223U (effective June 25, 2020) Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.
  • CPT 87426 (effective June 25, 2020)Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semi-quantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).
  • CPT 0225U (effective September 8, 2020) Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected.
  • CPT 0226U (effective September 8, 2020) ;Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum.
  • CPT 0240U (effective October 6, 2020) Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 0241U (effective October 6, 2020)Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.
  • CPT 87636 (effective October 6, 2020)Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.
  • CPT 87637 (effective October 6, 2020)Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique.
  • CPT 87811 (effective October 6, 2020) Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).
  • CPT 87913 (effective February 21, 2022) Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s).

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 treatments?

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. Contact your provider network representative if you need submission information.

Is Wellcare waiving prior authorizations for COVID-19 related 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)

 Updated 5/11/22

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. As of April 16, 2021, the FDA revoked its EUA for Eli Lilly’s bamlanivimab when administered alone. Learn more on the FDA's web page.

Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name
Q0239* bamlanivimab-xxxx
(FDA's EUA ended April 16, 2021)
Eli Lilly Injection, bamlanivimab, 700 mg
M0239 bamlanivimab-xxxx infusion
(FDA's EUA ended April 16, 2021)
Eli Lilly Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

Q0240 (eff. July 30, 2021)

 

Casirivi and imdevi 600mg

Regeneron

Injection, casirivimab and imdevimab, 600 mg

M0240 (eff. July 30, 2021)

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)

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

M0243 casirivi and imdevi infusion Regeneron Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring
M0244 (eff May 6, 2021)

casirivi and imdevi infusion home

Regeneron

Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence

Q0245* bamlanivimab and etesevimab Eli Lilly Injection, bamlanivimab and etesevima
2100 mg
M0245 bamlan and etesev infusion Eli Lilly Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

M0246

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 and ended April 5, 2022**)

Sotrovimab

GSK

Injection, sotrovimab, 500 mg

M0247 (eff. May 26 2021 and ended April 5, 2022**)

Sotrovimab infusion

GSK

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring

M0248 (eff. May 26 2021 and ended April 5, 2022**)

Sotrovimab inf, home admin

GSK

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence

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

*medication code not payable
**On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, this product is not currently authorized in any U.S. region and may not be administered to treat COVID-19 until further notice by the FDA for Sotrovimab monoclonal antibody codes Q0247, M0247, M0248.

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:

  1. Contact your PPG immediately.
  2. Notify your patients who have upcoming appointments about your office changes and provide. documentation of how your patients were notified to your PPG.
  3. 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:

  • Supportive relationships
  • Age-appropriate, healthy nutrition
  • Sufficient, high-quality sleep
  • Mindfulness and meditation
  • Adequate physical activity
  • Mental health care

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

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:

  1. Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
  2. 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.